免疫治疗对变应性鼻炎患者鼻分泌物中螨变应原特异性IgG1和IgG4抗体水平的影响

目的检测变应性鼻炎患者和健康人群鼻分泌物中螨变应原特异性IgG1和IgG4抗体水平,以了解变应原特异性IgG亚型抗体在人群鼻分泌物中的分布和免疫治疗对抗体浓度的影响.方法利用负压吸引法收集健康人群、变应性鼻炎未治疗组和免疫治疗组患者的鼻分泌物,采用间接非竞争生物素-链亲和素酶联免疫法检测鼻分泌物中粗制螨变应原、螨纯化变应原Der fⅠ和Der fⅡ各变应原特异性IgG1和IgG4亚型抗体浓度.结果变应性鼻炎患者鼻分泌物中螨粗制变应原特异性IgG1和IgG4抗体浓度均高于健康人(Z=-3.623、-3.061,P均<0.01);免疫治疗组患者IgG1和IgG4抗体浓度均高于非治疗组(Z=-2.453、-3.408,P均<0.01).免疫治疗组变应性鼻炎患者鼻分泌物中螨纯化变应原Der fⅠ特异性IgG4抗体水平较健康人群增高(Z=-3.518,P<0.01);而免疫治疗组Der f Ⅱ特异性IgG1和IgG4抗体水平均高于健康人(Z=-2.366、-2.936,P均<0.01)和未治疗组(Z=-2.366、-2.937,P均<0.01).IgG1和IgG4亚群抗体中,螨粗制抗原、Der fⅠ和Der f Ⅱ特异性抗体水平相互间具有相关性;三类变应原特异性IgG1和IgG4抗体间存在相关性;免疫治疗组患者鼻分泌物中螨粗制变应原IgG1和IgG4抗体与血清中特异性IgE抗体间具有相关性. 结论健康人群和变应性鼻炎患者均具有对其环境变应原产生特异性IgG1和IgG4抗体的能力,而变应性鼻炎患者具有更高的反应性,能产生高于健康人的特异性IgG亚型抗体,而变应原特异性免疫治疗能显著增加鼻分泌物中IgG1和IgG4抗体的水平.鼻分泌物中IgG1和IgG4抗体的增加可能是免疫治疗有效的机制之一.     

儿童变应性鼻炎免疫治疗的临床疗效及免疫学机制研究

目的 评价标准化尘螨变应原疫苗治疗儿童变应性鼻炎的临床疗效并初步探索其免疫学机制.方法螨过敏变应性鼻炎儿童64例,随机分为免疫治疗组(32例)和药物治疗组(32例).通过症状评分和药物评分评价临床疗效,并检测治疗前后血清中总IgE、螨特异性IgE、特异性IgG4的水平.结果 经过1年的治疗,免疫治疗组患儿的症状评分(4[3;6]分)和药物评分(0.35[0.30;0.43]分)较治疗前(分别为10[9;11]分、0.76[0.61;0.90]分)均明显减少且差异有统计学意义(Z值分别为-4.80、-4.74,P值均<0.01),与药物治疗组(分别为7[5;9]分、0.72[0.60;0.92]分)相比差异亦有统计学意义(U值分别为155.00、139.50,P值均<0.01).总IgE和螨特异性IgE水平未见明显改变,但免疫治疗组患儿血清中螨特异性IgG4的水平明显升高(U=6.00,P<0.01).结论 标准化螨变应原免疫治疗能够有效改善变应性鼻炎患儿的症状,减少药物使用,变应原特异性IgG4的增高可作为预测免疫治疗疗效的免疫学参考指标.

Abstract：

Objective To evaluate the efficacy and immunological changes of children receiving subcutaneous immunotherapy with Dermatophagoides pteronyssinus. Methods Sixty-four children with allergic rhinitis to Dermawphagoides pteronyssinus (Der p) were randomly allocated to receive either specificimmunotherapy (n = 32) or medical treatment (n = 32 ). Symptom and medication scores were assessed toevaluate the clinical efficacy in the baseline and after one year treatment. Total IgE, Der p-specific IgE, and specific IgG4 were measured. Results Immunotherapy reduced the symptom ( the scores reduced from 10[9;11] to4[3;6]) and medication score (the scores reduced from 0.76[0.61; 0.90] to 0.35[0.30;0. 43] ) in children with arlergic rhinitis significantly ( Z value were - 4.80 and - 4.74, respectively, each P＜0.01 ). There was a significant difference in symptom and medication scores between both groups after one year treatment ( U value were 155. 00 and 139.50, respectively, each P ＜ 0.01 ). There were no differences in levels of serum total IgE, specific IgE before and after one year treatment, but the level of serum specific IgG4 increased significantly after one year treatment. Conclusions Immunotherapy with standardized extract is efficacious to treat children sensitive to Der p, allergen-specific IgG4 is significant as immunological marker to predict efficacy of immunotherapy.     

