食物过敏的临床诊断

食物过敏是一个重要的临床课题,因其不仅在儿童中甚为常见,而且可发生于任何年龄,成为患者慢性衰竭或死亡的潜隐性原因。患者的年龄、过敏反应类型及当地的饮食习惯等均与本病的诊断有关(图)。病史与食物过敏有密切关系的病史,包括出生后的详细情况、特应症表现的发展过程、目前     

蚓激酶引起职业性哮喘:附2例病例报道

目的探讨皮肤点刺试验、结膜和(或)支气管激发试验,在蚓激酶这类罕见的职业环境中引起的职业性哮喘的诊断意义。方法对2例怀疑职业环境中接触蚓激酶粉尘引起的哮喘患者进行临床表现总结,并用蚓激酶粉剂稀释液(10μgml)分别对2例患者和3例健康对照进行皮肤点刺试验;对例1进行支气管激发试验;对例2进行结膜激发试验。结果 2例患者蚓激酶皮肤点刺试验均为阳性,3例健康对照者均为阴性。例1支气管激发试验阳性,FEV1.0从103%预计值降到83%预计值。例2左侧眼结膜激发试验阳性,作为对照的右侧眼结膜为阴性。结论蚓激酶作为一种药用蛋白质,其粉尘可以引起职业性哮喘,特异性皮肤点刺试验、结膜和(或)支气管激发试验有助于诊断。     

海南省蜉蝣过敏原临床致敏性

目的了解海南省临床蜉蝣过敏情况,为过敏性鼻炎的流行病学研究及临床诊断、治疗和预防提供依据。方法对500例过敏性鼻炎患者用蜉蝣过敏原进行前臂皮肤点刺试验,然后随机选择20例蜉蝣点刺阳性患者进行蜉蝣过敏原鼻黏膜激发试验。结果 500例皮肤点刺试验中,蜉蝣阳性者占58.6%（293/500）,20例阴性对照者皮肤点刺均为阴性100%（20/20）;20例蜉蝣皮肤点刺阳性患者中过敏原鼻黏膜激发试验阳性者为20例（100%）,20例阴性对照未见阳性反应。结论皮肤点刺和过敏原鼻黏膜激发试验结果相符合,蜉蝣为海南省重要过敏原。     

儿童哮喘变应原皮肤点刺试验549例结果分析

目的分析儿童哮喘的常见变应原和皮肤变应原点刺试验在哮喘病原诊断中的应用。方法采用复旦大学医学院螨类研究室提供的变应原皮试液,用生理盐水作阴性对照,盐酸组胺作阳性对照。在患儿前臂屈侧皮肤进行点刺试验。结果549例儿童哮喘中,变应原皮肤点刺阳性438例(79.8%),阳性率随年龄增加而增加。所有变应原中,尘螨阳性率最高(60.8%),其次是动物皮毛(21.5%)和棉絮(18.21%)。变应原阳性率与哮喘发作频度呈正相关,性别间无显著性差异。结论尘螨、动物皮毛、棉絮是本地区儿童哮喘最主要的变应原,变应原皮肤点刺试验更适宜在3岁以上有反复哮喘发作的患儿中应用。     

皮肤点刺试验和改良挑刺试验对比研究

目的对皮肤点刺试验和改良挑刺试验进行方法学对比,为临床应用提供数据。方法用磷酸组织胺和生理盐水（normalsaline,NS）点刺液同时进行皮肤点刺和改良挑刺试验,观察2种皮肤试验方法的安全性、可重复性及疼痛程度,并评价皮肤划痕征对皮肤反应性的影响。结果 2种方法均较安全,所致疼痛程度大致相当,可重复性均较高。皮肤划痕征阳性组和阴性组的组胺平均风团直径差异无统计学意义,改良挑刺法划痕征阳性组vs阴性组：（8.91±1.26）mmvs（8.83±1.58）mm,P=0.80;点刺法划痕征阳性组vs阴性组：（8.11±1.23）mmvs（7.59±1.56）mm,P=0.11。在皮肤划痕征阴性组,NS点刺和改良挑刺试验的平均风团直径分别为（2.29±1.17）mm和（1.50±0.68）mm,P=0.02;皮肤反应指数分别为0.25±0.11和0.17±0.07,虽差异有显著性,但两者均可判断为阴性。在皮肤划痕征阳性组,NS点刺试验平均风团直径大于改良挑刺试验（4.21±1.38）mmvs（2.29±1.17）mm,P〈0.001;NS点刺试验的反应指数（SI）明显高于改良挑刺试验0.52±0.16vs0.25±0.11,P〈0.001。结论用组织胺和NS进行皮肤点刺试验和挑刺试验安全性和重复度较高,两者疼痛程度大致相当,皮肤划痕征阳性者用改良挑刺试验的风团反应低于皮肤点刺试验。     

