变应原疫苗免疫治疗对过敏性支气管哮喘合并鼻炎的疗效分析

目的 评估标准化变应原疫苗免疫治疗(allergen immunotherapy,AIT)对过敏性哮喘合并鼻炎患者的近期疗效.方法设计调查问卷,对我院门诊接受标准化变应原疫苗-安脱达(Alutard(R)SQ)AIT治疗的39例过敏性哮喘合并鼻炎患者进行问卷调查,应用哮喘控制水平分级和哮喘控制测试(ACT)评分评价哮喘...     

广东惠州地区成人支气管哮喘合并过敏性鼻炎的流行病学调查分析

目的了解惠州地区支气管哮喘（简称哮喘）患者合并过敏性鼻炎的情况,分析两者在临床表现方面的相关性及调查对过敏性鼻炎认知程度和治疗现状。方法问卷调查惠州地区280例哮喘患者,详细了解其哮喘病史、严重程度分级、哮喘控制测试（asthma control test,ACT）评分、鼻炎情况包括患病情况、认知程度、相关家族遗传史及治疗现状等。建立相应个人数据档案,对数据进行统计学分析。结果 280例哮喘患者中,203例（72.50%）合并过敏性鼻炎,哮喘合并过敏性鼻炎组和单纯哮喘组在年龄、性别、病程间的差异无统计学意义（P〉0.05）。哮喘合并过敏性鼻炎组、二级（轻度持续）、三级（中度持续）、四级（重度持续）例数均高于单纯哮喘组（P〈0.05）。ACT评分,完全控制、良好控制例数均低于单纯哮喘组（P〈0.05）,未控制哮喘高于单纯哮喘组（P〈0.05）。鼻炎情况过敏性鼻炎起病早于哮喘占59.61%,两者同时起病占17.24%,鼻炎诱因依次为冷空气（82.10%）,刺激性气体（61.58%）,25.62%患者做过过敏原测验,56.65%使用药物治疗鼻炎,27.10%直系三代有哮喘或过敏性鼻炎家族史。结论惠州地区哮喘合并过敏性鼻炎发生率高,认知程度较低,治疗现状不容乐观,为今后防治措施及相关研究提供依据。     

舌下特异性免疫治疗对过敏性哮喘的临床疗效分析

目的探讨舌下特异性免疫治疗（SLIT）对过敏性哮喘的临床疗效。方法对57例舌下含服粉尘螨滴剂治疗的过敏性哮喘患者随访观察26周,比较患者治疗前后的症状评分、视觉模拟评分（VAS）、哮喘控制问卷（ACQ）评分、哮喘控制测试（ACT）评分、呼气峰值流速占正常预计值的百分比（PEF%）及对症治疗药物积分。结果治疗后患者日、夜间哮喘症状评分、VAS评分及对症治疗药物积分均明显降低（P〈0.05）;PEF%明显升高（P〈0.05）;ACQ评分及ACT评分均有显著改善（P〈0.05）。结论舌下特异性免疫治疗能明显改善过敏性哮喘患者的临床症状及患者自觉症状,减少患者用药量,提高患者的疾病控制水平和生活质量。     

广东惠州地区成人支气管哮喘合并过敏性鼻炎的流行病学调查分析

目的 了解惠州地区支气管哮喘(简称哮喘)患者合并过敏性鼻炎的情况,分析两者在临床表现方面的相关性及调查对过敏性鼻炎认知程度和治疗现状.方法 问卷凋查惠州地区280例哮喘患者,详细了解其哮喘病史、严重程度分级、哮喘控制测试(asthma control test,ACT)评分、鼻炎情况包括患病情况、认知程度、相关家族遗传史及治疗现状等.建立相应个人数据档案,对数据进行统计学分析.结果 280例哮喘患者中,203例(72.50％)合并过敏性鼻炎,哮喘合并过敏性鼻炎组和单纯哮喘组在年龄、性别、病程间的差异无统计学意义(P＞0.05).哮喘合并过敏性鼻炎组、二级(轻度持续)、三级(中度持续)、四级(重度持续)例数均高于单纯哮喘组(P＜0.05).ACT评分,完全控制、良好控制例数均低于单纯哮喘组(P＜0.05),未控制哮喘高于单纯哮喘组(P＜0.05).鼻炎情况过敏性鼻炎起病早于哮喘占59.61％,两者同时起病占17.24％,鼻炎诱因依次为冷空气(82.10％),刺激性气体(61.58％),25.62％患者做过过敏原测验,56.65％使用药物治疗鼻炎,27.10％直系三代有哮喘或过敏性鼻炎家族史.结论 惠州地区哮喘合并过敏性鼻炎发生率高,认知程度较低,治疗现状不容乐观,为今后防治措施及相关研究提供依据.     

