特应性皮炎儿童生活质量调查

目的：特应性皮炎常造成儿童行为、情感、心理发育等方面的异常。本研究旨在调查特应性皮炎幼儿的生活质量。方法：应用儿童特应性皮炎影响量表 (Childhood Atopic Dermatitis Impact Scale,CADIS)调查问卷进行生活质量调查, 并用特应性皮炎评分量表(SCORing Atopic Dermatitis,SCOARD)对特应性皮炎患儿进行临床症状评估。结果：患儿SCORAD评分为56.9±11.1;CADIS评分为38.0±7.9。CADIS与SCORAD存在显著正相关(ρ=0.934,P＜0.05), 其中,与受累面积(ρ=0.581,P＜0.01)、红斑(ρ=0.417,P＜0.01)、糜烂(ρ=0.579,P＜0.01)、水肿丘疹(ρ=0.595,P＜0.01)、渗出结痂(ρ=0.436,P＜0.01)、皮肤干燥(ρ=0.343,P＜0.01)、瘙痒和睡眠减少(ρ=0.0.344,P＜0.05)关系密切。结论：特应性皮炎对患儿生活质量有显著影响, 随着疾病严重程度升高,生活质量逐渐下降。［中国当代儿科杂志,2010,12（5）：351-353］     

特应性皮炎患儿食物致敏危险因素分析:一项单中心横断面研究北大核心CSCD

目的分析特应性皮炎(atopic dermatitis,AD)患儿食物致敏的危险因素,以及食物致敏对生活质量及临床体征的影响。方法回顾性收集241例AD患儿人口学特征、发病年龄、病情严重度、生活质量、体格检查、食物过敏原检查、血清总IgE和嗜酸性粒细胞计数等资料。根据过敏原检测结果分为食物致敏组(n=127)和无食物致敏组(n=114)。采用多因素logistic回归分析评估AD患儿食物致敏的危险因素。结果AD患儿食物致敏率为52.7%(127/241)。多因素logistic回归分析显示食物致敏危险因素为:秋季/冬季出生、AD发病年龄<12个月、重度AD、总IgE>150 IU/mL(P<0.05)。与无食物致敏组比较,食物致敏组生活质量较差(P=0.008),非特异性手足皮炎及掌纹症发生率较高(P<0.05)。与单种食物致敏组相比,多种食物致敏组AD病情较重,纯母乳喂养及总IgE>150 IU/mL者占比较高(P<0.05)。结论秋季/冬季出生、AD发病年龄<12个月、严重AD,或总IgE>150 IU/mL的AD患儿更易发生食物致敏。食物致敏AD患儿生活质量更差,更易出现非特异性手足皮炎及掌纹症。[中国当代儿科杂志,2022,24(8):887-893]     

The C−159T polymorphism in the CD14 promoter is associated with serum total IgE concentration in atopic Chinese children

Activation of macrophages through CD14 by microbes is crucial in inducing immunity by type 1 T helper cells. A C-to-T polymorphism at position −159 of CD14 was associated with serum total IgE level in Caucasians but not in Japanese subjects. The objective of this study is to determine whether this polymorphic marker is associated with atopy and asthma phenotypes in Chinese children. Restriction fragment length polymorphism was used to characterize CD14/−159 genotypes. Microparticle immunoassay was used to measure serum total IgE level; fluorescent enzyme immunoassay was performed to measure serum concentrations of specific IgE to aeroallergens; and enzyme-linked immunosorbent assay was used to measure serum levels of soluble CD14 (sCD14). Lung function in asthmatics was assessed by spirometry. Two hundred and fifty-eight patients and 92 control children were recruited. Their mean serum total IgE concentrations were 331 and 74 kIU/l, respectively (p < 0.0001). Atopy, defined as the presence of at least one allergen-specific IgE in serum, was found in 220 (85%) patients and in 41 (45%) controls (p < 0.0001). Serum sCD14 levels were significantly associated with CD14/−159 genotypes (p = 0.004). Atopic subjects with CC genotype in CD14/−159 had the highest serum total IgE levels compared with CT and TT genotypes, with the respective mean values being 661, 427 and 380 kIU/l (p = 0.015). Similarly, a higher proportion of subjects with CC genotype had increased serum total IgE concentration (p = 0.039). This polymorphic marker was not associated with asthma or aeroallergen sensitization in our cohort. Our results suggest that the C−159T of CD14 was associated with serum total IgE concentration in atopic Chinese children.     

