儿童变态反应性疾病

儿童变态反应性疾病的发病率近年来明显升高,严重影响儿童的生活质量。儿童变态反应性疾病的发病机制主要与遗传因素、妊娠环境、出生后的环境以及呼吸道感染等因素相关,临床主要表现为湿疹、变应性鼻炎、变应性结膜炎、变应性哮喘及变应性胃肠炎。治疗应重视早期干预、避免接触变应原,选择合适的药物治疗以及变应原特异性免疫治疗。     

标准化变应原皮肤试验与哮喘儿童年龄的关系

目的 探讨标准化变应原皮肤试验结果与哮喘儿童年龄的关系,为避免接触变应原及进行早期特异性免疫治疗提供参考依据.方法 对重庆医科大学附属儿童医院哮喘门诊2005年6月-2007年1月收治的913例哮喘患儿采用欧州丹麦ALK-ABELLO公司提供的13种标准化变应原皮肤点刺液进行试验,以变应原及组胺所致风团直径比判定其反应级别.分析各变应原的阳性率、皮肤指数(SI)、变应性哮喘的危险因素及各年龄组变应原SI和阳性项数.采用SAS 8.2软件进行统计学分析.结果 粉尘螨、屋尘螨和热带螨阳性率和SI分别居前3位.年龄是变应性哮喘的危险因素,其OR值为1.16,95%Cl为1.09～1.24.>5岁哮喘儿童变应原SI显著高于≤5岁哮喘儿童(Z=5.68 P<0.01).2～8岁组哮喘患儿,无论变应原SI还是阳性项数都逐渐增加,其中>5～8岁组哮喘患儿变应原SI和阳性项数水平高且增长快,>8～10岁为高峰平台期,10岁后则呈下降趋势.结论 年龄是变应性哮喘的危险因素.>5岁哮喘患儿的变应原SI显著高于≤5岁哮喘患儿.>5～8岁为变应性哮喘患儿特异性免疫治疗的最佳年龄期.应抓住这个特异性免疫治疗的窗口年龄期,尽早进行特异性免疫治疗.     

变应原特异性免疫治疗

变应原特异性免疫治疗是唯一可以改变变态反应性疾病进程的治疗方法,随着近年来变应原制剂质量及标准化程度的提高,使其不良反应更小、更适合临床应用.由于儿童患者正处于生长发育期,其免疫系统发育尚未完全,是接受变应原特异性免疫治疗的最佳时期,治疗效果较成人好.皮下注射的变应原特异性免疫治疗经多年的实践和研究,疗效公认;而目前已逐渐成熟的舌下脱敏治疗和皮下注射脱敏治疗的疗效一样,并得到儿童的喜爱.寻找到引起患者临床症状的主要变应原,用该抗原进行脱敏治疗方可达到预期的治疗目的.     

变应性疾病患儿皮肤变应原试验与血清尘螨特异性IgE及IgG4水平的关系

目的探讨变应性疾病(包括支气管哮喘和变应性鼻炎)患儿常见的变应原与血清尘螨特异性IgE(sIgE)和IgG4水平的关系。方法对310例4～13岁变应性疾病儿童进行12种常见变应原皮肤点刺试验,同期采用夹心ELISA方法检测血清尘螨sIgE和IgG4水平。采用SPSS13.0软件进行统计学分析。结果变应性疾病儿童皮肤变应原检测阳性100%(310/310例),≥3种变应原阳性者占35.8%(111/310例)。引起变应性疾病的变应原主要为吸入物,阳性率最高的变应原是粉尘螨。变应性疾病儿童血清尘螨sIgE和IgG4水平明显高于健康对照组(t=14.253、12.314,Pa<0.01)。血清尘螨sIgE水平与皮肤变应原试验阳性种类的多少无相关性(r=-0.004 3,P>0.05);粉尘螨变应原阳性强度与血清尘螨sIgE水平呈正相关(r=0.219 8,P<0.05);血清尘螨sIgE水平与IgG4水平呈一定正相关(r=0.173 0,P<0.05)。结论变应原皮肤点刺试验有助于发现变应性疾病儿童的变应原及了解机体免疫状态强度,提供应尽可能避免接触的变应原,有条件者可进行脱敏治疗。监测血清sIgE和IgG4水平对...     

