海南儿童哮喘常见吸入性变应原的调查

目的 了解海南地区儿童哮喘常见吸入性变应原,探讨有效实施变应原避免的措施,为成功开展特异性免疫治疗提供依据.方法 对2 361例哮喘儿童进行13种常见过敏原皮肤点刺试验,对其中450例患儿进行10种过敏原体外特异性IgE检测.结果 2 361例哮喘患儿皮肤点刺阳性率为86.0%,其中,屋尘螨及粉尘螨阳性率分别为91.2%及89.3%,热带螨为86.3%,且阳性级别高.对三种螨呈三级以上皮肤点刺阳性反应的患者分别占65.7%、65.4%和58.2%.动物皮毛中,狗毛阳性率为22.4%,猫毛14.4%;德国小蠊及美洲大蠊分别为28.7%及21.9%,但其阳性级别通常很低.450例体外过敏原检测阳性率为72.4%,其中仍以螨虫阳性率最高,屋尘螨66.2%,粉尘螨59.6%.结论 屋尘螨、粉尘螨和热带螨是海南地区最重要的过敏原,其阳性率和阳性级别均比国内其他地区高.狗毛、猫毛、蟑螂等过敏原在海南也占一定比例.     

Childhood asthma and exposure to indoor allergens: lowmite levels are associated with sensitivity

The prevalence and level of sensitivity to indoor allergens were studied in relation to current exposure at home in 124 children with perennial asthma living in three climatic zones of Sweden. The house dust mite (HDM) allergen levels were higher in the South than in the North (p < 0.001), while cat and dog allergen levels tended to be higher in the North than the South (n. s.). Thirty-four percent of the children were sensitive to the HDM Dermatophagoides pteronyssinus , as determined by IgE antibodies in vitro, 27% were sensitive to D. farinae , 57% to cat and 55% to dog. Sensitivity to HDM was significantly more prevalent in Southern, than in Central and Northern Sweden (p=0.001) where the children were more often sensitive to pets (cat p=0.005, dog p= 0.002). A significant association between the concentration of Der p I and Derf I in the house dust and both the prevalence of sensitivity to HDM and the IgE antibody levels against mites was found even at concentrations well below the commonly suggested risk level for sensitisation of 2 μg/g dust. No relationship was found between pet allergen concentration in the home dust and sensitivity to pets, possibly because of exposure outside home, e. g. in schools and meeting places for leisure activities. Similarly, there was no consistent association between the level of mite or pet allergen exposure at home and asthma severity as judged by symptom and medication score. The study indicates that there is no threshold value for sensitisation to mite allergens in asthmatic children, and therefore, dust allergen levels at home should be kept as low as possible in homes of children at risk for asthma.     

儿童哮喘过敏原检测及临床意义

目的 探讨皮肤过敏原点刺试验、血清过敏原检测在儿童哮喘病因诊断、治疗的临床意义。方法 应用粉尘螨及屋尘螨过敏原对121例哮喘患儿及111例对照组儿童进行皮肤点刺试验,其中59例哮喘患儿应用免疫条带印记法进行血清过敏原检测。结果 ①121例哮喘患儿尘螨过敏原皮肤点刺试验总阳性率为28．10％,高于对照组（P〈0．05）。②粉尘螨过敏原阳性33例（27．27％）;屋尘螨过敏原阳性32例（26．45％）。③粉尘螨及屋尘螨过敏原皮肤点刺试验结果与哮喘急性发作严重程度有关。④59例哮喘患儿血清过敏原检测阳性46例（77．97％）,其中猫毛26例（44．07％）。狗毛23例（38．98％）,粉尘螨13例（22．03％）,屋尘螨12例（20.34％）,海鲜组合10例（16．95％）。⑤皮肤点刺试验与血清过敏原检测的尘螨过敏原检出率,差异无统计学意义。结论 皮肤点刺试验可作为儿童哮喘过敏原检测优先选用的方法。     

Sensitivity and specificity of different skin prick tests with latex extracts in pediatric patients with suspected natural rubber latex allergy – A cohort study