变应性鼻炎对支气管哮喘患者临床控制和肺通气功能的影响

目的研究变应性鼻炎对支气管哮喘(简称哮喘)患者的临床控制和肺通气功能的影响。方法分析39例哮喘合并变应性鼻炎患者的变应性鼻炎视觉模拟量表(VAS)评分与哮喘控制测试(ACT)评分、哮喘控制问卷(ACQ)评分和肺通气功能之间的相关性。结果变应性鼻炎VAS评分与ACT评分呈负相关(r=-0.591,P0.05),与ACQ评分呈正相关(r=0.599,P0.05)。变应性鼻炎VAS评分与FEV1%pred、PEF%pred、FEF25%pred、FEF50%pred、FEF25%-75%pred均呈负相关(r=-0.473,-0.581,-0.591,-0.567,-0.494,P0.05)。结论在哮喘合并变应性鼻炎患者中,变应性鼻炎症状越重,哮喘控制越差,肺通气功能越低。     

变应性鼻炎对支气管哮喘患者临床控制和肺通气功能的影响

目的 研究变应性鼻炎对支气管哮喘(简称哮喘)患者的临床控制和肺通气功能的影响.方法 分析39例哮喘合并变应性鼻炎患者的变应性鼻炎视觉模拟量表(VAS)评分与哮喘控制测试(ACT)评分、哮喘控制问卷(ACQ)评分和肺通气功能之间的相关性.结果 变应性鼻炎VAS评分与ACT评分呈负相关(r=-0.591,P＜0.05),与ACQ评分呈正相关(r=0.599,P＜0.05).变应性鼻炎VAS评分与FEV1％pred、PEF％ pred、FEF25％ pred、FEF50％ pred、FEF25％75％ pred均呈负相关(r=-0.473,-0.581,-0.591,-0.567,-0.494,P＜0.05).结论 在哮喘合并变应性鼻炎患者中,变应性鼻炎症状越重,哮喘控制越差,肺通气功能越低.     

葎草花粉变应原免疫治疗疗效和安全性评估

目的回顾性评价单一葎草花粉变应原制剂治疗葎草花粉过敏性鼻炎伴发或不伴发过敏性哮喘的疗效和安全性。方法回顾近13年接受单一葎草花粉变应原免疫治疗(SIT)的葎草花粉过敏性鼻炎患者,比较SIT治疗前后过敏性鼻炎临床症状的严重程度,症状持续时间,治疗药物,总体自评和不良反应;对伴发过敏性哮喘患者比较SIT治疗前后发病季节哮喘控制测试(ACT)评分,治疗药物和总体自评。结果 40例葎草花粉过敏性鼻炎患者中7例(17.5%)伴发过敏性哮喘。过敏性哮喘患者的哮喘症状晚于鼻炎症状4(3,6)年出现,7例过敏性鼻炎伴过敏性哮喘患者中5例(71.4%)在鼻炎发病5年内发展伴发过敏性哮喘。SIT治疗前后,过敏性鼻炎症状总评分[10(9,11)vs.5(4,6)]、症状年累计时间[8(8,12)周vs.4(4,7)周]、药物积分[385(320,465)vs.125(69,200)]差异均有统计学意义(均P<0.001),85%总体自评为病情改善。2例患者发生全身不良反应,其中Ⅱ类和Ⅲ类各1例次。伴发过敏性哮喘的7例患者经SIT治疗,6例发病季节ACT评分由未控制改善为完全或良好控制,治疗前后哮喘药物积分[240(110,250)vs.25(0,70)]差异有统计学意义(P<0.05),所有患者总体自评均为明显改善。结论使用葎草花粉变应原单一制剂可有效、安全地治疗葎草花粉过敏性鼻炎伴发或不伴发过敏性哮喘。     

