High levels of urinary eosinophil protein X in young asthmatic children predict persistent atopic asthma

Levels of urinary eosinophil protein X (U-EPX) and eosinophil counts were measured in 32 children (12–36 months of age) who were hospitalized for acute asthma, and the U-EPX levels were measured in 20 healthy children of the same age. The ability of these parameters to predict persistent asthma (at least one wheezing episode during the last 6 months) and atopic asthma (a positive skin-prick test [SPT]), was evaluated at a follow-up 2 years later. On admission, levels of U-EPX were higher in children with asthma (median: 120 µg/mmol of creatinine; quartiles: 67–123 µg/mmol of creatinine) than in controls (60 µg/mmol of creatinine, 38–74 µg/mmol of creatinine; p< 0.001). The U-EPX level was higher in those with persistent atopic asthma at follow-up (173 µg/mmol of creatinine, 123–196 µg/mmol of creatinine, n = 16), than in those with persistent non-atopic asthma (73 µg/mmol creatinine, 46–105 µg/mmol of creatinine, n = 8; p< 0.05), and higher than in those with transient asthma (no symptoms at follow-up) (106 µg/mmol creatinine; 42–167 µg/mmol of creatinine, n = 8; p< 0.05). By multiple logistic regression analysis, U-EPX was the only parameter able to predict persistent atopic asthma; eosinophil counts, parental atopy, age or gender could not. Parental atopy was the only parameter predictive for persistent asthma, regardless of atopic status. In conclusion, levels of U-EPX, but not eosinophil counts, measured in young children hospitalized with acute asthma can predict the persistence of atopic asthma 2 years later.     

Allergic sensitization is associated with rhinovirus‐, but not other virus‐, induced wheezing in children

Jartti T, Kuusipalo H, Vuorinen T, Söderlund‐Venermo M, Allander T, Waris M, Hartiala J, Ruuskanen O. Allergic sensitization is associated with rhinovirus‐, but not other virus‐, induced wheezing in children.
Pediatr Allergy Immunol 2010: 21: 1008–1014.
© 2010 John Wiley & Sons A/S Background: Data on the link between atopy and viral wheeze are limited. Aim: To evaluate the association between IgE sensitization and viral infection in wheezing children. Methods: This is an observational study in hospitalized wheezing children (n = 247; median age 1.6 ; interquartile range 1.1, 2.9). Eighteen respiratory viral infections were studied using all available methods. A specific immunoglobulin E (IgE) sensitization for common food and aeroallergens and other atopy‐related variables including total IgE, blood and nasal eosinophils, exhaled nitric oxide, eczema and atopic eczema, parental allergy and asthma, number of wheezing episodes, positive asthma predictive index or asthma and use of inhaled corticosteroid were correlated with specific viral etiology. Results: Atopy was closely associated with sole rhinovirus etiology (n = 58) but not with sole respiratory syncytial virus, sole enterovirus, sole human bocavirus, sole other virus, mixed viral, or virus negative etiology. The number of sensitizations was particularly associated with sole rhinovirus etiology (odds ratio 4.59; 95% confidence interval 1.78, 11.8; adjusted to age and sex), followed by aeroallergen sensitization (respectively; 4.18; 2.00, 8.72), total IgE level (2.06; 1.32, 3.21), food allergen sensitization (2.02; 1.08, 3.78), and nasal eosinophil count (1.52; 1.08, 2.13). Conclusions: According to our data, allergic sensitization is positively linked to rhinovirus‐, but not other virus‐, associated wheezing and calls attention for studies to test rhinovirus‐associated wheezing as a part of asthma risk indices.     

尘螨阳性婴幼儿首次喘息后反复喘息发作的危险因素

目的 探讨尘螨阳性婴幼儿首次喘息后反复喘息发作的危险因素。方法 选取2014年8月至2015年2月间住院的首次喘息发作婴幼儿共1 236例,其中尘螨阳性387例,出院后随访1年,随访1年内再发喘息3次及3次以上的患儿设定为反复喘息组（n=67）,随访期间未再发生喘息的患儿设定为对照组（n=84）。采用单因素分析和多因素logistic逐步回归分析,探讨尘螨阳性的婴幼儿反复喘息发作的危险因素。结果 单因素分析显示,入院时年龄、入院前喘息时间、肺炎支原体感染率、流感病毒感染率与反复喘息发作相关联。多因素logistic逐步回归分析显示,入院时年龄较大（OR=2.21,P=0.04）、合并肺炎支原体感染（OR=3.54,P=0.001）为反复喘息发作的独立危险因素。结论 尘螨阳性的婴幼儿,特别是幼儿,若首次喘息时合并有肺炎支原体感染,则反复喘息发作的风险明显升高。     