Skin prick tests (SPT) with latex extracts are commonly used in the diagnostic approach of natural rubber latex (NRL) allergy. Non‐ammoniated latex extracts are commonly utilized for this purpose. There is only one commercially available ammoniated latex extract for both diagnostic and therapeutic purposes. To our knowledge, no direct clinical comparisons have been made so far comparing sensitivity and specificity of different latex extracts in patients with clinically confirmed latex allergy. The objective of this study was to evaluate sensitivity and specificity of non‐ammoniated or ammoniated SPT of latex extracts in children with a clinical history suggestive of NRL allergy. Forty‐two subjects (age 4–15 yr), referred to our Allergy Clinic Center, with suspected clinical signs of NRL allergy were evaluated. Patients were selected according to the following inclusion criteria: pediatric patients of age above 4 yr with a suspected clinical history of urticaria, rhinoconjunctivitis and/or asthma due to sensitization to NRL. A definitive NRL allergy diagnosis was made on the identification of latex‐specific IgE (>0.7 kU/l), positive glove use test and a highly indicative clinical history. NRL allergy was confirmed in 26 (62%) subjects. SPT for latex were performed with three different SPT solutions containing non‐ammoniated NRL extracts (product A: Lofarma SpA, Milan, Italy and product B: Stallergenes, Milan, Italy) or an ammoniated extract (product C: ALK‐Abellò, Madrid, Spain). A positive result was considered as the appearance of a wheal with a diameter >3 mm. In patients with confirmed NRL allergy, wheal mean (s.d.) diameters were 7.3 (2.1) with product C, and 5.7 (2.3) and 4.4 (1.8) with products B and A respectively (p = 0.004 C vs. B and A). Mean wheal diameters were significantly higher for product C in comparison with product B and A (p < 0.04). Sensitivity according to the different products tested was 65% (product A); 81% (product B) and 96% (product C) (p = 0.0084; C vs. A). No difference between the three products was observed regarding diagnostic specificity (94%, 88% and 94%, product A, B and C, respectively). Our study shows that diagnostic sensitivity of different latex extract for SPT could differ. In this particular clinical setting (i.e., children with NRL allergy) ammoniated latex extract shows a higher sensitivity in comparison with non‐ammoniated products. This aspect should be considered in the diagnostic approach in subjects with suspected NRL allergy. In children with clinical confirmed latex allergy, sensitivity and specificity of different commercially available skin prick test could vary. Ammoniated latex extract has shown a higher sensibility in comparison with non‐ammoniated products.     

Skin‐prick test findings in atopic asthmatic children: A follow‐up study from childhood to puberty

In a prospective cohort study we investigated the course of allergic sensitization from childhood to puberty in a group of children with atopic asthma. An attempt was made to correlate the findings with the persistence of asthma. A total of 150 children with atopic asthma established at 7 years of age were evaluated when 8–10 years of age. A battery of skin‐prick tests (SPTs) to common environmental allergens, a detailed clinical history for asthma severity classification, and spirometric analyses, were performed. In 127 of these children a re‐evaluation was performed at puberty. A variety of statistical methods were used to analyze the results regarding changes in skin test reactivity to individual aeroallergens and atopic index (degree of atopy), as well as to determine any correlation between these changes and the persistence of asthma in puberty. A wide spectrum of modification in skin reactivity to common environmental allergens was observed, including the complete loss of sensitization to some allergens or the development of a new one to others. Specifically, 34% of asthmatic children sensitive to Dermatophagoides pteronyssinus and 52.7% sensitive to cat lost their sensitivity in puberty, while only 7.5% and 11.1%, respectively, became sensitized (p = 0.03 and p = 0.001, respectively). In contrast, regarding pollen sensitivity, 30.2% and 24% of asthmatic children became sensitive in puberty to olive pollen and grasses mix, respectively, and only 11.7% and 12.5%, respectively, lost their sensitivity to these allergens (p = 0.04). No correlation was shown between the skin test reactivity changes to individual allergens and the persistence of asthma, but a significant correlation was found between atopic index to indoor allergens in childhood and the persistence of asthma at puberty (p = 0.04). Interestingly, multi‐sensitivity to allergens (≥ 4 allergens) in childhood was also found to correlate with the persistence of asthma at puberty [p = 0.05, odds ratio (OR) = 2.65, 95% confidence interval (CI) 1.2–7.2]. Our findings indicate that significant modification of skin reactivity to common environmental allergens in atopic children with asthma in puberty can occur. However, no association between these changes and the persistence of asthma could be demonstrated, although children with indoor allergic sensitization and multi‐reactivity were found to have a higher probability of maintaining their asthma in puberty.     

