气道高反应性与皮肤过敏反应之间关系分析

为了探讨气道高反应性与皮肤过敏反应之间关系 ,依据哮喘患者作为指示病例确定了 30 0 0个哮喘核心家系 ,对各家系的每位成员逐一询问调查、测定气道反应性和进行皮肤过敏试验。主要计算优势比(or值 )等指标。 1 2 51 6位哮喘核心家系亲属皮肤过敏实验的结果表明 :1 2 5 %的人皮斑阳性 ,而出现皮疹阳性的人占 51 3 %。且男性高于女性、低年龄组 (≤ 35岁 )高于高年龄组 (>35岁 ) ,其差别均有高度显著性 (P<0 0 1 )。哮喘家系中有 1 1 9%的人气道反应阳性 ,其中皮斑阳性与皮疹阳性人群出现气道高反应性分别为1 5 5 %和 1 2 7%。皮斑阳性与皮疹阳性者的气道高反应性发生的危险性均较高 ,OR值分别为 1 1 7和 1 44(P <0 0 1 )。并随着引起皮斑阳性或皮疹阳性过敏原的增多而出现气道高反应性的危险性逐渐增大。显示气道高反应性可能与皮肤过敏反应密切相关     

尘螨皮试与儿童支气管哮喘关系及脱敏疗法的应用价值

为了探讨尘螨皮试与儿童支气管哮喘之间的关系及其临床治疗价值 ,对 72例和 1 0 0例分别患支气管哮喘和上呼吸道感染儿童患者 ,采用 1∶ 1 0 0的尘螨浸液进行皮试 ,观察皮肤反应 ,皮肤风团≥ 5mm者为阳性 ;将呈现阳性反应的支气管哮喘患儿随机分为脱敏治疗组和对照组 ,观察临床疗效。结果 :1支气管哮喘组和上呼吸道感染组中的皮试阳性例数分别为 65例 (90 .3% )和 2 4例 (2 4 .0 % ) ,两组的阳性率比较差异显著 (P<0 .0 1 ) ;2脱敏治疗组的有效率明显高于对照组 (P<0 .0 5) ,而 2年复发率明显低于对照组 (P<0 .0 1 )。提示 :尘螨过敏与儿童支气管哮喘关系密切 ,脱敏治疗对其有较好的疗效和预防发作的作用     

支气管哮喘儿童青少年过敏原特点分析

目的了解温州市1 025例支气管哮喘(哮喘)儿童青少年过敏原分布特点及影响因素,为儿童青少年哮喘防治提供依据。方法选择2008—2015年在温州医科大学附属育英儿童医院就诊的1 025例2~16岁哮喘患者,对皮肤点刺试验(SPT)结果进行分析,尘螨SPT阳性的影响因素采用Logistic回归分析。结果 1 025例哮喘患者的过敏原总阳性率为91.80%,过敏原前6位是屋尘螨(89.46%)、粉尘螨(88.09%)、热带螨(41.36%)、猫毛(31.02%)、狗毛(26.53%)和蟑螂(22.14%)。尘螨SPT阳性影响因素Logistic回归分析结果显示,5~16岁年龄组哮喘患者的尘螨SPT阳性风险相对高于0岁~组(屋尘螨:OR=2.189,95%CI:1.409~3.398;粉尘螨:OR=2.569,95%CI:1.689~3.907);哮喘合并过敏性鼻炎患者的尘螨SPT阳性风险高于单纯哮喘患者(屋尘螨:OR=4.083,95%CI:2.484~6.710;粉尘螨:OR=4.904,95%CI:2.999~8.022);性别、居住环境与哮喘患者尘螨SPT阳性均未见统计关联(P0.05)。结论屋尘螨、粉尘螨是温州市哮喘儿童青少年最常见的吸入性过敏原,年龄大、哮喘伴过敏性鼻炎患儿的尘螨SPT阳性率更高。     

