新疆地区过敏性鼻炎患儿过敏原检测分析

目的 了解新疆地区过敏性鼻炎患儿过敏原的分布状况,为儿童过敏性鼻炎的防治提供科学依据。方法 采用体外特异性过敏原检测试剂盒（IVT）对104例过敏性鼻炎患儿进行吸入过敏原（IVT701）检测,其中88例患儿同时行食物过敏原（IVT702）检测。结果 104例过敏性鼻炎患儿IVT701测试总阳性率73．1％,以蒿属植物最高38．5％,其后依次为榆杨柳树31．7％,豚草（巨大豚草、普通豚草）20．2％,霉菌（点青霉、交链孢霉、黑根霉）14．4％,螨（粉螨、尘螨）11．5％,屋尘7．7％等。88例患儿IVT702的总阳性率为56．8％。过敏原主要为大豆、花生28．4％,其次为鳕鱼和鸡蛋,分别为15．9％、13．6％,蟹虾为11．4％,牛奶和牛羊猪肉分别为5．7％和4．5％。65例患儿对2种及2种以上过敏原过敏。蒿属的阳性率随年龄的增长而增长（X^2=4．662．P〈0．050）。结论 蒿属为新疆地区过敏性鼻炎患儿最主要的过敏原,食物过敏亦占相当比例。明确过敏原后对特异性免疫治疗具有重要的指导意义。     

Do the leukotriene receptor antagonists work in children with grass pollen‐induced allergic rhinitis?

Although cysteinyl-leukotriene receptor antagonists were recently approved for use in allergic rhinitis (AR), there has been no study to date investigating their application in children. The aim was to evaluate whether montelukast provides any benefit in nasal allergen challenge-induced symptoms in children, and whether it could improve the control provided by an antihistamine during pollen season. Two randomized studies, one a double-blind, placebo-controlled, nasal allergen challenge study and one an open-label, cross-over, parallel-group clinical study, were performed in 18 (11.7+/-0.7 years) and 32 children (10.5+/-0.5 years), respectively, with grass pollen allergy. In the first study, the effect of a single dose of montelukast and its combination with loratadine were compared with placebo on nasal responses induced by allergen challenge. In the second study, the additive effect of montelukast to loratadine was tested in an open-label cross-over clinical study. In the challenge study, early-phase and late-phase nasal reactions peaked at 15 min and 4 h after the challenge respectively. During the early phase, combination improved total nasal symptoms (p=0.004) during the first hour and sneezing (p=0.012) at 15 min compared with placebo group. During the late phase, montelukast (p=0.017) and combination (p=0.011) caused less nasal obstruction at 4 h and combination caused less sneezing at 6 h (p=0.015). In the clinical trial, montelukast provided protection on seasonal increase in pulmonary symptoms [0 (0, 14) vs. 6.5 (0, 27.7); p=0.016] and on the decrease in FEF25-75 [-0.09 (-0.34, 0.17) vs. -0.28 (-0.66, 0.02); p=0.002]. However, there was no improvement in nasal symptoms and flows. Although we showed protection against nasal challenge-induced congestion with montelukast, we were not able to show the same in the clinical study possibly because of low pollen counts and mildness of the symptoms of the patients with AR. However, montelukast provided better control of pulmonary symptoms and protection from seasonal decrease in lung function, indicating its potential therapeutic benefit in children with AR.     

Hypersaline nasal irrigation in children with symptomatic seasonal allergic rhinitis: A randomized study

Recent evidence suggests that nasal irrigation with hypertonic saline may be useful as an adjunctive treatment modality in the management of many sinonasal diseases. However, no previous studies have investigated the efficacy of this regimen in the prevention of seasonal allergic rhinitis-related symptoms in the pediatric patient. Twenty children with seasonal allergic rhinitis to Parietaria were enrolled in the study. Ten children were randomized to receive three-times daily nasal irrigation with hypertonic saline for the entire pollen season, which had lasted 6 weeks. Ten patients were allocated to receive no nasal irrigation and were used as controls. A mean daily rhinitis score based on the presence of nasal itching, rhinorrea, nasal obstruction and sneezing was calculated for each week of the pollen season. Moreover, patients were allowed to use oral antihistamines when required and the mean number of drug assumption per week was also calculated. In patients allocated to nasal irrigation, the mean daily rhinitis score was reduced during 5 weeks of the study period. This reduction was statistically significantly different in the 3th, 4th and 5th week of therapy. Moreover, a decreased consumption of oral antihistamines was observed in these patients. This effect became evident after the second week of treatment and resulted in statistically significant differences during the 3th, 4th and 6th week. This study supports the use of nasal irrigation with hypertonic saline in the pediatric patient with seasonal allergic rhinitis during the pollen season. This treatment was tolerable, inexpensive and effective.     