鼻声反射对特异性变应原皮下免疫治疗儿童变应性鼻炎的疗效评估

摘要：目的探讨鼻声反射测量评估特异性变应原皮下免疫治疗变应性鼻炎的疗效。方法对接受阿罗格（螨变应原注射液）皮下注射脱敏治疗的65例变应性鼻炎患儿进行研究,其中男40例,女25例;年龄5～13岁,平均年龄（7.1±2.2）岁。所有患儿均对屋尘螨和粉尘螨过敏,完成1年的特异性皮下免疫治疗。治疗前和治疗后1年分别进行症状评分和鼻声反射测量,分析治疗前后鼻腔容积（NV）及鼻腔最小横截面积（MCA）的变化,评估特异性变应原皮下免疫治疗的疗效。结果65例变应性鼻炎患儿特异性变应原皮下免疫治疗1年后症状评分明显改善,治疗1年后鼻腔容积及鼻腔最小横截面积与治疗前相比显著增加。结论鼻声反射测量是客观反映鼻腔通气状况的指标。鼻声反射测定值与患者主观感受具有高度一致性,对鼻腔通气功能的临床评估有应用价值。特异性变应原皮下免疫治疗变应性鼻炎疗效确切,用鼻声反射测量来评估是客观准确的。     

变应原特异性免疫治疗——中华耳鼻咽喉头颈外科杂志，2012，46（12）

张罗，韩德民．积极稳妥推广变应原特异性免疫治疗程雷，陈若曦．变应原特异性免疫治疗的现状与展望中华耳鼻咽喉头颈那个外科杂志编辑委员会鼻科组，中华医学会耳鼻咽喉头颈外科学分会鼻科学组．变应性鼻炎特异性免疫治疗专家共识     

标准化尘螨变应原疫苗治疗应性鼻炎一年的疗效和安全性研究

目的 评价标准化尘螨变应原免疫治疗变应性鼻炎的疗效及安全性.方法 60例螨过敏变应性鼻炎患者随机分为免疫治疗组30例和药物治疗组30例.通过症状评分、药物评分、鼻炎相关生活质量评分和不良反应分级评价免疫治疗的疗效和安全性.结果 经过1年治疗后,免疫治疗组症状评分和药物评分较治疗前均明显减少(P＜0.01),与药物治疗组相比亦有显著性差异(P＜0.01).同时,免疫治疗组患者的鼻炎相关生活质量明显改善.所有免疫治疗病例未出现严重不良反应.结论 标准化螨变应原免疫治疗可安全有效地治疗变应性鼻炎.     

变应性鼻炎和哮喘患者变应原类型及免疫治疗疗效的比较

目的 比较单纯性变应性鼻炎患者和哮喘患者变应原阳性率及变应原免疫治疗情况,分析机体对变应原反应程度与疾病的发生、发展及免疫治疗的关系.方法 对100例单纯性变应性鼻炎和100例哮喘患者行皮肤点刺试验,根据变应原类型从中挑选各30名符合混合螨免疫治疗条件者进行变应原免疫治疗.标准化皮肤点刺液和脱敏制剂均由阿罗格公司提供.结果 单纯变应性鼻炎组的主要吸入性变应原和摄入性变应原阳性率均显著低于哮喘组,且主要吸入性变应原屋尘螨和粉尘螨的强阳性率亦明显低于哮喘组.变应原免疫治疗则无显著差异.结论 机体对变应原的反应程度与疾病的发生、发展可能存在一定的关系.对变应性鼻炎的早期干预是必要的.     