标准化皮试与血清特异性IgE水平在哮喘儿童特异性诊断中的应用研究

目的探讨哮喘儿童标准化皮试与血清特异性IgE(sIgE)的关系,评价其对哮喘儿童特异性诊断的作用及意义。方法对115例哮喘儿童作uniCAP过敏原检测系统的过敏原过筛试验(phadiatop试验)同时采用过敏原皮试液(标准化皮试液)作点刺试验。以Phadiatop作为诊断儿童哮喘的过敏原的金标准,对标准化皮肤点刺试验进行方法评价。结果115例哮喘儿童中Phadiatop试验阳性96例,阳性率83.5%,皮肤点刺试验阳性91例,阳性率79.1%,其中89例二者测定均为阳性,灵敏性为92.7%,19例Phadiatop试验阴性中17例皮试阴性,特异性89.5%,阳性预测值97.8%,阴性预测值70.8%,无假阳性,假阴性9.0%。标准化皮试与Phadiatop试验的总符合率为91.9%,二种检测方法差异无统计学意义(p>0.5)。结论哮喘儿童标准化皮试测定与血清sIgE测定是哮喘儿童过敏原诊断的二种重要手段,二者的相关性好,临床应用中相补充。     

血清特异性IgE水平与标准化皮试在哮喘儿童特异性诊断中的应用探讨

目的探讨哮喘儿童血清特异性IgE(sIgE)与标准化皮试的关系,评价其对哮喘儿童特异性诊断的作用及意义。方法对62例哮喘儿童作Un iCAP过敏原检测系统的过敏原过筛试验(Phad iatop试验)同时采用默克集团-A llergopharm a公司的过敏原皮试液(标准化皮试液)作点刺试验。以Phad iatop作为诊断儿童哮喘的过敏原的金标准,对标准化皮肤点刺试验进行方法评价。结果62例哮喘儿童中Phad iatop试验阳性51例,阳性率82.3%,皮肤点刺试验阳性49例,阳性率79%,其中47例而二者测定均为阳性,灵敏性92.1%,11例Phad iatop试验阴性中10例皮试呈阴性,特异性90.9%,阳性预测值97.9%,阴性预测值71.4%,无假阳性,假阴性9.0%,标准化皮试与Phad iatop试验的总符合率为91.9%。2种检测方法差异无统计学意义(P>0.05)。结论哮喘儿童血清sIgE与标准化皮试的测定是哮喘儿童的过敏原诊断的2种重要手段,二者的相关性好,临床应用中应相互补充。     

肺功能检查和静脉血过敏原检测在3岁以内哮喘预测指数阳性患儿中的应用价值

目的评价肺功能检查和静脉血过敏原检测在3岁以内哮喘预测指数阳性患儿中的应用价值。方法连续选择2016年6月-2018年2月在该院诊断为哮喘预测指数阳性的3岁以内患儿60例,阴性患儿60例,采用婴幼儿潮气呼吸肺功能检测达峰时间比(Tpef/Te)、达峰容积比(Vpet/VTex)、潮气量(VT/kg)、呼吸频率(F)、吸呼比(Ti/Te)、呼出50%潮气容积的呼吸流速比(TEF50/TIF50),支气管舒张试验阳性率;吸入过敏原和食入过敏原的阳性率;分别以肺功能、静脉血过敏原和两者联合作为诊断哮喘预测指数阳性患儿的指标,采用受试者工作曲线(ROC)分析诊断灵敏度和特异度。结果阳性组肺功能指标中Tpef/Te和Vpet/VTex降低,VT/kg减小,TEF50/TIF50降低,支气管舒张试验阳性率增加,差异有统计学意义(P0. 05)。阳性组吸入和食入过敏原的阳性率均明显高于阴性组(P0. 05)。ROC分析得出:肺功能诊断哮喘预测指数阳性的灵敏度为85. 6%,特异度为88. 9%,准确性(曲线下面积AUC值)为0. 826;过敏原诊断的灵敏度为82. 3%,特异度为86. 6%,准确性为0. 806;联合诊断的灵敏度为89. 5%,特异度为92. 3%,准确性为0. 865。结论肺功能检查和静脉血过敏原检测对评估3岁以内哮喘预测指数阳性患儿具有较好的应用价值。     