天津地区支气管哮喘合并过敏性鼻炎的流行病学调查及肺功能分析

目的 了解天津地区支气管哮喘(简称哮喘)合并过敏性鼻炎(allergic rhinitis,AR)的流行病学情况,分析两者之间的临床相关性及对肺功能的影响.方法 对天津地区142例哮喘患者进行哮喘合并过敏性鼻炎流行病学问卷调查及肺功能测定,了解患者的认知情况、治疗现状和肺功能状况,并建立相应的个人数据库档案,对数据进行统计学分析.结果 142例哮喘患者中,有97例合并过敏性鼻炎(68％),其中60例为鼻炎发病在先,占哮喘合并鼻炎患者的61.9％.哮喘合并鼻炎组和单纯哮喘组两组患者在性别、年龄和哮喘病史方面比较差异无统计学意义(P＞0.05),但哮喘合并鼻炎组的组间比较显示鼻炎史显著长于哮喘史,差异有统计学意义(P＜0.05).与单纯哮喘组相比,鼻炎合并哮喘组的哮喘控制测试(asthma control test,ACT)评分明显偏低,差异有统计学意义(P＜0.05).与单纯哮喘组相比,哮喘合并鼻炎组患者的呼气峰流速(peak expirationg flow,PEF)显著下降,吸入性糖皮质激素量减低,小气道敏感指标肺活量为75％时最大呼气流量(MEF75％)和MEF50％显著降低,而脉冲振荡频率在20 Hz时呼吸阻力(R20)增高.过敏性鼻炎与哮喘严重程度呈明显的正相关(rs=0.604,P＜0.01).结论 过敏性鼻炎多在哮喘之前发生,其与哮喘严重程度具有高度的一致性,是引发哮喘的一项重要危险因素.哮喘合并过敏性鼻炎患者的ACT评分显著低于单纯哮喘患者,并且过敏性鼻炎进一步导致了肺通气功能的下降及气道阻力增加,提高了哮喘的控制难度.     

呼出气一氧化氮检测对支气管哮喘患者激素治疗敏感性的预测价值

目的探讨呼出气一氧化氮（FeNO）检测对支气管哮喘（简称哮喘）激素治疗敏感性的预测价值。方法纳入我院门诊2012年4月至2013年3月的116例新发哮喘患者,行FENO检测、哮喘控制情况问卷（ACT）;根据FeNO水平进行分组,FeNO≥50ppb为高水平组（46例）、FeNO值在25～50ppb为中水平组（44例）、FeNO≤25ppb为低水平组（26例）,所有患者正规吸入糖皮质激素联合长效Bz受体激动剂,12周后复查FeNO及ACT评分。结果治疗前哮喘患者FeNO与ACT评分呈负相关（R=-0．455,P〈0．0001）,治疗后不相关（R=-0．171,P=0．066）;各水平组治疗前、后FENO变化进行比较,高、中水平组FeNO显著下降（t=16．83,t=14．53,P〈O．0001）,低水平组较治疗前下降不明显（t=2．030,P=0．054）;根据治疗后ACT评分判断病情是否控制,高水平组控制率（81．40A）与中水平组控制率（72．5％）比较差异无统计学意义（x2=-0．93,P〉0．05）,中水平组控制率与低水平组控制率（44．0％）差异有统计学意义（X2=5．28,P〈O．05）。结论FeNO具有识别嗜酸粒细胞炎症型哮喘及预测糖皮质激素治疗疗效的价值。     