螨变应原特异性免疫治疗1年后免疫学变化

目的探讨标准化尘螨变应原疫苗进行集群免疫治疗过程中的免疫学机制。方法将60例螨过敏变应性鼻炎（AR）患者分为集群免疫治疗组（n=30）和药物治疗组（n=30）。检测基线和治疗1年后受试者血清中总IgE、螨特异性IgE、特异性IgG4水平,通过流式细胞术检测外周血单核细胞中Th1、Th2、天然调节性T细胞（CD4^＋CD25^＋Foxp3^＋ T细胞）和I型调节性T细胞（Tr1细胞,CD4^＋IL-10^＋IL-4^-T细胞）在CD4^＋T细胞中百分比。结果经过1年治疗后,总IgE和螨特异性IgE水平未见明显改变,但免疫治疗组患者血清中螨特异性IgG4水平明显升高（P〈0．0001）。Th1、Th2型细胞和天然调节性T细胞（CD4^＋CD25^＋Foxp3^＋T细胞）占CD4^＋T细胞的百分比在治疗前后均无明显变化（P=ns）,而Tr1细胞在免疫治疗1年后明显增高（P〈0．001）。结论特异性IgG4和Tr1细胞增高可作为产生免疫耐受的免疫学指标。     

舌下含服和皮下注射免疫治疗儿童变应性鼻炎的临床疗效观察

目的比较舌下免疫治疗（sublingual immunotherapy,SLIT）、皮下免疫治疗（subcutaneous immunotherapy,SCIT）及单纯药物治疗儿童变应性鼻炎（allergic rhinitis,AR）的临床疗效并初步探索其免疫机制。方法收集能坚持治疗并定期随访的螨过敏变应性鼻炎儿童90例,按数字随机法分成3组,SLIT组（30例）、SCIT组（30例）和单纯药物治疗组（30例）。通过症状评分、药物评分和视觉模拟评分量表（VAS）评价各组治疗后临床疗效,并检测治疗前后血清中总IgE、螨特异性IgE、特异性IgG4的含量。结果经过2年的治疗,SLIT组和SCIT组患儿的症状评分、药物评分及VAS较治疗前均明显减少且差异具有统计学意义（P均〈0.01）,与药物治疗组相比差异具有统计学意义（P均〈0.01）。两组免疫治疗组总IgE和螨特异性IgE水平未见明显改变,但血清中螨特异性IgG4水平明显升高（P〈0.01）。结论相对于单纯药物治疗儿童AR,采用SLIT和SCIT治疗能够有效改善患儿的症状,减少药物使用,变应原特异性IgG4的增高可作为预测免疫治疗疗效的参考指标。     

变应性鼻炎屋尘螨变应原皮下免疫治疗的远期疗效研究

目的 评价皮下注射标准化屋尘螨变应原疫苗治疗变应性鼻炎的远期疗效.方法 将92例单一屋尘螨过敏的变应性鼻炎患者随机分为免疫治疗组(46例)和药物治疗组(46例).通过症状评分、药物评分和屋尘螨特异性皮肤反应指数评价临床疗效,同时检测血清中屋尘螨特异性IgE、特异性IgG4的水平.结果 经过3年治疗后,免疫治疗组患者的症状评分、药物评分(中位数[25分位数;75分位数])和屋尘螨特异性皮肤反应指数(均值±标准差)分别为3.32 [2.49;5.12]分、0.31[0.28;0.45]分、1.34 ±0.29,较治疗前的9.20[7.50;11.13]分、0.72[0.47;0.83]分、1.71±0.53,均明显减少,差异有统计学意义(检验值分别为-5.13、-5.78、6.37,P值均＜0.05),以上3项指标免疫治疗组与药物治疗组相比差异亦有统计学意义(P值均＜0.05).血清屋尘螨特异性IgE水平治疗前为16.32[4.34;38.65] kU/L,免疫治疗3年后为15.85[4.93;46.27] kU/L,差异无统计学意义(Z=-0.84,P＞0.05);免疫治疗组患者血清中螨特异性IgG4治疗后为8387[ 7732;16 634]AU/L,较治疗前的486[ 319;1439] AU/L明显升高,差异有统计学意义(Z=-2.81,P＜0.05).7.5％(3/40)的免疫治疗组患者在3年后出现了哮喘症状,明显低于药物治疗组哮喘症状的发生率(27.8％),差异有统计学意义(x2=5.50,P＜0.05).15.0％ (6/40)的免疫治疗组患者在3年后出现了新的过敏原反应,明显低于药物治疗组(47.2％),差异有统计学意义(x2=9.32,P＜0.05).结论 对于变应性鼻炎患者而言,标准化屋尘螨变应原免疫治疗能够有效改善症状、减少药物使用及降低特异性皮肤反应,升高血清中特异性IgG4水平,有效减少哮喘和新的过敏反应的发生.     