乌鲁木齐地区喘息患儿发生支气管哮喘的危险因素

目的 探讨乌鲁木齐地区喘息患儿发生支气管哮喘(哮喘)的危险因素.方法 对2008年1 -12月在新疆医科大学第五附属医院门诊及住院的300例喘息患儿的临床资料进行统计.用统一的调查表调查其年龄、性别、湿疹、变应性鼻炎、食物过敏、家族过敏史/哮喘史、运动相关性喘息等.出院后通过门诊或电话进行随访.采用 Logistic回归分析方法对各因素与哮喘发生的关系及相关程度进行分析.结果 随访2a,275例获得随访;25例失访.275例喘息患儿在随访期内86例(31.2％)发生哮喘.Logistic回归分析发现湿疹、变应性鼻炎、家族过敏史/哮喘史、运动相关性喘息、反复下呼吸道感染( LRTI)、外周血嗜酸性粒细胞(EOS)增高与喘息患儿发生哮喘有关(湿疹:OR=2.376,95％ CI0.098～0.935,P=0.039;变应性鼻炎:OR=1.052,95％ CI2.267 ～14.283,P =0.024;家族过敏史/哮喘史:OR=1.886,95％CI1.004～3.542,P =0.048;运动相关性喘息:OR=1.881,95％ CI2.267 ～18.983,P =0.001;LRTI:OR=5.341,95％ CI1.676～ 10.983,P =0.016;外周血EOS增高:OR=3.915,95％ CI1.459～ 10.501,P=0.002).结论 个人过敏史(湿疹和变应性鼻炎)、家族过敏史/哮喘史、运动相关性喘息、LRTI、外周血EOS增高是乌鲁木齐地区喘息患儿发生哮喘的危险因素.     

Wheezy babies--wheezy adults? Review on long-term outcome until adulthood after early childhood wheezing.

Population-based birth cohort studies have documented that about 30% of children suffer from wheezing during respiratory infection before their third birthday. Recurrent wheezing is common in early childhood, but most patients outgrow their symptoms by school age. However, recent long-term postbronchiolitis follow-up studies from Sweden and Finland have revealed that asthma is present in about 40% of young adults and over half of the cases are relapses after many symptom-free years. In population studies, the principal predictors for later asthma have been parental asthma, recurrent wheezing, atopy and eosinophilia. In the Swedish postbronchiolitis study, atopic diathesis through the development of clinical atopy, and early passive smoking through bronchial hyper-reactivity or later active smoking led to adult asthma. The Finnish postbronchiolitis follow-up stressed early recurrence of wheezing, wheezing induced by less invasive viruses than respiratory syncytial virus (RSV), early-life atopy and eosinophilia and parental asthma as predictors for adult asthma. CONCLUSION: The majority of wheezing infants and children outgrow their symptoms by school age, but based on recent long-term follow-up studies, asthma relapses are common in young adults. These studies have highlighted parental asthma, maternal smoking and wheezing induced by other viruses than RSV as predictive factors for later asthma.     

Day care attendance, respiratory tract illnesses, wheezing, asthma, and total serum IgE level in early childhood

BACKGROUND: It has been hypothesized that day care--related infections may explain the inverse relation between day care attendance in early life and asthma in childhood. OBJECTIVE: To examine the relation between day care attendance or respiratory tract illnesses in the first year of life and wheezing and asthma in the first 4 years of life among children with a parental history of atopy who were followed up from birth. RESULTS: Day care attendance in the first year of life was inversely associated with geometric mean total serum IgE level (12.9 [+/-1 SD = 3.3, 51.4] IU/mL for day care vs 18.5 [[+/-1 SD = 5.3, 64.7] IU/mL for no day care; P =.03) at 2 years of age but not significantly associated with wheezing at or after 2 years of age. Having at least 1 physician-diagnosed lower respiratory tract illness in the first year of life was significantly associated with recurrent wheezing (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.0-4.1) and asthma (OR, 2.5; 95% CI, 1.1-5.5) at 4 years of age, but not with any wheezing (infrequent and frequent) at 3 years or older. Illnesses of the upper respiratory tract (> or = 1 physician-diagnosed upper respiratory tract illness or > or = 3 episodes of nasal catarrh) in the first year of life were associated with any wheezing (frequent and infrequent) between the ages of 1 and 4 years, but not with recurrent wheezing or asthma at 4 years of age. CONCLUSIONS: Our results suggest that among children with a parental history of atopy the protective effect of day care attendance in early life against the development of atopy has begun by 2 years of age, and that a protective effect of day care attendance in early life against wheezing may not be observed until after 4 years of age.     