Natural history of atopic dermatitis and its relationship to serum total immunoglobulin E in a population-based birth cohort study

We investigated the natural history of atopic dermatitis (AD) in a population-based birth cohort and assessed whether children at risk of visible eczema at 5 years of age can be identified from total immunoglobulin E (IgE) levels measured at 8, 12 and 18 months. AD data collected included a whole body examination for visible eczema at 49 months (4 years) and 61 months (5 years) of age and parent completed questionnaire data throughout their early lives. Children were divided into four groups based on their natural history of early AD: persistent (AD at 1, 6, 18, 30 and 42 months, n  = 34), intermittent early onset (before 18  months of age, n  = 495), intermittent late onset (18–42 months of age, n  = 273) and unaffected ( n  = 429). Visible eczema at 5 years of age was present in 12.2% (117/957) (95% confidence interval [CI] 10.1–14.3%) of the children. Levels of total IgE at 8, 12 and 18 months of age were associated with early onset of AD, but not with AD of later onset. For all four natural history groups, the geometric mean total IgE at 12 months was higher in those who subsequently had visible eczema than those who did not. However, the degree of overlap was such that total IgE at 12 months of age was a poor predictor of eczema at age five. A cutoff point of 78 kU/l had the highest positive predictive value for visible eczema at 5 years of age of 28.6%, with a sensitivity of 12% and specificity of 95%.     

血清特异性IgE和IgG检测在儿童特应性皮炎过敏原诊断中的应用

目的探讨血清特异性IgE和IgG检测在儿童特应性皮炎过敏原诊断中的应用和意义。方法对64例患特应性皮炎的儿童,采用酶联免疫方法检测血清中食物过敏原的特异性IgG,同时采用免疫印迹方法检测血清中食物过敏原和吸入性过敏原的特异性IgE。结果食物过敏原特异性IgG和特异性IgE的检测结果不一致(P<0.01),食物过敏原特异性IgG的总阳性率为93.75%,主要食物过敏原是牛奶和鸡蛋。食物过敏原特异性IgE的总阳性率为46.88%,主要食物过敏原是鸡蛋和鱼虾蟹。吸入性过敏原特异性IgE的总阳性率为34.38%,主要过敏原是尘螨和霉菌。在0～1岁的特应性皮炎患儿中,以食物过敏原特异性IgE阳性多见;1岁以上的患儿吸入性过敏原特异IgE阳性多见,同时合并呼吸道过敏症状增多(P均<0.05)。结论食物过敏原和吸入性过敏原均是引起儿童特应性皮炎的重要原因。联合测定食物过敏原的特异性IgE和特异性IgG是变态反应性皮肤病患儿诊断食物过敏原的有效方法。尽早采取有效的环境控制,对治疗儿童特应性皮炎和预防呼吸道过敏性疾病的发生非常重要。     

儿童特应性皮炎治疗前后生活质量的评估

目的评估儿童特应性皮炎(AD)患儿及其家庭生活质量,并探讨治疗后其生活质量的改善情况。方法应用婴儿皮炎生活质量指数(IDQOL)、儿童皮炎生活质量指数(CDLQI)和皮炎家庭生活影响指数(DFI)问卷,对109例AD患儿和55例正常对照儿童进行生活质量评估,并应用AD的严重程度评分(SCORAD)对疾病严重程度评估。间断外用糖皮质激素治疗3个月后观察疗效和生活质量改善情况。结果 IDQOL和CDLQI问卷显示影响患儿较大的3个问题均是"瘙痒或搔抓""情绪"和"睡眠";DFI问卷显示影响患儿看护人较大的3个问题是"睡眠""疲劳度"和"情绪"。SCORAD评分与IDQOL、CDLQI评分呈正相关(分别r=0.358、0.386;P0.05);在1~4岁患儿组SCORAD评分与DFI评分呈正相关(r=0.297,P0.05)。治疗后患儿SCORAD评分明显下降(P0.01),IDQOL/CDLQI及DFI评分均明显改善(P0.05)。结论 AD对患儿及其家庭的生活质量有明显影响;外用糖皮质激素可控制疾病并改善患儿其家庭的生活质量。     