宝泰PM免疫调节剂治疗常年性变应性鼻炎临床疗效观察及免疫机理探讨

应用宝泰PM免疫调节剂治疗60例常年性变应性鼻炎，根据治疗前后病情分级的改善和变应原鼻粘膜激发试验评定，有效率分别为90％和86．7％。治疗前后血清及鼻分泌物中广谱凝集抗体效价、特异性IgG和SIgA抗体阳性检出率及抗体满度均有不同程度改变，其中血清绿脓杯自MSHA菌毛株凝集抗体液度比治疗前增加4～64倍，鼻分泌物中治疗前后绿脓杆菌菌毛株凝集抗体阳性人数检出率有非常显著性差异（P＜0．005）；治疗后血清中变形杆菌、大肠杆菌、绿脓杆菌菌毛株特异性IgG荧光抗体滴度有一定程度增加，鼻分泌物中绿脓杆菌菌毛株特异性SIgA荧光抗体治疗前后阳性人数检出卓有高度显著性差异（P＜0．005）。本治疗机理是采用低毒、广谱、较强免疫原性的绿脓杆菌MSHA菌毛株菌苗，进行全身免疫治疗，刺激机体产生高效价、跨菌属抗体，并结合其他免疫调节作用达到治疗目的。     

温州2991例变应性鼻炎患者皮肤点刺试验结果分析

目的　了解温州地区变应性鼻炎患者变应原分布特征。方法　回顾性分析2013年1月～2014年12月具有变应性鼻炎症状、行皮肤点刺试验的患者的临床资料,分析皮肤点刺试验结果的分布特征。结果　①2991例患者总阳性率为82.0%,主要变应原是粉尘螨和屋尘螨;吸入性变应原阳性率高于食入性致敏原（χ2=2006.557,P＜0.01）;变应性鼻炎患者以双重过敏者为主;粉尘螨、屋尘螨反应强度均以（++++）为主,二者间反应强度差异无显著性（Z =-0.391,P =0.696）。②不同季节变应原阳性率有显著性差异（χ2=34.254,P＜0.01）。③不同病程组变应原阳性率差异无显著性（χ2=16.102,P =0.065）。④不同年龄组变应原阳性率差异有显著性（χ2=223.317,P＜0.01）,阳性率随年龄增大而升高,在10～12岁年龄段达高峰,之后减小。结论  尘螨为温州地区变应性鼻炎患者的主要变应原,季节和年龄是影响皮肤点刺试验阳性率及变应性鼻炎发病的重要因素,变应原阳性率与年龄存在一定的关系。     

Humoral mucosal immunity in allergic rhinitis

BACKGROUND: Mucosa-immunologic aspects are gaining an increasing awareness in the pathophysiology of type I allergies. Humoral mucosal immune responses are dominated by secretory IgA, but there is evidence for a relevant role of IgG in nasal mucosa-associated lymphoid tissue. OBJECTIVE: was to measure allergen-specific immunoglobulins (IgA and IgG) in nasal secretions as an expression of a humoral mucosal immune response in allergic rhinitis. For tissue eosinophilia we studied nasal Eosinophilic Cationic Protein (ECP) and for mast cell activation nasal tryptase. METHODS: Nasal secretions of 40 patients suffering from allergic rhinitis were analyzed for allergen-specific IgA, IgG, and IgE, and for ECP and tryptase. Patients were highly sensitized against the major allergens of house dust mites, timothy, and birch pollen. 43 non-atopic individuals served as controls. In order to study possible effects of the actual pollen season on the studied parameter we secondly compared patients allergic to seasonal allergens co- (n = 28) and extra-seasonally (n = 41). In order to determine a possible influence of allergen-specific IgA in eosinophilic degranulation we additionally studied 5 patients after nasal allergen challenge. RESULTS: In allergic rhinitis we found significantly increased levels of allergen-specific immunoglobulins of all studied subclasses and allergens in nasal secretions. Comparison of nasal ECP and tryptase showed significantly increased concentrations in allergic individuals as well. Co-seasonally we found elevated allergen-specific IgE, ECP, and tryptase but lower concentrations of allergen-specific IgA and IgG. There was no association between late phase eosinophilia and IgA concentrations after local allergen challenge. CONCLUSIONS: The occurrence of allergen-specific immunoglobulins in nasal secretions is interpreted as a local humoral mucosal immune response. The physiologic role of local allergen-specific immunoglobulins is not clear to date. Involvement in degranulation of eosinophils or mast cells, like suggested before, seems unlikely.     