Age and sex as factors of response to RSV infections among those with previous history of wheezing

Although enhanced immune reaction caused by the respiratory syncytial virus (RSV) in allergen-sensitized animal model has been reported, RSV illnesses in children already sensitized or having recurrent wheezing episodes have not been completely studied. In addition, the reason for male dominances in RSV infection at young ages was also inconclusive. Therefore, gender analysis in recurrent wheezing children with RSV infection can shed light on asthma pathogenesis. We studied the clinical features and the laboratory data of RSV infections in children who had recurrent wheezing histories. The subjects with RSV infection consisted of 98 boys and 58 girls. The children under 4 yr of age were 123 (78.8%) in number. Children with pneumonia were 78 and those with febrile episode were 119. Children above 1 yr of age were highly sensitized with mite antigen (75/96, 78.1%). The clinical symptoms and signs differed according to their ages. Children in each age group behaved differently in their immune reaction to RSV. Above all, 3-yr-old children deteriorated clinically during acute RSV infection, accompanied by transient elevated C-reactive protein (CRP) and suppressed blood eosinophil counts. Clinical features differed in several points between boys and girls. In general, the white blood cell count and the CRP levels were higher in girls in every age group. Blood eosinophil counts at the acute illness were significantly higher in boys than girls aged 2 and 3< yr. Age and gender comparison in already sensitized children might suggest a clue to asthma pathogenesis.     

Early exposure and sensitization to cat and dog: Different effects on asthma risk after wheezing in infancy

Birth cohort studies have suggested that early exposure to furred pets protects from later asthma and allergy. The aim of the present study was to evaluate the association between exposure or sensitization to cat or dog in infancy, and later asthma and allergy assessed at the median ages of 4.0, 7.2 and 12.3 yr, in children who have wheezed at <24 months of age. Exposure to cat and dog in infancy was assessed by interviewing the parents. The child was considered as sensitized, if the allergen-specific IgE to cat or to dog was ≥0.35 kU/l, or if there was a positive skin test response. When the 20 children with persistent childhood asthma (doctor-diagnosed asthma at all three control visits) were compared with the other 61 children, an early exposure to dog (OR = 0.14, p = 0.034)) decreased the asthma risk and an early sensitization to cat (OR = 5.92, p = 0.008) and dog (OR = 9.33, p = 0.001) increased the asthma risk. There were less cat and dog keeping in atopic families and the effect of sensitization was, but the effect of exposure was not, robust to adjustments in multivariate analyses. The present study demonstrates, in a long-term follow-up after early wheezing, that early sensitization to cat and dog increases the risk of later asthma but early exposure to cat or dog has no such effect. Dog keeping was less frequent in atopic families, which may explain that the protective effect of early exposure to dog was lost in multivariate analyses.     

Wheezy babies—wheezy adults? Review on long-term outcome until adulthood after early childhood wheezing

Population-based birth cohort studies have documented that about 30% of children suffer from wheezing during respiratory infection before their third birthday. Recurrent wheezing is common in early childhood, but most patients outgrow their symptoms by school age. However, recent long-term postbronchiolitis follow-up studies from Sweden and Finland have revealed that asthma is present in about 40% of young adults and over half of the cases are relapses after many symptom-free years.
In population studies, the principal predictors for later asthma have been parental asthma, recurrent wheezing, atopy and eosinophilia. In the Swedish postbronchiolitis study, atopic diathesis through the development of clinical atopy, and early passive smoking through bronchial hyper-reactivity or later active smoking led to adult asthma. The Finnish postbronchiolitis follow-up stressed early recurrence of wheezing, wheezing induced by less invasive viruses than respiratory syncytial virus (RSV), early-life atopy and eosinophilia and parental asthma as predictors for adult asthma.
Conclusion: The majority of wheezing infants and children outgrow their symptoms by school age, but based on recent long-term follow-up studies, asthma relapses are common in young adults. These studies have highlighted parental asthma, maternal smoking and wheezing induced by other viruses than RSV as predictive factors for later asthma.     