辽宁地区过敏性支气管哮喘患者变应原分布特征

目的了解辽宁地区2003至2007年过敏性支气管哮喘（简称哮喘）患者变应原的种类、分布和反应强度。方法应用12种标准化变应原（Alutard⑧）对2003至2007年我院变态反应免疫治疗中心的辽宁地区哮喘初诊患者进行变应原皮肤点刺试验（skinpricktest,SPT）。结果5年哮喘患者SPT阳性率为25．24％（1817／7200）。每年SPT阳性率分别为16．52％（95／575）、18．07％（229／1267）、27．30％（519／1901）、28．87％（507／1756）和27．45％（467／1701）。SPT变应原阳性率分布前5位的依次为粉尘螨、屋尘螨、蒿草、豚草和动物毛变应原,其次为树木、蟑螂、霉菌、向日葵、蓰草和牧草。变应原SPT反应强度分布：＋504例（11．25％）、＋＋1895例（42．29％）、＋＋＋1665例（37．16％）、＋＋＋＋417例（9．31％）,以＋＋、＋＋＋等级为主。结论尘螨为辽宁地区过敏性哮喘的占绝对优势的变应原;蒿草、豚草花粉分别居第二位、第三位,亦为季节性哮喘伴鼻炎的主要变应原。SPT变应原反应强度以＋＋和＋＋＋为主。     

辽宁地区过敏性支气管哮喘患者变应原分布特征

目的 了解辽宁地区2003至2007年过敏性支气管哮喘(简称哮喘)患者变应原的种类、分布和反应强度.方法 应用12种标准化变应原(AlutardR)对2003至2007年我院变态反应免疫治疗中心的辽宁地区哮喘初诊患者进行变应原皮肤点刺试验(skin prick test,SPT).结果 5年哮喘患者SPT阳性率为25.24%(1 817/7 200).每年SPT阳性率分别为16.52%(95/575)、18.07%(229/1 267)、27.30%(519/1 901)、28.87%(507/1 756)和27.45%(467/1 701).SPT变应原阳性率分布前5位的依次为粉尘螨、屋尘螨、蒿草、豚草和动物毛变应原,其次为树木、蟑螂、霉菌、向日葵,稚草和牧草.变应原SPT反应强度分布:+504例(11.25%)、++1 895例(42.29%)、+++1 665例(37.16%)、++++417例(9.31%),以++、+++等级为主.结论 尘螨为辽宁地区过敏性哮喘的占绝对优势的变应原;蒿草、豚草花粉分别居第二位、第三位,亦为季节性哮喘伴鼻炎的主要变应原.SPT变应原反应强度以++和+++为主.     

辽宁地区变应性鼻炎患者吸入变应原谱分析

目的了解辽宁地区变应性鼻炎患者的变应原种类、分布特征、变应原反应强度及其与变应性鼻炎发病的关系。方法用20种变应原对辽宁地区4995例鼻炎初诊患者进行皮肤点刺试验（skin prick test,SPT）。结果鼻炎患者中变应原SPT阳性率为53.9%（2697/4995）,其中1种变应原阳性率占9.3%（250/2697）,2种以上占90.7%（2447/2697）。变应原SPT阳性率分布在前4位的是粉尘螨、屋尘螨、艾蒿、豚草花粉,其他依次为狗毛、混合树木、蟑螂、猫毛、葎草、霉菌。粉尘螨、屋尘螨的SPT阳性率,儿童（55.0%、52.8%）高于成人（24.9%、21.3%）,P均〈0.001;男性（18.9%、17.0%）高于女性（12.5%、11.1%）,P均〈0.01。艾蒿、豚草SPT阳性率,成人（27.8%、19.4%）明显高于儿童（15.8%、9.5%）,P均〈0.01;成人男性（31.4%、22.1%）高于女性（25.2%、17.5%）,P均〈0.01。15～34岁年龄组SPT阳性率占优势。结论尘螨为辽宁地区常年性变应性鼻炎的首位变应原,儿童阳性率高于成人;艾蒿、豚草为季节性变应性鼻炎的主要变应原,成人阳性率高于儿童。     