潍坊地区过敏性鼻炎和支气管哮喘患儿过敏原检测结果分析

目的 了解潍坊地区过敏性鼻炎、支气管哮喘患儿的主要过敏原,为过敏性疾病的预防及诊治提供参考。方法 对234例患儿(71例过敏性鼻炎、84例支气管哮喘、46例过敏性鼻炎合并支气管哮喘)进行皮肤点刺试验(SPT),并对试验结果进行统计学分析。结果 234例被检测患儿中阳性201例(85.90%)。最常见的两种过敏原为屋尘螨和粉尘螨,分别占总阳性例数的79.10%、77.11%;其余依次为带鱼(17.91%)、狗上皮(17.41%)、海虾(16.92%)、牛奶(13.43%)、青霉菌(12.44%)等;吸入性过敏原组SPT阳性率显著高于食物类过敏原组(P＜0.001);过敏性鼻炎、支气管哮喘、过敏性鼻炎合并支气管哮喘三组,SPT阳性率分别为88.75%、86.60%、80.70%,且三组间SPT阳性率差异均无统计学意义(P＞0.05)。结论 屋尘螨、粉尘螨是潍坊地区最常见的过敏原;随年龄的增长吸入性过敏原皮肤点刺的阳性率有增高趋势,食物类过敏原阳性率随年龄的增长而减少;吸入性过敏原是儿童过敏性鼻炎和支气管哮喘最常见的诱发因素。     

三明市小儿哮喘过敏原调查

[目的]调查三明市小儿哮喘患者的常见过敏原,为今后哮喘防治工作提供指导依据.[方法]对532例小儿哮喘患者皮肤过敏原皮试结果进行回顾性调查.[结果]皮试阳性率最高为户尘螨、粉尘螨,其次为大蚂蚁、海蟹和花生等.[结论]哮喘的发作与过敏原有关,改善居住环境,避开过敏原,有助于哮喘的预防和治疗.     

气道高反应性对青少年支气管哮喘的影响

目的：探讨气道高反应性在青少年哮喘发病过程中的作用。方法：利用遗传流行病学的方法,收集了支气管哮喘核心家系的资料,对家系中每一成员测定其气道反应性。结果：气道高反应性的亲属患哮喘的危险性明显增加,是没有气道高反应性亲属的8．10倍（P＜0．01）;其中气道高反应性的双亲和子女患哮喘的危险性分别增加7．10倍和4．59倍,有高度显著性意义;即使调整了遗传因素可能的混杂作用,气道高反应性子女患哮喘的危险性仍较无气道高反应性子女增加2．96倍（P＜0．01）。结论：气道高反应性不仅是支气管哮喘的重要特征,而且可能是支气管哮喘的重要危险因素。     

青少年支气管哮喘与气道反应性的遗传流行病学分析

利用遗传流行病学的方法，调查了230个子女为青少年（6－16岁）的哮喘核心家系，分析了父或母对子女患哮喘和气道高反应性的影响。结果显示：在哮喘核心家系中，儿子比女儿更易患哮回与气道高反应性；与父母均无哮喘史家系的子女比较，父母亲的哮喘史将使子女患哮喘的危险性增加10-30倍（P＜0．01），其中母亲对子女的影响更为明显，是父亲对子女影响的两倍。父母的气道高反应性也显著增加子女气道高反应性的危险性（OR=2.49，P＜0．01）。不仅遗传因素是支气管哮喘的重要危险因素之一，而且气道高反应性与遗传因素密切相关。两者可能既有共同的遗传基础又有各自不同的遗传易感基因。     

Predisposing factors in laboratory animal allergy: a study of atopy and environmental factors

A population of 101 laboratory technicians handling laboratory animals was studied with regard to predisposing factors for allergy. Twenty-seven had symptoms indicating laboratory animal allergy (LAA); of these, nine had asthma and were skin prick test positive for animal allergens. The LAA asthmatics had an increased frequency of a family history of allergy (relative risk, RR = 3.8); the predictive value was 0.27. There was also an increase of skin prick positivity against common nonanimal allergens (RR = 15); the predictive value was 0.60. All persons with marked positive skin prick tests (greater than or equal to +2) to environmental allergens had developed animal-test-positive LAA asthma. In 56% of the LAA asthma cases the serum IgE levels were elevated (greater than 100kU/L). In preemployment screening of susceptible individuals two important selection criteria emerged, viz., family history of allergy and positive skin prick reactions against environmental allergens.     