特异性免疫治疗新进展

特异性免疫治疗(SIT)作为目前唯一可能根治变应性疾病的治疗方法,不仅可以减轻过敏症状,减少用药,还可阻止自然病程的进展,预防新变应原的产生.近年来舌下SIT因其良好的安全性、有效性和易操作性已在欧洲各国广泛开展.标准化的变应原制剂在国内外逐步应用,已取代非标准化制剂.然而无论是皮下注射还是舌下含服方法,其具体有效剂量、治疗方案、治疗疗程尚待规范统一.随着对其作用机制的不断深入研究,以及以重组变应原为主的新制剂的研发,SIT的应用范围将会进一步扩大,更好地用于变应性疾病的治疗.     

标准化屋尘螨变应原特异性免疫治疗对儿童变应性鼻炎合并哮喘的临床疗效

目的 评估标准化屋尘螨变应原特异性免疫治疗(specific immunotherapy,SIT)对儿童变应性鼻炎合并哮喘的临床疗效.方法 选择我院42例接受标准化屋尘螨SIT的变应性鼻炎合并哮喘儿童为研究对象.所有患儿治疗前、治疗1年后均进行变应原皮肤点刺试验、测定血清屋尘螨和粉尘螨特异性IgE水平、进行肺功能测定和自觉症状评分.结果 治疗1年后屋尘螨和粉尘螨的皮肤指数和自觉症状评分均较治疗前显著降低(P＜0.01,P＜0.05),而治疗前后屋尘螨和粉尘螨特异性IgE水平、肺功能(肺活量、第1秒用力呼气量、最大呼气中段流量)均无明显变化(P＞0.05).结论 变应性鼻炎合并哮喘儿童给予SIT1年后其皮肤敏感性显著改善,临床症状明显好转,但对气道炎症的影响有待于进一步的观察.     

儿童过敏性疾病免疫治疗新进展

变应原特异性免疫治疗（AIT）属主动免疫疗法,能调节固有免疫和适应性免疫。变应性鼻结膜炎、哮喘的AIT新途径为淋巴结内免疫治疗和表皮内免疫治疗,但有效性及标准方案仍需进一步研究。低变应原性的重组变应原衍生物和具有免疫原性的肽段,联合新佐剂均是新的AIT研究方向。食物过敏口服免疫治疗具有一定疗效,但不良反应尤其是严重过敏反应的风险仍是需要解决的问题。近年来,被动免疫疗法应用于过敏领域的进展迅速,多种单克隆抗体生物制剂在传统治疗控制不佳的哮喘、特应性皮炎中有着较好效果,AIT联合生物制剂治疗提供了新的治疗选择。     

标准化特异性免疫治疗儿童变应性鼻炎并发支气管哮喘的临床疗效评价

目的 评价标准化特异性免疫治疗儿童变应性鼻炎并发支气管哮喘的临床疗效.方法 选择70例变应性鼻炎并发支气管哮喘的儿童,根据知情自愿的原则,分为对照组(n=40)和观察组(n=30),对照组给予药物治疗,观察组在药物治疗基础上给予标准化特异性免疫治疗,治疗18个月后比较两组患儿肺功能指标及变应性鼻炎评分,并统计观察组治疗期间出现的不良反应情况.结果 治疗18个月后,观察组患儿FEV1、FEV1/FVC、FVC、PEF及变应性鼻炎症状评分与体征评分均显著优于对照组,差异有统计学意义(P＜0.05);观察组治疗后不良反应发生率低且较轻微.结论 标准化特异性免疫治疗儿童变应性鼻炎并发支气管哮喘临床疗效明显,可改善患儿预后,且安全可靠,值得广泛开展.     