Sensitization to common indoor allergens and its association with allergic diseases in Thai female high-school students

Allergic sensitization is generally agreed to be an important risk factor for allergic diseases. It has been demonstrated in most of the children attending allergy clinics in Thailand but has never been studied in Thai general populations. The objectives were (i) to describe the prevalence of sensitization to common indoor allergens in Thai female-high-school students and (ii) to evaluate the association of allergic sensitization to allergic diseases in these students. cross-sectional analytic study was designed. Seven hundred and six schoolgirls were enrolled during May-June 2002. Written ISAAC questionnaires were completed by the students and skin prick tests were performed in 344 (48.7%) students with a battery of seven common allergens including Dermatophagoides pteronyssinus, Dermatophagoides farinae, American cockroach, Cat, Cladosporium, Penicillium, and Aspergillus. Positive test was defined as a mean wheal diameter of at least 3 mm at the 15 min reading. The adjusted odds ratios (OR) and 95% confidence intervals (CI) were obtained from multiple regression analysis for the independent effect of sensitization to each allergen on allergic diseases. A total of 154 (44.8%) students had evidence of allergic sensitization on skin prick tests. The prevalence rates of sensitization to various groups of allergens were as follows; mites 43.0%, cockroach 12.8%, cat 4.1%, and molds 1.2%. The independent effect of allergic sensitization on allergic diseases was observed only in mite sensitization on nose problem (OR = 1.73, CI = 1.07-2.78 for nose problem ever and OR = 1.85, CI = 1.13-3.02 for nose problem in 12 months). The risk of nose problem was also increased with the number of positive reactions. CONCLUSION: We found that sensitization to the four common allergen groups were weakly associated with the presence of allergic diseases in Thai schoolgirls. This confirms the observation that the development of allergic diseases is not solely attributable to allergic sensitization.     

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??Objective To understand the trend of inhaled allergen positive rate among 0-12-year-old children from 2006 to 2013 in Chongqing Children’s Hospital??and to provide evidence for preventing allergic rhinitis in children. Methods??All cases were collected from Otorhinolaryngological Department of the Children’s Hospital of Chongqing Medical University from 1st January??2006 to 29th October??2013. Totally 10983 children with allergic rhinitis aged 0-12 years old in Chongqing urban districts were enrolled. All the patients underwent skin prick test??SPT?? with 13 standardized common inhalant allergens. Then the children were divided into the infants group??aged??3 years????preschool children??3 years≤aged??7 years?? and school-age children??7 years≤aged??12 years?? according to age. The trend of inhaled allergen positive rate over 8 years was observed. Results From 2006 to 2013??the SPT positive rate increased sharply??then tended to be stable??and then decreased slowly??Curve Estimation??R 2??0.836??adjustment R 2??0.770. ANOVA test??F??12.727??P??0.011??. It may be related to meteorological factors. With the growth of age??the positive rates of Dermatophagoides pteronyssinus??Dermatophagus farinae??Blomia tropicalis??Cockroaches??cat fur??dog fur and mugwort increased??which were 121.200??123.060??103.237??104.784??17.042??8.515 and 11.256??respectively????P was 0.000??0.000??0.000??0.000??0.000??0.014 and 0.004??respectively??. Conclusion ??Meteorological factors and age may have effects on allergic rhinitis??AR?? in children??with the growth of age??the positive rates of inhaled allergens have tendency variation.     

Skin test reactivity to molds in pre-school children with newly diagnosed asthma

BACKGROUND: The aim of the present study was to evaluate the prevalence of sensitization to molds and to house dust mites (HDM) in pre-school children with newly-diagnosed asthma. METHODS: From 1996 to 2000, 122 children 1 to 6 years of age with fresh asthma treated in the Kuopio University Hospital, Kuopio, Finland, were recruited in the study; 94% attended. Skin prick tests were performed to common inhalant allergens and to 10 molds. The homes were surveyed for moisture damage. RESULTS: A majority of the houses had signs of dampness and moisture. One-third of the children reacted to inhalant allergens. There were 11 positive reactions to molds in five children who all reacted to at least one animal dander or seasonal pollen. Aspergillus fumigatus, Botrytis cinerea, and Cladosporium herbarum were the most common mold allergens. There were only two children with positive reactions to HDM, and none of them reacted to molds. No associations were found between the presence or degree of moisture problems at home and mold or HDM allergy. CONCLUSION: Sensitization to molds seems to play only a minor role in pre-school children with newly-diagnosed asthma in a northern climate where the incidences of mold and HDM allergies are rather low.     