食物依赖运动诱发严重过敏3例并文献复习

目的：提高对食物依赖运动诱发严重过敏（FDEIA）的诊疗水平。方法：回顾分析3例食物依赖运动诱发过敏反应患者的临床特征及诊疗情况,并复习相关文献。结果：2例患者在进食小麦面食后,1例患者在进食海虾后由运动诱发全身荨麻疹、呼吸困难及意识障碍,发病时间均在进食食物后30min～2h,经肾上腺素、糖皮质激素及抗组胺药物治疗后缓解。3例患者致敏食物皮肤点刺试验和血清特异性IgE均为阳性。2例患者在禁食致敏食物1年,随访期间未发生过敏反应。结论：FDEIA临床罕见,患者可反复发生过敏性休克而导致死亡,临床进食某些食物过敏原和进食后运动2个因素同时存在时才会诱发FDEIA,治疗方法以抗组胺药物、肾上腺素和糖皮质激素等对症治疗为主,禁食致敏食物及进食致敏食物后4h内避免剧烈运动有可能避免本病的发生。     

西安及周边地区918例哮喘患者吸入性过敏原分析

目的 分析西安市及周边地区支气管哮喘患者常见吸入性过敏原的分布情况.方法 采用皮肤过敏原点刺试验(SPT)检测918例来自西安市及周边地区的支气管哮喘患者,共测定14种常见吸入性过敏原.结果 1.不同年龄段支气管哮喘患者中,1～10岁、11～20岁、21～30岁这3个年龄段过敏原阳性比例较高,分别为75.0％、55.9...     

Increase of natural killer cells in children with liver transplantation-acquired food allergy

Background

Transplantation-acquired food allergies (TAFA) are frequently reported and considered to be caused by immunosuppressive therapy.The aim of this study was to investigate the allergic and immunologic responses in children who had liver or kidney transplantations.

Drug allergy in tertiary care in Turkey: Results of a national survey. The ADAPT study: Adult drug allergy perception in Turkey

BackgroundNo data are available on the incidence of drug hypersensitivity (DH) reactions in outpatient settings of tertiary allergy/immunology clinics. Our aims were to document the frequency of outpatient hospital admissions due to DH reactions to allergy/immunology clinics in adults and the management of these reactions in real life. We also investigated whether drug allergy affected social and medical behaviours of the patients.MethodsThis multi-centre study was performed for one year with the participation of 11 out of 16 tertiary allergy/clinical immunology clinics in Turkey. The study group consisted of the patients with DH reactions. Results of a questionnaire including drug reactions and management were recorded.ResultsAmong 54,863 patients, 1000 patients with DH were enrolled with a median of 2.1% of all admissions. In real life conditions, the majority of approaches were performed for finding safe alternatives (65.5%; 1102 out of 1683) with 11.7% positivity. Diagnostic procedures were positive in 27% (154/581) of the patients. The majority of the patients had higher VAS scores for anxiety. A total of 250 subjects (25%) reported that they delayed some medical procedures because of DH.ConclusionOur results documented the frequency of admissions due to DH reactions to allergy/clinical immunology clinics for the first time. Although physicians mostly preferred to perform drug tests in order to find safe alternatives, considering the fact that DH was confirmed in 27% of the patients, use of diagnostic tests should be encouraged, if no contraindication exists in order to avoid mislabelling patients as DH.     

Food allergy in gastroenterologic diseases： Review of literature

INTRODUCTION Food allergy is recognized as a common worldwide prob- lem, and, like other atopic disorders, its incidence seems to increase. Moreover, food-related allergic disorders are the leading cause of anaphylactic reactions treated in the emer- genc…     

The role of gene-environment interactions in the development of food allergy

The rates of IgE-mediated food allergy have increased globally, particularly in developed countries. The rising incidence is occurring more rapidly than changes to the genome sequence would allow, suggesting that environmental exposures that alter the immune response play an important role. Genetic factors may also be used to predict an increased predisposition to these environmental risk factors, giving rise to the concept of gene-environment interactions, whereby differential risk of environmental exposures is mediated through the genome. Increasing evidence also suggests a role for epigenetic mechanisms, which are sensitive to environmental exposures, in the development of food allergy. This paper discusses the current state of knowledge regarding the environmental and genetic risk factors for food allergy and how environmental exposures may interact with immune genes to modify disease risk or outcome.     