广州市儿童变应性疾病流行病学调查分析

目的 了解广州市城区儿童支气管哮喘(哮喘)、变应性鼻炎及湿疹等变应性疾病的流行状况,为今后儿童变应性疾病防治工作提供科学依据.方法 采用多阶抽样的方法抽取广州市社区0～14岁儿童4072名,通过变应性疾病国际通用的International Study of Asthma and Athergies in Childhood( ISAAC)调查书面问卷的核心问卷对儿童哮喘、变应性鼻炎及湿疹等变应性疾病患病情况进行调查,了解儿童变应性疾病的患病情况.采用SPSS 13.0软件进行统计学分析.结果 儿童哮喘患病率为2.09％,男女患病率之比为1.59:1.00,其中2～6岁儿童患病率最高,首次发作年龄＜3岁者占60.00％.变应性鼻炎患病率为7.83％,3岁后逐渐上升,以6～9岁儿童发病率较高.儿童湿疹患病率为7.22％,且随年龄增加逐渐降低.哮喘并变应性鼻炎占34.83％,并湿疹占19.10％.结论 广州市社区儿童变应性疾病患病率呈上升趋势.     

北京地区学龄儿童变应性鼻炎相关因素分析

目的 了解北京城区学龄儿童变应性鼻炎的主要变应原、伴发结膜炎的情况及其与气道高反应的关系.方法 2006年和2007年8-9月在首都儿科研究所耳鼻喉科门诊就诊的100例6～14岁的变应性鼻炎患儿为病例组,小学健康儿童(无变态反应性疾病)30名为正常对照组,进行问卷调查及吸入变应原皮肤点刺试验(skin prick test,SPT);随机选取病例组中53例鼻炎患儿和对照组30名儿童做乙酰甲胆碱气道激发试验(methacholine bronchial provocation test,Mth BPT).结果 ①变应性鼻炎组中螨、霉菌、艾蒿、猫狗毛、夏秋季花粉、葎草SPT阳性率较高,分别为55%、39%、36%、34%、31%、27%、22%.②变应性鼻炎组中各年龄组螨SPT阳性率差异无统计学意义,而艾蒿和夏秋季花粉随年龄增加SPT阳性率明显增JJ玎(x2=7.51,6.29,P均＜0.05).③变应性鼻炎合并结膜炎患儿为65%.合并结膜炎组患儿变应原阳性数量高于单纯变应件鼻炎组,差异有统计学意义(t=3.06,P＜0.05).④变应性鼻炎症状越重,变应原阳性数幂越多(r=0.21,P=0.04),越可能合并变应件结膜炎(r=0.31,P=0.002).⑤变应性鼻炎组53例患儿乙酰甲且日碱气道激发试验阳性率为77%,正常对照组儿童为16.7%,两组差异有统计学意义(x2=28.56,P＜0.0001).变应性鼻炎组激发试验阳性的发生概率是正常对照组的17.08倍(95%可信区间5.38～54.26).结论 北京城区儿童8-9月变应性鼻炎就诊高峰和花粉变应原有关,其中艾蒿、夏秋季花粉和年龄有相关性.变应性鼻炎合并结膜炎发病率高,应注重结膜炎的诊断和治疗.变应性鼻炎儿童气道反应性增加,应对其积极治疗,减缓和预防哮喘的发生.     

EAACI guidelines on allergen immunotherapy: Prevention of allergy

Allergic diseases are common and frequently coexist. Allergen immunotherapy (AIT) is a disease‐modifying treatment for IgE‐mediated allergic disease with effects beyond cessation of AIT that may include important preventive effects. The European Academy of Allergy and Clinical Immunology (EAACI) has developed a clinical practice guideline to provide evidence‐based recommendations for AIT for the prevention of (i) development of allergic comorbidities in those with established allergic diseases, (ii) development of first allergic condition, and (iii) allergic sensitization. This guideline has been developed using the Appraisal of Guidelines for Research & Evaluation (AGREE II) framework, which involved a multidisciplinary expert working group, a systematic review of the underpinning evidence, and external peer‐review of draft recommendations. Our key recommendation is that a 3‐year course of subcutaneous or sublingual AIT can be recommended for children and adolescents with moderate‐to‐severe allergic rhinitis (AR) triggered by grass/birch pollen allergy to prevent asthma for up to 2 years post‐AIT in addition to its sustained effect on AR symptoms and medication. Some trial data even suggest a preventive effect on asthma symptoms and medication more than 2 years post‐AIT. We need more evidence concerning AIT for prevention in individuals with AR triggered by house dust mites or other allergens and for the prevention of allergic sensitization, the first allergic disease, or for the prevention of allergic comorbidities in those with other allergic conditions. Evidence for the preventive potential of AIT as disease‐modifying treatment exists but there is an urgent need for more high‐quality clinical trials.     