支气管哮喘儿童皮肤点刺试验结果分析

目的 分析支气管哮喘(bronchial asthma,BA)儿童皮肤点刺试验(skin prick test,SPT)结果,并提出预防策略.方法 对2007年3月至2010年10月在我院哮喘门诊就诊的200例BA患儿进行SPT结果分析,采用SPSS 17.0软件分析过敏原分布情况及其与年龄、性别的相关性.结果 (1) 200例BA患儿SPT阳性率为72.5%(145/200例),吸入性变应原阳性率62.5%(125/200例),食入变应原阳性率14.0%(28/200例),其中粉尘螨73例(36.5%)、屋尘螨81例(40.5%)、室外霉菌38例(19.0%)、艾蒿34例(17.0%)、猫上皮34例(17.0%)、树木花粉(树Ⅰ)26例(13.0%)、鸡蛋16例(8.0%)、牛奶11例(5.5%);(2) 18种变应原中猫上皮、艾蒿、室外霉菌及树Ⅰ随年龄增加其过敏频率升高,鸡蛋、牛奶随年龄的增加其过敏频率降低,而变应原过敏频率与性别无显著相关性;(3) 18种变应原中粉尘螨、屋尘螨、豚草、藜随年龄增加其过敏严重程度增加,而变应原过敏严重程度与性别无显著相关性.结论 粉尘螨、屋尘螨、猫上皮、室外霉菌、艾蒿、树Ⅰ、鸡蛋、牛奶等是BA儿童的主要变应原.BA儿童应避免接触这些过敏因素.

Abstract：

Objective To investigate the outcome of allergen skin prick test in children with bronchial asthma,and propose prevention strategy.Methods Sensitinogen prick test on the skin was applied on 200 children who were in asthma clinic of our hospital between Mar 2007 and Oct 2010.Then,the distribution of sensitinogen and their correlation with age and sex were analysed by SPSS 17.0.Results (1) The positive rate of sensitinogen prick test in 200 children with asthma was 72.5%(145/200).The positive rate of inhalant allergen and ingestion allergen were 62.5%(125/200),14.0%(28/200),respectively,of which dermatophagoides farinae,dermatophagoides pteronyssinus,outdoor mould,mugwort,cat epidermis,tree Ⅰ,egg,milk were 36.5%,40.5%,19.0%,17.0%,17.0%,13.0%,8.0%,5.5% respectively.(2) The frequency of sensitivity to cat epidermis,mugwort,outdoor mold and tree Ⅰ increased with age and the frequency of sensitivity to egg and milk decreases with age.The sensitivity rate to all other allergens had no relation with sex.(3) The severity of sensitivity to dermatophagoides farinae,dermatophagoides,ragweed and pigweed increased with age,while severity of sensitivity had no significant relation with sex among the 18 kinds of allergens.Conclusion Dermatophagoides farinae,dermatophagoides pteronyssinus,outside mould,mugwort,tree Ⅰ,cat epidermis,egg and milk are the major allergens in children with bronchial asthma,who should avoid contact with these facters.     

Effect of montelukast on exhaled NO in asthmatic children exposed to relevant allergens

The level of exhaled nitric oxide (FENO) is increased in house dust mite (HDM)-sensitized asthmatic children after exposure to HDM antigen, and inhaled steroids can prevent this increase. The aim of this study was to evaluate whether montelukast could prevent an increase in FENO levels in allergic asthmatic children after a brief period of exposure to relevant allergens. Sixteen children were evaluated at the residential house 'Istituto Pio XII' (Misurina, Bellunio, Italy) in the Italian Alps, a dust mite-free environment. FENO levels were evaluated before ( t ₀) and immediately after ( t ₁) the children were exposed to HDM allergens for 2 weeks in their homes at sea level. No significant difference in FENO was observed in the fluticasone-treated group of children after 2 weeks at sea level. In the group treated with montelukast, an increase in FENO was observed between t ₀ and t ₁, which failed to reach statistical significance. These preliminary data suggest that oral montelukast could be effective in preventing the relapse in airway inflammation in allergic asthmatic children who are occasionally exposed to relevant allergens for a short period of time.     