复旦大学附属儿科医院2413例过敏性鼻炎患儿过敏原筛查结果分析

目的　了解过敏性鼻炎（allergic rhinitis,AR）患儿的过敏原,为儿童AR的预防和治疗提供依据。方法　采用免疫印迹法对2013年1月至2018年7月就诊于复旦大学附属儿科医院耳鼻咽喉头颈外科的2413例AR患儿进行过敏原检测并进行分析。结果　吸入性过敏原前4位分别为户尘螨（49.52%）、混合霉菌（23.62%）、狗毛（17.99%）、屋尘（15.54%）。食入性过敏原前4位分别为牛奶（46.54%）、鸡蛋（22.92%）、腰果（19.10%）、螃蟹（9.45%）。部分AR患儿（46.33%）同时存在吸入性及食入性过敏。男女患儿过敏原阳性率比较差异有统计学意义（P＜0.05）。随着年龄增长,儿童的吸入性过敏原阳性率逐渐增加,食入性过敏原阳性率逐渐降低。结论　儿童吸入性过敏原以尘螨及混合霉菌为主,食入性过敏原以牛奶及鸡蛋为主,过敏原检测有助于了解患儿的过敏状态。     

儿童过敏性鼻炎的流行病学

过敏性鼻炎（allergic rhinitis,AR）是儿童常见的慢性疾病之一。经全球流行病学调查,不同年龄段、不同地区之间的儿童AR患病率都有差异,AR患病率整体呈现缓慢增加的趋势。但不同地区过敏原种类分布不一,在欧美及我国新疆地区,以植物类为主要过敏原;我国其他地区则以螨类为主要过敏原。     

Efficacy of pollen immunotherapy in seasonal allergic rhinitis

BACKGROUND: The efficacy of subcutaneous pollen immunotherapy has been documented in published double-blind, placebo-controlled studies related to treatment of seasonal allergic rhinitis. In the present study, subjective (symptom scores) and objective (nasal peak inspiratory flow, nasal smear, nasal biopsy) parameters were used to study the efficacy of pollen immunotherapy. METHODS: Forty-eight patients (32 male), mean +/- SE age 13.6 +/- 2.8 years allergic to grass-pollen participated in the present study. Patients were divided into three groups: group I, 24 patients who did not receive pollen immunotherapy; group II, 12 patients who received the build-up phase of pollen immunotherapy; and group III, 12 patients who had just finished pollen immunotherapy. With regard to objective and subjective parameters these three groups were compared. RESULTS: When group I was compared to groups II and III, the patients who had not received any immunotherapy were found to have a high daytime nasal symptoms score (P < 0.01), high daytime eye symptoms score(P < 0.01) and high night-time symptoms score (P < 0.01). In objective parameters, it was found that group I had low nasal peak inspiratory flow (P < 0.05), and a high eosinophil count in nasal smears (P < 0.05) and peripheral blood (P < 0.05). It was also demonstrated that there was an increased eosinophil infiltration (P < 0.01) and mast cell infiltration (P < 0.05) in nasal biopsy in group I. There was no significant difference between group II and group III according to these results (P > 0.05). CONCLUSIONS: Immunotherapy leads to a better clinical and histopathological prognosis in children with seasonal allergic rhinitis.     

New concepts in pediatric rhinitis

Rhinitis—and especially allergic rhinitis (AR)—remains the most frequent hypersensitivity condition, affecting up to a quarter of the population and impacting the quality of life of individual patients and the health economy. Data, especially with respect to underlying pathophysiologic mechanisms, mainly derive from studies on adults and are subsequently extrapolated to the pediatric population. Therapeutic algorithms for children with rhinitis are long based on the same principles as in adults. We explore and describe novel aspects of rhinitis, ranging from mechanisms to disease classification, phenotypes, diagnostic and monitoring tools, and the use of treatments, with a focus on the traits of pediatric age groups.     

Cytokines in nasal fluids from school children with seasonal allergic rhinitis

Allergic rhinitis is a particularly good model for studies of cytokine pro-duction in vivo , in this study the occurrence of the cytokines IL-4, IL-5. IL-10 and IFN-yas well as the soluble receptor tbr IL-4 in nasal lavage flu-ids were assayed in 38 school children, with seasonal allergic rhinitis, and 19 healthy age matched, non atopic controls, using highly sensitive enzyme immunossays. IL-4 levels in patients with seasonal allergie rhinitis were markedly increased in comparison with those in non-atopic controls or in atopic pa-tients before the start of the pollen season. In controls, but not in the atopic patients, levels of IFN-yand IL-5 were significantly higher in specimens obtained during the pollen season than in those obtained outside the season. The IL-4/IFN-y ratios were significantly higher in atopic than in nonalopic subjects and further increased in atopic patients during the season. In addition to IL-4, elevated levels of IL-10 were observed in association with seasonal rhinitis. Following treatment with a topical steroid (budeso nide) there was a statistically significant increase of the levels of soluble IL-4 receptor. These findings indicate that nonatopic and atopic individuals react to pollen exposure with distinct cytokine patterns in agreement with the Thl/ Th2 concept. Topical steroids may possibly decrease inflammation by increasing the formation of soluble IL-4 receptor.     