支气管哮喘抗原免疫治疗最新研究进展

目前世界范围内支气管哮喘( 简称哮喘) 抗原免疫治疗(allergen immunotherapy,AIT) 应用严重不足,而其是 惟一可以改变过敏性疾病进程的方法。最新相关国内指南提出中- 重度过敏性鼻炎合并轻度哮喘的患者推荐使用 AIT ;部分控制或即使得到正规治疗而第一秒用力呼气量占预计值百分比<70% 的哮喘患者禁用AIT。AIT 与单纯 对症治疗相比节省费用,无论短期还是长期其安全性好。哮喘AIT 可以选择皮下和舌下免疫治疗,但与传统的皮下 免疫治疗相比,多种变应原的舌下免疫治疗无效。AIT 还可以选择经淋巴结免疫治疗,但主要针对草花粉过敏导致 的鼻结膜炎患者。哮喘治疗需要重视AIT。     

SCIT Versus SLIT: Which One Do You Recommend,Doc?

Allergic rhinitis is a prevalent condition that has a significant impact on the quality of life of many patients. When initial therapy fails to control the symptoms, allergen immunotherapy (AIT) has been suggested as an option by the Joint Task Force on Practice Parameters. The 2 main forms of AIT are via subcutaneous and sublingual routes, called subcutaneous immunotherapy and sublingual immunotherapy, respectively. There is debate about which is the better option for patients with each method offering its own pros and cons. We present 2 patients with allergic rhinitisAR that were deemed good candidates for AIT and explore current evidence for both subcutaneous immunotherapy and sublingual immunotherapy. The advantages and disadvantages of each method are discussed with the goal of providing a framework for the physician when deciding on AIT for their patients. In addition, we explore the use of AIT in patients with asthma and atopic dermatitis as potential patient populations that may benefit from the treatment. We use the discussion to provide recommendations regarding which method of AIT is best suited for both our patients.     

屋尘螨变应原免疫治疗炎症细胞因子与特异性IgE和IgG4的动态相关分析

目的 分析屋尘螨(dermatophagoides pteronyssinus,Der p)的sIgE和sIgG4与炎症细胞因子治疗前后的动态相关性,探讨标准化Der p变应原免疫治疗(allergen immunotherapy,AIT)过程的可能机制.方法 选取55例在广州医科大学附属第一医院和珠海市人民医院接受AIT的鼻炎或鼻炎合并哮喘患者,分别在治疗前、治疗后4个月与12个月检测血清IL-5、IL-8、IL-10、IL-13、IL-17和肿瘤坏死因子α共6种炎症细胞因子的水平.结果 AIT后,Der p sIgE水平曾一度升高,但随之开始下降,随着治疗的进行,Der p sIgG4水平均显著性升高.虽然对55例患者细胞因子AIT前后相比无明显差异,但是进行年龄分组(儿童/成人)和疾病分组(鼻炎/鼻炎合并哮喘)后,AIT后细胞因子水平有组间差异,如IL-5水平儿童组高于成人组,且儿童组治疗12个月比治疗前降低;AIT 12个月,鼻炎合并哮喘组IL-5水平较治疗前低(P＜0.05).Der p sIgE和sIgG4与细胞因子在不同免疫治疗阶段与不同的细胞因子有相关性,特别是sIgG4的升高在不同的免疫治疗阶段与不同的细胞因子的变化有关.结论 AIT后sIgG4升高,sIgE降低.且儿童与成人组,鼻炎与鼻炎合并哮喘组的细胞因子变化水平不同,Der p sIgE和sIgG4水平与细胞因子在AIT过程存在一定的相关性,说明sIgE和sIgG4在AIT中反映了机体的免疫状态.     