An evaluation of the diagnostic value of different skin tests with egg in clinically egg-allergic children having atopic dermatitis

Skin testing is a common diagnostic procedure in food allergy, but the final diagnosis of food allergy is based on the clinical response to food challenge. We studied the value of the skin prick-prick test (SPT), skin application food test (SAFT) and atopy patch test (APT) with fresh egg extract in diagnosing egg allergy. Ten clinically egg-allergic children with atopic dermatitis (AD; age 10 months to 8.4 yr, mean 3.4 yr) and 10 egg-tolerant children with and 10 without AD (age 2.4-11 yr, mean 5.5 yr) participated. In SAFT several false-negative reactions were seen, whereas all clinically egg-allergic children were positive in SPT and 40-60% in APT. In APT and in SPT false-positive reactions to egg were observed. In this study comprising a small number of patients including control subjects, neither SAFT nor APT with fresh whole egg extract were able to increase the diagnostic accuracy in detecting egg-allergic children with AD compared with SPT.     

超重与正常体重过敏性哮喘儿童特异性免疫治疗前后尘螨皮肤点刺试验强度分析

目的对超重和正常体重过敏性哮喘患儿屋尘螨变应原标准化皮下注射特异性免疫治疗前后皮肤点刺试验(SPT)尘螨过敏原强度的分析。方法 215例SPT屋尘螨、粉尘螨均阳性的过敏性哮喘患儿纳入该研究,按照体重指数分为超重组(63例)和正常体重组(152例),比较两组标准化皮下注射特异性免疫治疗6个月及1年后屋尘螨、粉尘螨过敏原皮肤指数(SI)变化情况。结果在控制检测时间点变异的情况下,超重组组胺皮丘直径大于正常体重组(P0.05);在控制体重变异的情况下,患儿屋尘螨SI、粉尘螨SI均随治疗时间的变化差异有统计学意义(P0.05)。治疗后6个月及1年,两组屋尘螨SI、粉尘螨SI均可见明显下降,但超重组较正常组下降更显著。结论超重过敏性哮喘患儿对组胺反应更强烈;特异性免疫治疗能降低哮喘患儿尘螨过敏强度;在特异性免疫治疗后1年内,超重过敏性哮喘患儿尘螨过敏程度下降更明显。     

The association of allergic symptoms with sensitization to inhalant allergens in childhood

Although it is generally agreed that sensitization is an important risk factor for allergic diseases, the extent to which sensitization accounts for allergic symptoms in children is controversial. As part of the Aalst Allergy Study, this cross‐sectional study investigated the prevalence of allergic symptoms and their association with sensitization in an unselected population of Flemish children aged 3.4–14.8 yr. Skin prick testing with the most common aeroallergens was performed and allergic symptoms were documented by a parental questionnaire. In the children older than 6 yr, a significant association of current wheezing, current dyspnea, airway hyperreactivity, rhinoconjunctivitis, and current eczema with sensitization was found, while in the pre‐school children these associations were less pronounced. The association with sensitization was strongest for rhinoconjunctivitis and current respiratory symptoms – the association was less striking for children with current eczema. The impact of a positive family history of allergy on the association with sensitization was more important for eczema than for the other analyzed allergic symptoms. Persistent and late‐onset wheezers were significantly more likely than non‐wheezers and transient early wheezers to be associated with sensitization and a personal history of rhinoconjunctivitis. Late‐onset wheezing was associated with a positive family history of allergy, while transient early wheezing was associated with day‐care attendance. An association with eczema was found for all three childhood wheezing phenotypes. The association of allergic symptoms with sensitization is significant in the older but less pronounced in pre‐school children and is more pronounced for current allergic symptoms. Diagnosis and disease definition of allergy symptoms remains difficult at pre‐school age. The influence of a positive family history of allergy on the association of the respective allergic symptoms with sensitization was most important for eczema. Our data confirm the atopic characteristics of the different wheeze phenotypes.     