Basophil Activation Test and specific IgE measurements using a panel of recombinant natural rubber latex allergens to determine the latex allergen sensitization profile in children

There are no documented studies that describe natural rubber latex (NRL) sensitization in children with a history of surgical intervention but without any congenital malformation (urogenital anomalies, spina bifida, etc.), although some authors have studied NRL allergy in children without a history of surgical intervention. The aim of this work was to evaluate the sensitization profile to single NRL allergens in children without spina bifida and without repeated surgical interventions, by using different recombinant and natural latex allergens in two analytical techniques: specific serum immunoglobulin E (IgE) quantification and flow cytometry determination of activated basophils expressing CD63, after stimulating cells from patients with NRL allergens. A total of 23 patients and 10 healthy children were selected. Conjunctival and in-use NRL provocation tests were carried out, as well as specific IgE determination in all patients' and controls' sera with the recombinant NRL allergens: rHev b 1, rHev b 2, rHev b 3, rHev b 5, rHev b 6.01, rHev b 6.02, rHev b 8, rHev b 9 and rHev b 11 and with NRL (k82) using appropriate ImmunoCAPs. The Basophil Activation Test (BAT) was performed with whole latex extract and with the recombinant allergens rHev b 5 and rHev b 6.01, as well as with the natural allergen Hev b 6.02. The sensitivity and the specificity of NRL-specific IgE (k82) were 100%. Positive IgE responses to rHev b 5 were found in sera of 10 children, to rHev b 6.01 in 16 and for rHev b 6.02 in 15 children's sera. Specific IgE to rHev b 8 was found in four sera of the children. We only found significant differences in sensitization to rHev b 5 in children with two or more surgical interventions compared with the non-intervened group or those with only one intervention. Specific IgE in sera of children with latex-fruit syndrome recognized rHev b 6.02, but not to rHev b 11. The patients sensitized to Hev b 8, Hev b 9 and/or Hev b 11 were atopic. The four patients presenting a positive response to the NRL profilin Hev b 8 were allergic to pollen. The BAT against whole NRL extract was positive in 22 of 23 children; against rHev b 5 in 14 of the patients studied; against rHev b 6.01 in seven cases and against nHev b 6.02 in 19 children. In all the control subjects, the results using this technique were negative. If combined rHev b 5, rHev b 6.01 and nHev b 6.02 together, BAT could detect 20 of the 23 children with latex allergy. The combined use of ImmunoCAP with all the recombinant NRL allergens and BAT with rHev b 5, rHev b 6.01 and nHev b 6.02, enabled the identification of NRL allergy in 22 of 23 patients. There is a positive and significant correlation between sensitization to Hev b 5 and the number of interventions. BAT and allergen-specific IgE determination could be used as first-line in vitro diagnostic tests in patients with NRL allergy.     