Food specific oral immunotherapy: a potential treatment for food allergy

Food allergy is a potentially life-threatening condition affecting up to 8% of children and up to 2% of adults in westernized countries. There are currently no approved treatments for food allergy apart from avoidance. The apparent increase in incidence of food allergies over the past few decades calls attention to the need for effective, disease-modifying therapies for food allergies. Oral immunotherapy (OIT) is a promising experimental treatment in which food allergic patients consume increasing quantities of food in attempt to increase their threshold for allergic reaction. Studies are ongoing to determine whether OIT is capable of safely inducing not only desensitization but also tolerance to the allergenic foods. This article focuses on recent relevant studies of OIT for the treatment of common food allergies.     

Japanese guidelines for food allergy 2017

Five years have passed since the Japanese Pediatric Guideline for Food Allergy (JPGFA) was first revised in 2011 from its original version. As many scientific papers related to food allergy have been published during the last 5 years, the second major revision of the JPGFA was carried out in 2016. In this guideline, food allergies are generally classified into four clinical types: (1) neonatal and infantile gastrointestinal allergy, (2) infantile atopic dermatitis associated with food allergy, (3) immediate-type of food allergy (urticaria, anaphylaxis, etc.), and (4) special forms of immediate-type of food allergy such as food-dependent exercise-induced anaphylaxis and oral allergy syndrome (OAS). Much of this guideline covers the immediate-type of food allergy that is seen during childhood to adolescence. Infantile atopic dermatitis associated with food allergy type is especially important as the onset of most food allergies occurs during infancy. We have discussed the neonatal and infantile gastrointestinal allergy and special forms of immediate type food allergy types separately. Diagnostic procedures are highlighted, such as probability curves and component-resolved diagnosis, including the recent advancement utilizing antigen-specific IgE. The oral food challenge using a stepwise approach is recommended to avoid complete elimination of causative foods. Although oral immunotherapy (OIT) has not been approved as a routine treatment by nationwide insurance, we included a chapter for OIT, focusing on efficacy and problems. Prevention of food allergy is currently the focus of interest, and many changes were made based on recent evidence. Finally, the contraindication between adrenaline and antipsychotic drugs in Japan was discussed among related medical societies, and we reached an agreement that the use of adrenaline can be allowed based on the physician's discretion. In conclusion, this guideline encourages physicians to follow the principle to let patients consume causative foods in any way and as early as possible.     

Japanese guidelines for food allergy 2020

Five years have passed since the Japanese Pediatric Guideline for Food Allergy (JPGFA) was first revised in 2011 from its original version. As many scientific papers related to food allergy have been published during the last 5 years, the second major revision of the JPGFA was carried out in 2016. In this guideline, food allergies are generally classified into four clinical types: (1) neonatal and infantile gastrointestinal allergy, (2) infantile atopic dermatitis associated with food allergy, (3) immediate-type of food allergy (urticaria, anaphylaxis, etc.), and (4) special forms of immediate-type of food allergy such as food-dependent exercise-induced anaphylaxis and oral allergy syndrome (OAS). Much of this guideline covers the immediate-type of food allergy that is seen during childhood to adolescence. Infantile atopic dermatitis associated with food allergy type is especially important as the onset of most food allergies occurs during infancy. We have discussed the neonatal and infantile gastrointestinal allergy and special forms of immediate type food allergy types separately. Diagnostic procedures are highlighted, such as probability curves and component-resolved diagnosis, including the recent advancement utilizing antigen-specific IgE. The oral food challenge using a stepwise approach is recommended to avoid complete elimination of causative foods. Although oral immunotherapy (OIT) has not been approved as a routine treatment by nationwide insurance, we included a chapter for OIT, focusing on efficacy and problems. Prevention of food allergy is currently the focus of interest, and many changes were made based on recent evidence. Finally, the contraindication between adrenaline and antipsychotic drugs in Japan was discussed among related medical societies, and we reached an agreement that the use of adrenaline can be allowed based on the physician's discretion. In conclusion, this guideline encourages physicians to follow the principle to let patients consume causative foods in any way and as early as possible.