Prediction of atopic disease in infancy by determination of immunological parameters: IgE, IgE- and IgG-antibodies to food allergens, skin prick tests and T-lymphocyte subsets

The possibility of predicting the development of atopic diseases up to 18 months of age, by using IgE, IgE- and IgG-antibodies (Ab) to food allergens, skin prick tests (SPT) and T-lymphocyte subsets, was prospectively studied in 163 infants with atopic heredity. IgE determinations in cord blood showed a positive allergy-predictive value of only 21%, using an optimal cut-off limit (≥ 0.9 kU/l). The corresponding figure for a weakly positive RAST (≥ 0.15 < 0.35 PRU/ml) to ovomucoid (OVO) or β-lactoglobulin (BLG) at 6 months of age was 25% and for a positive RAST ≥ 0.35 PRU/ml 100%. The predictive value of positive SPT to ovalbumin (OA), OVO, BLG and whole cow's milk varied between 67 and 100% and for IgG-Ab levels to the same food allergens the predictability did not exceed 30%. Total numbers of T cells (CD2, CD3) were higher (p < 0.05) at delivery among atopic infants, but neither in cord blood nor in blood samples, taken at 2 and 6 months of age, could absolute T-cell subset numbers or the CD4/CD8 ratios predict atopic diseases in more than 45% of the cases. A low sensitivity was observed in most of the parameters studied. Thus, none of the tests used in the present study seems suitable for predicting the development of atopic diseases during early infancy.     

Comparison of two IgE antibody tests with skin test and clinical history in asthmatic patients

The multiple allergosorbent chemiluminescent assay (MAST-CLA) is a system to measure total and allergen-specific IgE in human serum by means of a chemiluminescent immuno-enzymatic system. The test has been compared with skin test, RAST and clinical history in 67 atopic, asthmatic children. The individual percentage agreement between MAST-CLA and skin test was grass pollen 67%, tree pollen 82%, cat 76%, dog 84%, house dust mite 87%, alternaria 64%, aspergillus 79%, cladosporium 84%, penicillium 93%, milk 78% and egg 76% and between MAST-CLA and RAST was grass pollen 62%, tree pollen 72%, cat 75%, dog 72% and mite 87%. The total IgE levels on MAST-CLA did not agree with PRIST results. MAST-CLA was randomly duplicated and proved repToducible in 85% of tests. Changes between positive and negative results occurred in only 4% of tests. Clinical history predicted allergy diagnosis accurately in 21 (31. 5%) cases whilst MAST-CLA provided additional information in 14 (21%). MAST-CLA proved least reliable for grass pollen allergy diagnosis, which has prompted a change in allergen composition for this assay. MAST-CLA is a simple in vitro test for specific IgE to 35 allergens which compares favourably with RAST. The variation in correlates with other techniques of allergy diagnosis, however, indicates that there are differences in credibility for each result within the multiple test system.     

温州地区402例哮喘患儿特应质现象分析

目的 对温州地区15岁以下哮喘患儿特应质现象进行分析,探讨其临床及理论价值.方法 回顾性分析402例哮喘患儿皮肤过敏原诊断试验、血清特异性IgE、总IgE、个人过敏史、家族史、过敏原检出率、类型及与年龄关系.结果 哮喘发病有家族聚集倾向,家族过敏史总阳性率为52.74%.个人过敏史总阳性率为61.69%.过敏原皮肤诊断试验和过敏原血清特异IgE阳性率达83.58%,吸人性过敏原阳性人数占检测患儿的74.13%,其中以粉尘螨(61.44%)、屋尘螨(58.96%)为主;食人性过敏原阳性占24.38%,以小虾(16.67%)、牛奶(8.46%)为主.血清总IgE阳性率87.9%,总IgE阳性组和阴性组的哮喘患儿血清嗜酸性细胞阳离子蛋白(ECP)、户尘螨sIgE(D1)、粉尘螨sIgE(D2),皮肤过敏原诊断试验(pt)、家族过敏史、个人过敏史差异有统计学意义(P均≤0.05).哮喘患儿3岁前、后过敏原分布不同,3岁以后吸人性过敏原阳性为主.发病诱因中以上呼吸道感染为最多,哮喘症状发作的时间主要集中在临睡、夜晚、清晨.结论 儿童哮喘存在明显特应质现象,对其的正确认识和诊断对哮喘免疫机制的深入研究、综合治疗如在糖皮质激素吸入治疗的基础上,增加患儿教育、过敏原避免、特异性的免疫治疗等具有实用和理论指导意义.     