儿童变应性鼻炎舌下免疫治疗的临床疗效及免疫因子IL-10水平检测

目的评价标准化尘螨变应原疫苗舌下免疫治疗儿童变应性鼻炎的临床疗效并初步探讨其免疫学机制。方法尘螨过敏的变应性鼻炎儿童60例,随机分为免疫治疗组(31例)和药物治疗组(29例)。通过症状评分和药物评分评价临床疗效,并检测治疗前后血清中总LgE、螨特异性LgE、免疫因子IL-10的水平。结果经过1年的治疗,免疫治疗组患儿的症状评分[(4±0.50)分]和药物评分[(0.35±0.04)分]较治疗前症状评分[(10±1.0)分]及药物评分[(0.76±0.08)分]均明显减少且差异具有统计学意义(Z值分别为-4.65、-4.43,P值均<0.01);与药物治疗组症状评分[(7±0.5 0)分]和药物评分[(0.7 2±0.0 5)分]比较,差异具有统计学意义(U值分别为1 4 3.0 0、1 3 8.5 0,P值均<0.0 1)。总LgE无明显变化,螨特异性LgE水平明显下降,免疫治疗组患儿血清中IL-1 0的水平明显升高(U=5.00,P<0.01)。结论标准化尘螨变应原疫苗舌下免疫治疗能够有效改善变应性鼻炎患儿的症状,减少药物使用,细胞因子IL-10的增高可作为预测舌下免疫治疗疗效的免疫学参考指标。     

标准化屋尘螨变应原特异性免疫治疗变应性鼻炎的疗效评估

目的：探讨标准化屋尘螨变应原特异性免疫治疗（SIT）变应性鼻炎（AR）的临床疗效。方法：将对屋尘螨过敏的102例AR患者随机分为2组,每组51例。SIT组：对症治疗基础上加用3年标准化屋尘螨变应原SIT;对症治疗组（ST组）：仅对症治疗。评价疗效指标包括：鼻炎症状评分、用药评分、皮肤反应指数、血清特异性IgE（sIgE）、外周血嗜酸粒细胞（Eos）计数,AR发展成哮喘和出现新的致敏原的比例。结果：SIT组经3年治疗后,患者血清Eos计数、皮肤反应指数、症状及药物评分均较ST组明显降低（均P〈0.01）;SIT后slgE有所下降,但差异无统计学意义。SIT组无AR患者发展为哮喘,2.1%出现新的致敏原;ST组17.4%的患者发展为哮喘,32.6%出现新的致敏原。治疗过程中未发生严重不良反应。结论：坚持长期SIT对螨致敏的AR安全有效,同时能减少新的过敏发生,阻止AR发展为哮喘。     

Die (ausschließlich) lokale IgE-Produktion in der Nasenschleimhaut

Background

IgE production at the site of the nasal mucosa without systemic allergic sensitization in skin tests or in serum represents so-called “local allergic rhinitis (LAR)” as a subgroup of patients with symptoms of allergic rhinitis (AR). Formerly, in case of negative allergological test results, seasonal (intermittent) or perennial (persistent) allergic symptoms have been diagnosed as “non-allergic rhinitis” (NAR). However, there is evidence for specific Th2 cytokine, tryptase, and ECP (eosinophil catonic protein) production in the nasal secretion after allergen exposure in these patients without systemic sensitization.

Diagnosis

Taking this into account, we recommend performing an allergen-specific nasal challenge and measuring the (local) nasal IgE-levels in addition to standard allergy tests in clinical routine in this subgroup of patients. These tests should be perfomed while or shortly after allergen exposure. In addition, an update of the allergy testing should be performed after a time interval since it has been demonstrated that patients formerly diagnosed with NAR may develop LAR or AR, or patients with LAR may develop AR in the future.

Treatment

The pharmacological therapeutic options in LAR are in line with the treatment of AR. If and to what extent this subgroup of AR patients benefit from allergen-specific immunotherapy (SIT) is currently being evaluated in clinical trials.     