Comparison of fecal microflora in children with atopic eczema/dermatitis syndrome according to IgE sensitization to food

Atopic eczema/dermatitis syndrome (AEDS) commonly often arises during early infancy. In several intervention studies a beneficial influence on AEDS course of certain intestinal bacteria, administered as 'probiotics', has been described. To evaluate the possible role of the natural intestinal microflora in children with allergic eczema/dermatitis syndrome regarding immediate type hypersensitivity to food allergens, children with food allergy (AAEDS, n = 68) have been compared with children without detectable food allergy (NAEDS, n = 25). All children (n = 93) in preschool age, mean age of 2.6 (+/-1.8) years, diagnosed with AEDS who were treated as inpatients in 2003 in a dermatological hospital were included. The correlation between fecal microflora, parasites and specific immunoglobulin E (IgE) antibodies against common food allergens was analyzed. A similar composition of intestinal microflora in children with AAEDS and NAAEDS was found. The food allergens that were most frequently detected were egg white, cow milk, casein, peanut and hazelnut. Furthermore, a significant association between IgE sensitization against important food allergens and components of the fecal microflora could not be demonstrated. With aging changes occur in the intestinal microbiota [Proteus/Klebsiella and age (rho = -0.607) and Enterococcus and age (rho = -0.428)]. In two subjects of the AAEDS group Blastocystis hominis was found. The composition of natural intestinal microflora in children with AAEDS and NAAEDS was similar. Hence, there is no evidence of a role of the intestinal microflora with regard to the development of infant (food) allergy in children with AEDS. The possible consequences for allergic diseases later in life require further investigation.     

Cord serum immunoglobulin E as a risk factor for allergic symptoms and sensitization in children and young adults

Early markers of atopic predisposition are needed for targeting allergy preventive measures to high-risk infants. An elevated cord serum immunoglobulin E (CS-IgE) level is considered a risk factor for subsequent allergy in childhood. However, the previous studies have not assessed the predictive value of CS-IgE in a follow-up extended to adulthood. We aimed at clarifying whether CS-IgE is useful in predicting subsequent atopic manifestations up to age 20 yr. A cohort of 200 unselected, full-term newborns were prospectively followed up from birth to age 20 yr. The CS-IgE level was successfully measured in 190 subjects at birth. The subjects were re-examined at ages of 5, 11 and 20 yr with assessment of the occurrence of allergic symptoms during the preceding year, skin prick testing and measurement of serum total IgE. An elevated CS-IgE level was associated with allergic symptoms and skin prick test positivity at age 5 yr (p = 0.03 and 0.01), with allergic rhinoconjunctivitis at age 20 yr (p = 0.04) and with an elevated serum total IgE at ages of 11 and 20 yr (p = 0.02 and 0.01). The sensitivity of CS-IgE, i.e. the probability of an elevated CS-IgE in an infant who subsequently develops atopy, in predicting skin prick test-verified atopy at ages of 5 and 20 yr was 50% and 26%, respectively. The combination of elevated CS-IgE and positive family history of allergy was strongly associated with subsequent atopic manifestations. Nevertheless, it showed a reduced sensitivity as compared to CS-IgE or family history of allergy. We conclude that an elevated CS-IgE level predicts subsequent atopy up to age 20 yr.     

哮喘发作患儿CD30分子表达及与Th2源细胞因子和血浆免疫球蛋白E水平的相关性研究

目的　探讨CD3 0 在哮喘发病中的作用。方法　随机选择哮喘急性发作期患儿 2 7例 ,急性上呼吸道感染 (上感 )患儿 16例 ,对照组 19例。采用直接免疫荧光流式细胞术检测外周血单核细胞 (PBMC)中CD4 细胞表达CD3 0 百分率 ,采用ELISA法检测培养上清IL 4、IL 13及血浆IgE水平。 结果　 1.哮喘患儿PBMC中CD4 细胞表达CD3 0 百分率较对照组和上感组明显增高 ,差异有显著性 (P均 <0 .0 5) ;2 .哮喘患儿PBMC培养上清IL 4、IL 13和血浆总IgE水平均较对照组和上感组增高 ,上感组血浆IgE水平亦较对照组增高 ,差异均有显著性 ;3 .哮喘组CD4 细胞表达CD3 0 百分率与培养上清IL 4、IL 13和血浆IgE水平呈显著正相关。 结论　分泌IL 4和IL 13的Th2类细胞活化、增殖的克隆可能主要是由CD3 0 阳性细胞克隆组成 ,Th2细胞表面CD3 0 与CD3 0 L结合后导致Th2细胞分化成熟及释放Th2源细胞因子 ,IL 4和IL 13增加可诱导B细胞分泌较多的IgE。说明CD3 0 信号传导在哮喘发生发展过程中起重要作用     