Discriminant analysis in allergic rhinitis and asthma: methacholine dose-response slope allows a good differentiation between mild asthma and rhinitis

Asthma and rhinitis frequently coexist in allergic patients, but nasal symptoms may predominate, leading to asthma underdiagnosis and undertreatment. Discriminant analysis obtains the best differentiation between groups using one or one set of variables. Our aim was to identify the laboratory test [allergen exposure, total and specific serum IgE, lung function, blood eosinophils and, bronchial response and sensitivity to methacholine (Mth) and allergen] or combination of them that allowed the best differentiation between mild asthma and allergic rhinitis. A cross-sectional analysis was performed in 86 Dermatophogoides pteronyssinus allergic rhinitis patients, who were classified according to clinical data as rhinitis plus mild asthma (n = 62) or "pure" rhinitis (n = 24). Bronchial symptoms had been exhaustively evaluated during a 2-years pre-inclusion period. Patients underwent skin tests and bronchial challenge with Mth and allergen. The exposure to D. pteronyssinus allergen (Der pl) was quantified in dust samples. Dose-response curves with Mth [until the FEV1 fell by 40% or the maximal dose (200 mg/ml) was inhaled] were attained. We developed multiple models of discriminant analysis in order to evaluate the capacity of the above variables to differentiate groups. Asthma patients had higher total and specific IgE levels and a greater sensitivity (PD20 values) and response [dose-response slope (DRS)] to both Mth and allergen. The model entering these variables was the one that correctly classified more patients (79.2%). The discriminative power of the model that only included Mth-DRS values was similar to the above (78.8%). Bronchial response to Mth is quantitatively different in allergic rhinitis patients who display mild asthma symptoms when compared to those that only report rhinitis, suggesting a distinct bronchial intrinsic behavior. The utilization of complete dose-response curves with Mth allows a good separation between mild asthma and "pure" rhinitis patients and might be useful in the diagnosis of mild asthma. Whether the early detection and treatment of these patients prevents the development of symptomatic asthma needs further evaluation.     

Update on efficacy of allergen immunotherapy for allergic rhinitis and asthma.

Specific allergen immunotherapy (IT) has long been used to treat allergic rhinitis and asthma. Review of the literature from the past 5 years continues to support this use of IT as the only disease-modifying treatment of allergic disease currently available. In addition, studies suggest that allergen IT may prevent the progression of allergic disease. In monosensitized patients, IT may prevent polysensitization. In younger patients with allergic rhinitis only, IT may prevent the new onset of asthma. Although these studies require further validation, the evidence is important enough to consider disease prevention as one of the indications for prescribing allergen IT.     

Human basophil releasability. VI. Changes in basophil releasability in patients with allergic rhinitis or bronchial asthma.

We evaluated basophil releasability in two groups of allergic patients with positive skin tests to Dermatophagoides pteronyssinus major allergen (Der p l) (29 adults with bronchial asthma and 17 with allergic rhinitis) and in 31 age-matched normal donors. Both basophil reactivity (maximal percent histamine release) and basophil sensitivity (the concentration that causes 50% of maximal percent histamine release: HC50) to Der p l in patients with asthma were similar to those in patients with allergic rhinitis. On the contrary, basophil reactivity to anti-IgE was significantly higher in patients with asthma (58.0 +/- 3.6%) than in patients with allergic rhinitis (46.3 +/- 5.2%; p less than 0.05). Both groups of patients showed an increased releasability compared to control subjects (27.3 +/- 4.6%; p less than 0.001), whereas there were no significant differences in basophil sensitivity to anti-IgE among the three groups of donors. Differences were also found with respect to basophil reactivity and sensitivity to f-met peptide, whereas no differences appeared when basophils from the three groups of donors were challenged with the Ca2+ ionophore A23187. There was a significant correlation between basophil reactivity and sensitivity to Der p l and to anti-IgE in both asthmatic and allergic rhinitis patients. A significant correlation was found between basophil reactivity and sensitivity to anti-IgE and serum IgE level only in patients with bronchial asthma, whereas no correlations were found in patients with allergic rhinitis. There was no correlation between in vivo mast cell releasability and in vitro basophil releasability in response to Der p l in either group of allergic patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