Development of a standardized methodology for double-blind, placebo-controlled food challenge in patients with brittle asthma and perceived food intolerance

OBJECTIVE: To develop a standardized, double-blind, placebo-controlled, food challenge (DBPCFC) methodology for identifying food intolerance in patients with brittle asthma. SUBJECTS/SETTING: Patients with brittle asthma and perceived food intolerance were studied in hospital. DESIGN: Each of 3 protocols began with 5 days of dietary exclusion. Protocol 1 consisted of open food challenges in 29 patients, protocol 2 consisted of 2 daily DBPCFCs in 22 patients, and protocol 3 involved 1 daily DBPCFC in 18 patients. Total immunoglobulin E level was measured and food-specific radioallergosorbent tests and skin prick tests were conducted. A standard panel of hyperallergenic foods were masked in a soup (developed specially for this study) for every food challenge. Peak expiratory flow, forced expiratory volume, and symptoms were assessed as objective measures of response. Open food challenges at home followed each protocol. Each protocol took approximately 14 days in the hospital and 4 to 6 months at home. RESULTS: For protocols 1, 2 and 3, positive reactions were experienced by 52%, 55%, and 66% of patients, respectively. Radioallergosorbent tests and skin prick tests were shown to have 40% and 71% sensitivity, respectively, and 74% and 77% specificity for predicting a positive food challenge. APPLICATIONS/CONCLUSIONS: The high prevalence of food intolerance in patients with brittle asthma was confirmed, as was the poor positive predictive value of skin prick tests and radioallergosorbent tests. The food challenge method developed enables standardized identification of food intolerances in patients with brittle asthma and may be useful in other groups.     

Asthma, rhinitis, and dermatitis in workers exposed to reactive dyes.

A survey was conducted at 15 textile plants with dyehouses in western Sweden. Employees with a history of work related rhinitis, asthma, or skin symptoms were offered a clinical and immunological investigation including skin prick tests, skin patch tests, and radioallergosorbent tests (RASTs) to detect specific allergy to reactive dyes. Among the 1142 employees, 162 were exposed to reactive dyes and 10 of these (6%) reported work related respiratory or nasal symptoms. An allergy to reactive dyes could be confirmed in five (3%, 95% confidence interval 1-7%). All but one had been exposed to reactive dyes for one year or less before the onset of symptoms. Positive RASTs could be detected in four of the five patients. All of the RAST positive patients were positive to remazol black B, but six out of eight additional remazol dyes also elicited positive results. RAST and RAST inhibition showed a cross reactivity between some of the dyes. Seven persons with work related dermatitis and three with urticaria or Quincke oedema were found. In one patient contact dermatitis to a monoazo dye was shown, but no positive patch test reactions to reactive dyes. IgE-mediated allergy to reactive dyes seems to be an important cause of respiratory and nasal symptoms among dyehouse employees exposed to dust from reactive dyes.     

Development of a Standardized Methodology for Double-blind, Placebo-controlled Food Challenge Patients with Brittle Asthma and Perceived Food Intolerance