Local allergic rhinitis: A critical reappraisal from a paediatric perspective

The so‐called local allergic rhinitis (LAR) has been proposed as a phenotype of rhinitis with Th2‐driven prominent local allergic inflammation, nasal synthesis of specific IgE and a positive response to a nasal allergen provocation test, in the absence of ‘systemic’ atopy (negative skin prick test and serum allergen‐specific IgE antibodies). To date, available data on LAR are mostly focused on adults. The purpose of this ‘Rostrum’ was to critically discuss data and implications of the ‘LAR concept’ in paediatrics. In the natural history of rhinitis due to IgE‐mediated reactions triggered by exposure to allergens, a ‘LAR’ can be either the initial, transient stage of classical allergic rhinitis or a stable phenotype never evolving to ‘systemic’ IgE sensitization. Given the present difficulties in performing routinely nasal allergen provocation test in children, the development of sensitive and specific tests to detect IgE in the child's nasal secretions is a research priority. We suggest also the hypothetical role of allergen immunoprophylaxis or immunotherapy in LAR. Last, the term ‘local allergic rhinitis’ may be inappropriate, as rhinitis is always ‘local’, while IgE sensitization can be either ‘local’ or ‘systemic’.     

儿童过敏性鼻炎的特异性免疫治疗

特异性免疫治疗（AIT）是目前惟一可能改变儿童过敏性鼻炎（AR）自然病程的治疗方法,在取得了良好临床疗效的同时减少了AR患儿的药物用量,提高了生活质量。预防AR进展到哮喘,并减少新的变应原过敏。针对AIT产生的新方法、新技术的目的是缩短达到免疫耐受的时间,提高患儿依从性,增强治疗的安全性,并尽可能的降低治疗负担。该文对AR患儿AIT临床进展进行综述。     

Nasal hemophilic pseudotumor in a patient with mild hemophilia A and allergic rhinitis

Hemophilic pseudotumor is a rare complication, even in patients with severe hemophilia. Herein we report on a case of hemophilic pseudotumor in a patient with mild hemophilia A and allergic rhinitis, initially suspected to be a nasal tumor. The pseudotumor was cured by supplementation with recombinant factor VIII concentrates, and medication for allergic rhinitis. Pseudotumor should always be considered in hemophiliac patients, even in those with only mild deficiency of coagulation factors.     

呼吸道变态反应性疾病患儿植物类变应原反应性研究

目的 探讨上海地区呼吸道变应性疾病患儿植物类变应原致敏情况及与临床的相关性.方法 采用德国阿罗格公司提供的国际标准化变应原试剂16种,利用皮肤点刺试验,对2006年10月-2008年9月收治的346例呼吸道变应性疾病患儿进行检测.结果 346例患儿中植物类变应原皮试阳性48例,其中男性38例,女性10例;平均年龄(9.71±2.97)岁,4～7岁13例,～14岁35例;春季发病2例,夏季发病22例,秋季发病17例,冬季发病7例;单纯哮喘18例,单纯变应性鼻炎16例,哮喘合并变应性鼻炎14例.被植物类变应原敛敏者以松属和杂草类变应原居多,被单纯一种植物类变应原致敏者居多.植物类变应原阳性反应患儿大部分合并螨虫变应原阳性反应;植物类变应原阳性率大年龄患儿高于小年龄患儿,且与季节有着明显的相关性,以夏秋季更明显.结论 上海地区呼吸道变应性疾病患儿中,13.87%患儿植物类变应原皮试呈阳性反应;植物类变应原间同时呈阳性反应者较少,合并螨虫阳性者居多;植物类变应原皮试阳性率与年龄、季节有关.     

自然杀伤细胞在儿童过敏性哮喘和(或)鼻炎中的变化

目的探讨自然杀伤细胞(nature killer cells,NK)在过敏性哮喘和(或)鼻炎患儿中的变化。方法选择2009年8月—2010年12月在儿科门诊和病房诊断明确、3～14岁过敏性哮喘和(或)变应性鼻炎发作且未用药物治疗的患儿45例,正常对照儿童30例,采用乳酸脱氢酶释放法检测外周血NK细胞杀伤活性,流式细胞技术测定外周血NK细胞数量,应用免疫磁珠分选技术纯化NK细胞,分别采用标准刺激剂(离子霉素+佛波酯)和尘螨试剂刺激NK细胞,流式细胞技术检测NK细胞内γ-干扰素(IFN-γ)和白介素(IL-4)的表达情况。结果过敏性哮喘和(或)鼻炎患儿与对照组比较,NK细胞数量减少,差异有统计学意义(P=0.015);NK细胞活性下降,差异有统计学意义(P=0.023)。在尘螨刺激下,NK细胞内IFN-γ和IL-4表达均升高,但IL-4升高幅度较IFN-γ强,导致IFN-γ/IL-4比值显著降低,差异有统计学意义(P<0.05)。结论在过敏性哮喘和(或)鼻炎发作患儿中,NK细胞数量与活性均下降;在尘螨刺激下,NK细胞内IFN-γ/IL-4比值升高,导致NK细胞向NKⅡ型细胞方向失衡。推测NK细胞的数量、功能变化及...