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。     

Eosinophilic gastrointestinal disorders and allergen immunotherapy: Lights and shadows

Allergic diseases, such as IgE-mediated food allergy, asthma, and allergic rhinitis, are relevant health problems worldwide and show an increasing prevalence. Therapies for food allergies are food avoidance and the prompt administration of intramuscular epinephrine in anaphylaxis occurring after accidental exposure. However, allergen immunotherapy (AIT) is being investigated as a new potential tool for treating severe food allergies. Effective oral immunotherapy (OIT) and epicutaneous immunotherapy (EPIT) induce desensitization and restore immune tolerance to the causal allergen. While immediate side effects are well known, the long-term effects of food AIT are still underestimated. In this regard, eosinophilic gastrointestinal disorders (EGIDs), mainly eosinophilic esophagitis, have been reported as putative complications of OIT for food allergy and sublingual immunotherapy (SLIT) for allergic asthma and rhinitis. Fortunately, these complications are usually reversible and the patient recovers after AIT discontinuation. This review summarizes current knowledge on the possible causative link between eosinophilic gastrointestinal disorders and AIT, highlighting recent evidence and controversies.     

Allergen specific sublingual immunotherapy in children with asthma and allergic rhinitis

Background

The incidence of asthma and allergic rhinitis (AR) is significantly increased, especially in younger children. Current treatment for children with asthma and allergic rhinitis include allergen avoidance, standard pharmacotherapy, and immunotherapy. Since standard pharmacotherapy is prescribed for symptoms, immunotherapy at present plays an important role in the treatment of allergic diseases. This article presents insights into the up-to-date understanding of immunotherapy in the treatment of children with allergic rhinitis and asthma.

Data sources

PubMed articles published from 1990 to 2014 were reviewed using the MeSH terms "asthma", "allergic rhinitis", "children", and "immune therapy". Additional articles were identified by hand searching of the references in the initial search.

Results

Numerous studies have shown that sublingual application of allergen specific immunotherapy (SLIT) is an adequate, safe and efficient substitution to subcutaneous route of allergens administration (SCIT) in the treatment of IgE-mediated respiratory tract allergies in children. According to the literature, better clinical efficacy is connected with the duration of treatment and mono sensitized patients.

Conclusions

At least 3 years of treatment and stable asthma before the immunotherapy are positive predictors of good clinical efficacy and tolerability of SLIT. SLIT reduces the symptoms of allergic diseases and the use of medicaments, and improves the quality of life of children with the diseases.

     

Clinical practice

Allergen-specific immunotherapy (SIT) in its various application forms represents the main treatment approach of IgE-mediated allergic diseases in adults and children. Despite this clear recommendation, many particularities of products, patient characteristics, and product availability in different countries hamper the use of allergen-specific immunotherapy in particular in children. The frequently asked questions by parents, patients, and physicians are the backbone of this review. Thus, the potentials and limitations of allergen-specific immunotherapy in children and adolescents will be highlighted. IgE-mediated allergic diseases are affecting about 20% of the population. They manifest commonly early in life, and hence, the use of SIT should be considered also early in the course of the disease.     

New visions in specific immunotherapy in children: an iPAC summary and future trends