Analysis of the efficacy of specific immunotherapy with house-dust mite extracts in adults with allergic rhinitis and/or asthma

BACKGROUND: Allergen specific immunotherapy and allergen reduction are the only therapies in perennial allergic diseases to reduce symptoms in the long term. Specific immunotherapy has the potential to reduce symptoms and the need for medication significantly and furthermore to prevent progression into more severe disease e. g. asthma. METHODS: The clinical value of specific immunotherapy has been studied for the last 30 years. We undertook an analysis of clinical trials of subcutaneous specific immunotherapy with Der p or Der f in adults to assess the efficacy of this controversial form of allergy treatment. RESULTS: A computerized bibliographic search revealed 13 randomised double-blind, placebo-controlled trials of specific immunotherapy with Der p/Der f for rhinitis and/or asthma in adults since 1970. The results extracted included patients symptoms, medication requirements, lung function, specific challenge-tests as titrated nasal, conjunctival or bronchial challenge test and side effects. For studies with continuous outcomes as symptom score and medication score the effect size was obtained by the difference in the scores between the active therapy and the placebo groups. For studies with categorical outcomes as increase or decrease in challenge-tests the results were expressed as odds ratios for improvement against no change and 95 % confidence intervals were calculated. DISCUSSION: Focused on the studies after 1980 there was a significant improvement on symptom score and medication score in the actively treated group compared to the placebo group, while the lung function was not significantly altered. Allergen provocation tests reflect the sensitivity of the shock organ. As the documentation of the clinical effects measured by challenge tests shows a highly significant improvement in the actively treated group, we recommend allergen provocation tests as a useful and sensitive parameter during specific immunotherapy. The risk of life-threatening side effects is low, although severe anaphylactic reactions may be induced. Specific immunotherapy using a standardized house-dust mite extract is effective and safe in adults when administered under optimal conditions.     

House dust mite-specific IgE, IgG1, and IgG4 antibodies in patients with perennial rhinitis

Serum samples were obtained from patients with house dust mite-sensitive nasal allergies before and 6 months after immunotherapy, and the level of immunoglobulin (Ig)E, IgG1, and IgG4 antibodies in those sera was determined by the enzyme-linked immunosorbent assay. The present data showed that the mite-specific IgG4 antibodies increased in patients who responded well to immunotherapy but not in those who responded poorly. It was suggested from the present study that IgG4 antibodies seem to act as "blocking antibodies" to reduce the allergic reaction in the target organ, and that an increase of allergen-specific IgG4 antibodies following immunotherapy can be of clinical benefit to patients suffering from mite-specific nasal allergy.     

变应性鼻炎患者10030例吸人性变应原谱分析

目的 调查不同年龄和性别的10 030例变应性鼻炎(allergic rhinitis,AR)患者的吸入性变应原谱分布情况.方法 采用21组共43种标准化变应原对54 813例慢性鼻炎患者进行皮肤点刺试验,诊断AR 10 030例,男性和女性均按年龄(以周岁记)分为4组,分别是:3～17岁、18～39岁、40 ～59岁以及≥60岁组(共8组),分析各组患者变应原分布状况.结果 ①不同年龄组患者对不同变应原反应呈阳性的例数分析显示,男性占前4位的变应原依次为粉尘螨、屋尘螨、艾蒿、德国小蠊,女性依次为粉尘螨、屋尘螨、艾蒿和藜.②患者阳性变应原个数的分布显示,不同年龄男性和女性患者,双重变应原阳性均位列首位,其次是三重变应原阳性或单一变应原阳性.③单一阳性变应原分析显示,男性3 ～17岁患者前4位是粉尘螨、屋尘螨、交链孢霉菌、艾蒿,其余年龄组男性患者阳性变应原前4位均是粉尘螨、屋尘螨、艾蒿和德国小蠊;女性3～17岁患者阳性变应原前4位是粉尘螨、屋尘螨、艾蒿和交链孢霉菌,18 ～39岁组是粉尘螨、屋尘螨、艾蒿和蒲公英,40～59岁组是粉尘螨、屋尘螨、艾蒿和混合树1,≥60岁患者前4位变应原是粉尘螨、屋尘螨、混合动物毛和艾蒿.④不同年龄和性别患者双重阳性变应原占首位的均是粉尘螨+屋尘螨.在3 ～17岁的患者中,对交链孢霉菌的双重阳性患者例数排在粉尘螨+屋尘螨之后,高于其他变应原组合.18岁以上的患者,交链孢霉菌双重阳性患者比例下降,而花粉类变应原、德国小蠊、粉尘螨或屋尘螨的双重阳性率上升.⑤不同性别患者三重阳性变应原居首位的是粉尘螨+屋尘螨+德国小蠊,其次是粉尘螨+屋尘螨+混合动物毛和粉尘螨+屋尘螨+艾蒿,其余组合少见.结论 尘螨、夏秋花粉及杂草花粉、交链孢霉菌和德国小蠊是导致我国北方地区AR的主要变应原,不同性别和年龄阶段的患者,致病变应原有所不同.