Association of early growth response-1 gene polymorphisms with total IgE and atopy in asthmatic children

Early growth response-1 ( Egr-1 ) is expressed in human airways and found to modulate tumor necrosis factor, immunoglobulin E (IgE), airway responsiveness, and interleukin-13-induced inflammation in mice. We investigated the effects of Chinese-tagging single nucleotide polymorphisms (SNPs) of Egr-1 on asthma traits in 298 Chinese asthmatic children and 175 controls, and a replication community cohort of 191 controls. Tag SNP (−4071 A→G) and three additional SNPs (−1427 C→T, −151 C→T and IVS1 −42 C→T) were genotyped by restriction fragment length polymorphism (RFLP). Significant associations were found between plasma total IgE concentration and −4071 A→G (p = 0.008) and IVS1 −42 C→T (p = 0.027) in asthmatic patients. After Bonferroni correction, only −4071 A→G showed significant association. Multivariate regression analysis confirmed this significant association with a standardized coefficient β of 0.156 (95% CI: 0.046–0.317; p = 0.009) in asthmatics among the three SNPs with age and gender-adjusted. In −4071 A→G, IgE_log was significantly higher in patients with the GG genotype than the AA genotype (p = 0.009). In addition, −4071 A→G was significantly associated with atopy (p = 0.016) and high total IgE concentration (p = 0.030) among asthmatics. Patients with the G allele had a 3.5-fold risk of having atopy and a 2.0-fold risk of having high total IgE concentration than those homozygous for the A allele. This is the first report to show significant association of Egr-1 polymorphisms with plasma total IgE and atopy in asthmatics. It may help to explore the pharmacogenetics of Egr-1 inhibitors.     

血清Eotaxin、IL-13及总IgE在支气管哮喘患儿中的表达及意义

目的 探讨支气管哮喘(哮喘)患儿Eotaxin、IL-13及总IgE在哮喘发病中的作用及其相互关系.方法 选择30例哮喘儿童及22例健康儿童为研究对象,酶联免疫吸附法检测血清Eotaxin、IL-13,荧光酶联免疫法检测总IgE水平.哮喘息儿同时做肺功能检测.结果 (1)哮喘患儿急性发作期与临床缓解期肺功能各项指标比较...     

Effect of probiotics on gastrointestinal symptoms and small intestinal permeability in children with atopic dermatitis

OBJECTIVE: To determine whether probiotic lactobacilli may alleviate small intestinal inflammation and strengthen the intestinal barrier function in children with atopic dermatitis. STUDY DESIGN: In a double-blinded, placebo-controlled, cross-over study, probiotic lactobacilli (Lactobacillus rhamnosus 19070-2 and L reuteri DSM 12246) were administered for 6 weeks to 41 children with moderate and severe atopic dermatitis. Gastrointestinal symptoms were registered before and during treatment and small intestinal permeability was measured by the lactulose-mannitol test. RESULTS: During Lactobacillus supplementation, there was a significant decrease in the frequency of gastrointestinal symptoms (39% during the placebo period versus 10% during active treatment, P=.002). There was a positive association between the lactulose to mannitol ratio and the severity of the eczema (r=0.61, P=.02 after placebo and r=0.53, P=.05 after active treatment). After probiotic treatment, the lactulose to mannitol ratio was lower (0.073) than after placebo (0.110, P=.001). CONCLUSIONS: Impairment of the intestinal mucosal barrier appears to be involved in the pathogenesis of atopic dermatitis. The study suggests that probiotic supplementation may stabilize the intestinal barrier function and decrease gastrointestinal symptoms in children with atopic dermatitis.     