Specific immunotherapy is indicated for confirmed immunoglobulin E-mediated airway diseases using standardized allergen products with documented clinical efficacy and safety. For decades the subcutaneous route of administration (SCIT) has been the gold standard. Recently, the sublingual immunotherapy (SLIT) has also been investigated in children. SCIT, especially with grass and birch pollens but also house dust mites, is an effective treatment in children with allergic rhinitis and asthma when a significant part of their symptoms are caused by these allergens. A long-term effect up to 12 yr after discontinuation of SCIT with timothy allergen has been shown. Efficacy and safety of SLIT in pollen allergic rhinoconjunctivitis have been demonstrated in adults. The evidence in children is a little less convincing, and more data is needed. The clinical relevance, long-term results and the size of the effect, as well as the dose, the treatment regimen and duration has not been sufficiently elaborated. It is demonstrated that SCIT has the potential for preventing the development of asthma in children with allergic rhinoconjunctivitis. Also one randomized study indicates a preventive effect of SLIT in children on the development of asthma. At present, there are no studies who clearly demonstrates either a long-term effect or a preventive effect on the development of asthma of SLIT in children. The areas with lack of evidence should be addressed in well performed prospective, randomized long-term studies both with SCIT and SLIT. This review was initiated by iPAC (international Pediatric Allergy and Asthma Consortium) and aims to review current knowledge related to specific immunotherapy in childhood, and to identify needs for future research in this field.     

Hyposensibilisierungstherapie bei allergischen Erkrankungen unter besonderer Berücksichtigung des atopischen Ekzems

According to modern concepts allergen immunotherapy influences the capacity of allergen specific T cells to react to allergen presentation. Subcutaneous immunotherapy with allergen extracts has been shown to be superior to placebo in the treatment of allergic rhinoconjunctivitis and allergic asthma. Because the treatment does not interfere with other antiinflammatory and symptomatic treatments of asthma and rhinoconjunctivitis it is an additional treatment option in children aged 5 years and older in whom allergen exposure is an important determinant of the course of the disease. As yet, there is no sufficient data to recommend allergen immunotherapy in the treatment of atopic eczema. However, allergen immunotherapy for rhinoconjunctivitis or asthma is not contraindicated if atopic eczema is present. If allergy to hymenoptera venom leads to life-threatening symptoms, specific immunotherapy is indicated absolutely even in children below the age of 5 years     

长期特异性免疫治疗对螨过敏儿童血清IgG4的影响

目的探讨长期特异性免疫治疗对螨过敏儿童血清IgG4的影响。方法对60例过敏性哮喘和(或)过敏性鼻炎的患儿,予屋尘螨特异性过敏原免疫治疗,在治疗前、治疗16周、治疗1年和治疗3年时分别进行血清IgG4检测。结果随着治疗的进行,螨特异性IgG4显著增高(F=83.91,P<0.001),各时间段差异均有统计学意义(P均<0.01),并且以治疗剂量递增过程患儿血中螨特异性IgG4含量增长最快,在三年治疗结束时血清IgG4值达到最高。结论螨特异性过敏原免疫治疗对患儿体内免疫状态有明显的调节作用,有利于改善螨过敏患儿的症状和体征。     

Demographic features and compliance of children with allergic diseases receiving sublingual immunotherapy北大核心CSCD

目的探讨标准化舌下免疫治疗(sublingual immunotherapy,SLIT)过敏性疾病患儿的人口学特征,并分析依从性的影响因素。方法纳入江西省儿童医院2018年1月1日—2020年12月31日接受SLIT的1789例过敏性疾病患儿为研究对象,回顾性分析患儿的人口学特征和随访资料,分析SLIT的依从性及其影响因素。结果共1789例SLIT患儿,其中男性1271例(71.05%),女性518例(28.95%),年龄4~14岁;完全依从777例(43.43%);脱落1012例(56.57%),因自觉使用不便脱落354例(34.98%),因疗效欠佳脱落346例(34.19%),因症状改善自行停用253例(25.00%),因不良反应停用的59例(5.83%)。脱落主要集中在开始治疗后1~4个月(74.31%,752/1012)。女性患儿依从率低于男性患儿,患单一疾病者依从率低于患多种疾病者(P<0.05)。多因素分析结果显示,与男性相比,女性发生脱落的风险增加(OR=0.811,95%CI:0.658~0.998,P<0.05);相对于患多种疾病者,患单一疾病者发生脱落的可能性增加(OR=1.313,95%CI:1.005~1.715,P<0.05)。结论过敏性疾病患儿SLIT依从性不理想,与患儿性别、所患疾病数量等特征有关;主要脱落原因为自觉使用不便和疗效欠佳。