3085例儿童过敏性疾病吸入性过敏原皮肤点刺试验及临床意义

目的：探讨西安及其周边地区儿童过敏性疾病吸入性过敏原状况及分布,为该地区儿童过敏性疾病的防治提供理论依据。方法：采用丹麦ALK-ABELL公司提供的13种标准化变应原皮肤点刺液,对2006年7月至2011年7月因各种过敏性疾病等原因就诊的来自西安及其周边地区的3085例儿童进行吸入性过敏原皮肤点刺试验（skin prick test, SPT）。结果：3085例患儿中,吸入性SPT阳性1368例,阳性率为44-34%。过敏原阳性率较高的前5位依次为屋尘螨804例（26.06%）、粉尘螨793例（25.71%）、热带螨440例（14.26%）、艾蒿282例（9.14%）、猫毛204例（6.61%）。<4岁组、4岁～组、7～15岁组SPT阳性率依次为28.66%、41.85%、58.61%,组间比较差异有统计学意义（P<0.01）,表现为随年龄增长SPT阳性率增加。男性SPT阳性率较女性高（47.78% vs 38.50%,P<0.05）。在各种不同的过敏性疾病中,以过敏性鼻炎患儿的SPT阳性率最高,达72.41%,其次依次为支气管哮喘（62-25%）、变态反应性皮肤病（45-83%）、过敏性紫癜（36.28%）。结论：西安及其周边地区儿童过敏性疾病吸入性过敏原以屋尘螨、粉尘螨、热带螨、艾蒿、猫毛等为主;SPT阳性率随年龄增长而增加;男性儿童SPT阳性率较女性高;在常见过敏性疾病中,以过敏性鼻炎患儿SPT阳性率最高。     

Atopy patch testing in children with asthma and rhinitis symptoms allergic to house dust mite

The atopy patch test (APT) is generally used to assess immunoglobulin E (IgE) mediated sensitization to allergens in patients with atopic dermatitis, but its diagnostic role in children with respiratory allergy is still controversial. The aim of the study was to evaluate APT with house dust mite (HDM) in children with asthma and rhinitis symptoms allergic to HDM and its relevance to skin prick test (SPT) diameters and specific IgE levels. The study population consisted of 33 children, aged 8-16 yr (median: 12 yr) with asthma and 30 children with allergic rhinitis in the same age range (median: 11 yr). All patients had positive SPT results and high serum specific IgE levels for Dermatophagoides pteronyssinus APT was performed on back skin of all patients with 200 index of reactivity (IR)/ml of D. pteronyssinus allergen extracts in petrolatum (Stallerpatch) and evaluated at 72 h. Of 63 patients, 16 (25%) showed a positive patch test result. APT with HDM showed 30% (10/33) positivity among the patients with asthma and 20% (6/30) positivity among the patients with allergic rhinitis. APT presented no significant correlation with age, SPT diameter, serum total and specific IgE levels for D. pteronyssinus, nasal provocation test or pulmonary function test results. Patch testing with HDM may partly identify mite sensitive children with respiratory allergy. Positive APT results may imply that delayed hypersensitivity reactions play a role in children with asthma and rhinitis allergic to HDM.     

The diagnostic value of skin prick testing in children with food allergy

The diagnostic accuracy of the skin prick test (SPT) in food allergy is controversial. We have developed diagnostic cut-off levels for SPT in children with allergy to cow milk, egg and peanut. Based on 555 open food challenges in 467 children (median age 3.0 yr) we defined food-specific SPT weal diameters that were '100% diagnostic' for allergy to cow milk (>or=8 mm), egg (>or=7 mm) and peanut (>or=8 mm). In children < 2 yr of age, the corresponding weal diameters were >or=6 mm, >or=5 mm and >or=4 mm, respectively. These SPT cut-off levels were prospectively validated in 90 consecutive children 相似文献