标准化屋尘螨提取液治疗儿童支气管哮喘的安全性研究

目的 通过观察进行标准化屋尘螨特异性免疫治疗(脱敏治疗)的支气管哮喘(简称哮喘)患儿,在脱敏治疗过程中出现的不良反应,评价脱敏治疗的安全性.方法 对在苏州大学附属儿童医院哮喘专科门诊临床确诊的110例哮喘患儿,应用(丹麦ALK-Abell(o)公司安脱达)标准化屋尘螨提取液进行皮下注射脱敏治疗.观察每次注射后不良反应发生情况,统计脱敏治疗的不良反应发生率.结果 在110例患儿共接受免疫注射2332人次,发生局部不良反应291人次(发生率12.48%),其中速发型局部不良反应146人次(6.26%),迟发型局部不良反应145人次(6.22%).局部不良反应在20～800SQU、2000～80 000SQU、100 000 SQU阶段的发生率分别是:1.05%(6/569)、12.05%(97/805)和19.62%(188/958),差异有统计学意义.发生全身不良反应79人次(3.39%),1例次为3级非致命性全身反应,其余均为轻度全身反应(包括哮喘、过敏性鼻炎,过敏性结膜炎、过敏性皮炎),其中速发型全身不良反应49人次(2.10%).迟发型全身不良反应为30人次(1.29%).全身不良反应在20～800 SQU、2 000～80 000 SQU、100 000 SQU阶段的发生率分别是:0.35%(2/569)、6.71%(54/805)和2.51%(24/958),差异有统计学意义.结论 哮喘患儿对标准化屋尘螨提取液特异性免疫治疗耐受性良好.绝大多数局部不良反应为轻度,其发生率随注射提取物浓度增高而增高.全身不良反应绝大多数为轻度,以发生在2 000～80 000 SQU剂量明显上升阶段为最多,在此阶段多加注意.全身不良反应以注射浓度2 000～80 000 SQU为最高.而局部不良反应以100 000 SQU组为最高,提示局部不良反应和全身不良反应不平行.局部不良反应发生不提示全身不良反应发生.     

Mite allergen exposure, sensitisation and clinical symptoms in Valdivia, Chile.

One hundred consecutive asthmatic paediatric patients were evaluated and skin tested with a battery of skin prick test reagents, including 8 different standardized house dust mite extracts. Asthma severity was graded according to the Global Initiative for Asthma (GINA) document in mild persistent (52 patients), moderate persistent (39) and severe persistent (9). Sixty patients had asthma and allergic rhinitis, 12 asthma and eczema, and 8 asthma, allergic rhinitis and eczema. The patient population was divided into 2 different socioeconomic groups (50 patients per group) based on a standardized, validated questionnaire. A dust sample was collected with an adapted vacuum cleaner from the mattress of each patient and analysed for Der p 1, Der f 1 and Der p 2 allergen content using monoclonal antibodies. Eighty patients were skin test positive to at least one mite species. All positive skin test patients were positive to Dermatophagoides pteronyssinus, 99% to D. farinae, 92% to Euroglyphus maynei, 80% to Lepidoglyphus destructor, 73% to Tyrophagus putrescientae, 72% to Blomia tropicalis; 70% to Acarus siro and 68% to Chortoglyphus arcuatus. All patients with severe persistent asthma had a positive skin test to mites, 85% in the moderate group, and 73% in the mild group (p < 0.01). 95% of patients with asthma and allergic rhinitis had a positive skin test to mites, 92% of patients with asthma and eczema and 100% of patients with asthma, allergic rhinitis and eczema; (p < 0.01). Mean Der p 1, Der f 1 and Der p 2 allergen concentrations were 18.3, 0.6 and 5.6 microg/g of mattress dust, respectively. Mean Der p 1 allergen levels in the middle-low socioeconomic group were significantly higher than in the middle high group (p < 0.01). There is a high rate of allergic sensitisation among pediatric asthmatic patients in Chile. More than one species are implicated, although sensitisation and exposure to D. pteronyssinus predominates. Mite allergic patients are exposed to high mite allergen concentrations, exceeding previously established risk levels for sensitisation and symptoms.