Objective To develop a standardized, double-blind, placebo-controlled, food challenge (DBPCFC) methodology for identifying food intolerance in patients with brittle asthma.Subjects/setting Patients with brittle asthma and perceived food intolerance were studied in hospital.Design Each of 3 protocols began with 5 days of dietary exclusion. Protocol 1 consisted of open food challenges in 29 patients, protocol 2 consisted of 2 daily DBPCFCs in 22 patients, and protocol 3 involved 1 daily DBPCFC in 18 patients. Total immunoglobulin E level was measured and food-specific radioallergosorbent tests and skin prick tests were conducted. A standard panel of hyperallergenic foods were masked in a soup (developed specially for this study) for every food challenge. Peak expiratory flow, forced expiratory volume, and symptoms were assessed as objective measures of response. Open food challenges at home followed each protocol. Each protocol took approximately 14 days in the hospital and 4 to 6 months at home.Results For protocols 1, 2 and 3, positive reactions were experienced by 52%, 55%, and 66% of patients, respectively. Radioallergosorbent tests and skin prick tests were shown to have 40% and 71% sensitivity, respectively, and 74% and 77% specificity for predicting a positive food challenge.Applications/conclusions The high prevalence of food intolerance in patients with brittle asthma was confirmed, as was the poor positive predictive value of skin prick tests and radioallergosorbent tests. The food challenge method developed enables standardized identification of food intolerances in patients with brittle asthma and may be useful in other groups. J Am Diet Assoc. 2000;100:1361–1367.     

Quantitative skin prick and bronchial provocation tests with platinum salt.

Occupational asthma due to platinum salts is a frequent disease in platinum refineries. The diagnosis is based upon a history of work related symptoms and a positive skin prick test with platinum salts. Bronchial provocation tests have not been performed in epidemiological studies because the skin test is believed to be highly specific and sensitive. As no reliable data about this issue currently exist, this study assesses the use of skin prick and bronchial provocation tests with methacholine and platinum salt in platinum refinery workers. Twenty seven of 35 workers, who were referred to our clinic with work related symptoms and nine control subjects with bronchial hyperreactivity underwent a skin prick test and bronchial provocation with methacholine and platinum salt. For skin prick and bronchial provocation tests with platinum salt a 10(-2)-10(-8) mol/l hexachloroplatinic acid solution, in 10-fold dilutions was used. Four of the 27 subjects and all controls showed neither a bronchial reaction nor a skin reaction. Twenty three subjects were considered allergic to platinum salt; 22 of these showed a fall of 50% or more in specific airway conductance after inhalation of the platinum salt solution. Four workers experienced a positive bronchial reaction despite a negative skin prick test. No correlation of responsiveness to methacholine with responsiveness to platinum salt was found, but the skin prick test correlated with the bronchial reaction to platinum salt (rs = 0.50, p less than 0.023, n = 22). One dual reaction was seen in bronchial provocation tests. Side effects of both skin tests and bronchial provocation tests with platinum salt were rare and were not encountered in workers without a skin reaction to platinum salt. It is concluded that bronchial provocation tests with platinum salts should be performed on workers with work related symptoms but negative skin tests with platinum salts.     

Quantitative skin prick and bronchial provocation tests with platinum salt.

Occupational asthma due to platinum salts is a frequent disease in platinum refineries. The diagnosis is based upon a history of work related symptoms and a positive skin prick test with platinum salts. Bronchial provocation tests have not been performed in epidemiological studies because the skin test is believed to be highly specific and sensitive. As no reliable data about this issue currently exist, this study assesses the use of skin prick and bronchial provocation tests with methacholine and platinum salt in platinum refinery workers. Twenty seven of 35 workers, who were referred to our clinic with work related symptoms and nine control subjects with bronchial hyperreactivity underwent a skin prick test and bronchial provocation with methacholine and platinum salt. For skin prick and bronchial provocation tests with platinum salt a 10(-2)-10(-8) mol/l hexachloroplatinic acid solution, in 10-fold dilutions was used. Four of the 27 subjects and all controls showed neither a bronchial reaction nor a skin reaction. Twenty three subjects were considered allergic to platinum salt; 22 of these showed a fall of 50% or more in specific airway conductance after inhalation of the platinum salt solution. Four workers experienced a positive bronchial reaction despite a negative skin prick test. No correlation of responsiveness to methacholine with responsiveness to platinum salt was found, but the skin prick test correlated with the bronchial reaction to platinum salt (rs = 0.50, p less than 0.023, n = 22). One dual reaction was seen in bronchial provocation tests. Side effects of both skin tests and bronchial provocation tests with platinum salt were rare and were not encountered in workers without a skin reaction to platinum salt. It is concluded that bronchial provocation tests with platinum salts should be performed on workers with work related symptoms but negative skin tests with platinum salts.     