IL-13鳞状细胞癌抗原及IgE在儿童咳嗽变异性哮喘中的检测价值

目的　咳嗽变异性哮喘是一种与白细胞介素 13(IL 13)相关的以气道炎症为特征的疾病。研究表明 ,IL 13所诱导的基因中鳞状细胞癌抗原 (SccAg)表达最多 ,因此推测SccAg在咳嗽变异性哮喘中的发病中也起重要作用。本文旨在评价IL 13、SccAg及免疫球蛋白E(IgE)在咳嗽变异性哮喘患儿中的检测价值。 方法　用酶联免疫吸附试验 (ELISA)法检测 5 1例咳嗽变异性哮喘患儿、2 6例哮喘患儿、33例正常儿童血清IL 13、SccAg及IgE水平 ,并对结果进行统计学处理。 结果　①咳嗽变异性哮喘患儿发作期血清IL 13(2 38.88± 4 0 .0 7ng/L)、SccAg (2 .81± 0 .38ng/ml)水平显著高于缓解期 (85 .15± 17.98ng/L,2 .2 9± 0 .31ng/ml)及正常对照组 (77.2 7±18.16ng/L,2 .2 9± 0 .34ng/ml) (均P <0 .0 1) ,但缓解期及正常对照组间差异无显著性 ;②咳嗽变异性哮喘发作期患儿血清IgE (6 2 2 .4 8± 2 95 .0 1KU/L)水平显著高于缓解期 (373.81± 15 7.92KU/L) ,两组均显著高于正常对照组 (10 2 .99± 38.81KU/L) (均P <0 .0 1) ;③咳嗽变异性哮喘患儿发作期血清IL 13、SccAg及IgE水平与哮喘患儿发作期 (2 6 3.12± 4 9.99ng/L ,3.0 1± 0 .37ng/ml,717.0 4± 314 .0 1KU/L)间差异无显著性。结论　联合检测血清IL 13、SccAg及IgE水     

Allergy,total serum immunoglobulin E,and airflow in children and adolescents in TENOR

Haselkorn T, Szefler SJ, Simons FER, Zeiger RS, Mink DR, Chipps BE, Borish L, Wong DA, for the TENOR Study Group. Allergy, total serum immunoglobulin E, and airflow in children and adolescents in TENOR.
Pediatr Allergy Immunol 2010: 21: 1157–1165.
© 2010 John Wiley & Sons A/S In children and adolescents with difficult‐to‐treat asthma, few data exist characterizing the relationships between basic patient characteristics (e.g., age, sex) and atopic indicators in asthma. These associations were examined in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR), an observational study of a large cohort of patients with severe or difficult‐to‐treat asthma. To characterize allergy patterns and the relationship between total serum immunoglobulin E (IgE) and airflow in young patients with severe or difficult‐to‐treat asthma. A total of 1261 patients from the TENOR study were stratified into four age groups at baseline (6–8, 9–11, 12–14, and 15–17 yr). The objective was to characterize allergy patterns and the relationship between total serum immunoglobulin E (IgE) and ratio of pre‐bronchodilator forced expiratory volume in 1 second to forced vital capacity (FEV₁/FVC) in young patients with severe or difficult‐to‐treat asthma. The chi‐square test for categorical variables and analysis of variance for continuous variables were used to identify significant differences among age groups. Multivariable linear regression was used to evaluate the association between IgE and FEV₁/FVC. Allergic rhinitis was reported in approximately two‐thirds of patients. Up to 25% of patients had atopic dermatitis, which differed across age groups in boys (p < 0.05). Positive allergen skin test rate differed across age groups in boys (p < 0.05). Rates of asthma triggers were higher and differed across age groups in girls (p < 0.05), particularly around menarche (12–14 yr). IgE levels were higher in boys and differed across age groups in boys (p < 0.01) and girls (p < 0.05). IgE was associated with a lower FEV₁/FVC after adjusting for age and sex (p < 0.01). Severe or difficult‐to‐treat asthma in children and adolescents is characterized by high frequencies of comorbid allergic diseases, allergen sensitization, and high IgE levels. This burden is amplified by the association of more airflow limitation with higher IgE levels, suggesting the need for allergy evaluations.