Clinical and immunological responses to occupational exposure to alpha-amylase in the baking industry.

alpha-Amylase is a starch cleaving enzyme often used in the baking industry as a flour additive. It is usually of fungal origin, produced by Aspergillus oryzae. One previous report has shown IgE antibodies and positive skin prick test against alpha-amylase in asthmatic bakers. This paper describes four alpha-amylase sensitised index cases with occupational asthma or rhinitis and the results of a cross sectional study of 20 workers from the same factory who were also exposed to alpha-amylase powder. Air sampling detected airborne alpha-amylase at a concentration of 0.03 mg/m3. Significantly more work related symptoms such as rhinitis and dermatitis were found among the alpha-amylase exposed workers compared with referents. A skin prick test to alpha-amylase was positive in 30% (6/20) of the exposed workers. Most of the persons showing a positive skin prick test had work related symptoms and were also skin prick test positive to common allergens. Nasal challenge tests with amylase were performed in selected cases and validated three cases of alpha-amylase induced rhinitis. Two non-symptomatic workers had precipitins to alpha-amylase. Specific IgG antibodies were shown by two further serological techniques. The nature and relevance of these antibodies are currently being studied. It is concluded that alpha-amylase powder is a potent occupational sensitiser. Precautions should be taken when handling this allergenic enzyme.     

Clinical and immunological responses to occupational exposure to alpha-amylase in the baking industry.

alpha-Amylase is a starch cleaving enzyme often used in the baking industry as a flour additive. It is usually of fungal origin, produced by Aspergillus oryzae. One previous report has shown IgE antibodies and positive skin prick test against alpha-amylase in asthmatic bakers. This paper describes four alpha-amylase sensitised index cases with occupational asthma or rhinitis and the results of a cross sectional study of 20 workers from the same factory who were also exposed to alpha-amylase powder. Air sampling detected airborne alpha-amylase at a concentration of 0.03 mg/m3. Significantly more work related symptoms such as rhinitis and dermatitis were found among the alpha-amylase exposed workers compared with referents. A skin prick test to alpha-amylase was positive in 30% (6/20) of the exposed workers. Most of the persons showing a positive skin prick test had work related symptoms and were also skin prick test positive to common allergens. Nasal challenge tests with amylase were performed in selected cases and validated three cases of alpha-amylase induced rhinitis. Two non-symptomatic workers had precipitins to alpha-amylase. Specific IgG antibodies were shown by two further serological techniques. The nature and relevance of these antibodies are currently being studied. It is concluded that alpha-amylase powder is a potent occupational sensitiser. Precautions should be taken when handling this allergenic enzyme.     

Skin prick test reactivity to common allergens among women in Entebbe, Uganda

The objectives of this study were to estimate the prevalence of atopic sensitization, and to identify common aeroallergens associated with atopic sensitization among women in Entebbe, Uganda, and to determine risk factors for atopic sensitization among those with and without a history of asthma or eczema. A case-control study was conducted within a trial of deworming in pregnancy, approximately 2 years after the intervention. Skin prick test reactivity was assessed among 20 women with a history of asthma, 25 with history of eczema and 95 controls. Overall prevalence of reactivity was estimated by adjusting for the prevalence of asthma in the whole cohort. Overall skin prick test prevalence was: any allergen 30.7%, Blomia tropicalis 10.9%, Dermatophagoides mix 16.8%, cockroach 15.8%. The prevalence of a positive skin prick test was significantly associated with a history of asthma (70% to any allergen vs. 32%, P=0.002) but not with a history of eczema (44% vs. 36%, P=0.49). Women with Mansonella perstans had significantly reduced odds for atopic sensitization (adjusted odds ratio 0.14, 95% CI 0.03-0.69); women with a history of asthma were less likely to have hookworm (adjusted odds ratio 0.24, 95% CI 0.07-0.81) but this association was weaker for women with a history of eczema. [Clinical Trial No. ISRCTN32849447].