Exhaled nitric oxide, total serum IgE and allergic sensitization in childhood asthma and allergic rhinitis

Exhaled nitric oxide (eNO) levels are correlated with several markers of atopy and inflammatory activity in the airways, but the relationship between eNO and total serum IgE has not been fully elucidated in the context of allergic sensitization. The aim of this study was to investigate the relationship between eNO, total serum IgE and allergic sensitization in childhood asthma and allergic rhinitis. eNO levels, lung function, skin prick tests and total serum IgE were determined in 109 children (mean age, 10.4 yr) with mild intermittent asthma and in 41 children (mean age, 10.1 yr) with allergic rhinitis; 25 healthy non-atopic children were recruited as controls. eNO levels (median) were significantly higher in patients with asthma (22.7 p.p.b.) and in those with allergic rhinitis (15.3 p.p.b.) than in healthy controls (5.9 p.p.b.). Children with allergic asthma had higher eNO levels than children with allergic rhinitis. A significant positive correlation was found between eNO and total serum IgE (asthma, r = 0.42, p < 0.0001; allergic rhinitis, r = 0.31, p < 0.01), and between eNO and the number of positive skin prick tests (asthma, r = 0.31, p < 0.0001; allergic rhinitis, r = 0.39, p < 0.01). eNO levels were better correlated with total IgE than with the number of positive skin prick tests. This correlation was independent of allergic sensitization. High total serum IgE represents a specific and predictive marker of eNO increase in children with asthma or allergic rhinitis. This finding adds further support to the hypothesis that increased serum IgE could be a marker itself of airway inflammation in patients with allergic disease.     

Total serum IgE and outcome in infants with recurrent wheezing.

OBJECTIVE: To investigate the relation between total serum IgE at 0.5-3 and 3-6 years, and the risk of allergic sensitisation and persistent wheezing up to 8 years of age. METHODS: Prospective follow up study of 45 infants with highly recurrent wheezing, no allergic symptoms, and negative skin tests. RESULTS: In the last follow up year, 15 children still suffered from wheezing. Five wheeze-free and four episodically wheezing children had become sensitised. No association was found between early (0.5-3 years) IgE z scores and the recurrence of wheezing during follow up, or atopic sensitisation. IgE z scores at 3-6 years were significantly higher in children with positive skin tests (p = 0.013), but were still not associated with recurrence of wheezing. CONCLUSIONS: In subjects with frequent early wheezing and no signs of atopy, early total serum IgE measurements are not predictive of outcome.     

Serum eosinophilic cationic protein may predict clinical course of wheezing in young children

Thirty eight children aged between 2 and 4 years with three or more episodes of wheezing were studied to evaluate the role of eosinophil inflammation and its relation to persistence of wheezing two years later. Serum eosinophilic cationic protein, total eosinophil count, total IgE, skin prick test, and clinical features were evaluated at visit 1. Two years later at a second clinical evaluation the children were separated into two groups: group 1, those with persistent wheezing (n = 20); group 2, those who had been asymptomatic over the past six months (transient wheezing) (n = 18). Mean (SEM) eosinophilic cationic protein at visit 1 was higher in group 1 than in group 2 (29.63 (5.16) v 14.42 (2.77) micrograms/l), and the probability of continuing wheezing at age 5 years was greater in children with values > or = 20 micrograms/l at visit 1 than in those with lower values (relative risk = 2.88, 95% confidence interval 1.42 to 5.87, p < 0.001). Eosinophil inflammation is present from the beginning of the disease in the children who are going to continue with wheezing at age 5 years. The measurement of serum eosinophilic cationic protein may help in evaluating which wheezing infants are going to continue with asthma in the future.     

Efficacy of prednisolone in children hospitalized for recurrent wheezing

Data on the efficacy of corticosteroids on respiratory picornavirus-induced wheezing are limited. To determine whether prednisolone is effective in rhinovirus- or enterovirus-induced recurrent wheezing, we conducted a controlled trial comparing oral prednisolone (2 mg/kg/day in three divided doses for 3 days) with placebo in hospitalized wheezing children and studied post hoc virus-specific efficacy in early wheezing (<3 episodes, reported elsewhere) and in recurrent wheezing (>or=3 episodes). Virus-negative children where excluded. Our primary endpoint was the time until children were ready for discharge. Secondary endpoints included oxygen saturation and exhaled nitric oxide during hospitalization, duration of symptoms, blood eosinophil count, and impulse oscillometry 2 wk after discharge, and occurrence of relapses during the following 2 months. Virus-specific effects were analyzed with interaction analysis in a multivariate regression model. During the study period, 661 patients were hospitalized, 293 randomized, and 59 were accepted in this analysis (mean age 2.6 yr, s.d. 1.3). Prednisolone did not significantly decrease the time until ready for discharge in all patients (prednisolone vs. placebo, medians, 18 vs. 24 h, p = 0.11). However, prednisolone decreased the time until ready for discharge in children with picornavirus infection (respectively, 12 vs. 24 h, p = 0.0022) and more specifically, in children with enterovirus infection (6 vs. 35 h, p = 0.0007). In the secondary endpoints, prednisolone decreased the duration of cough and dyspnea in rhinovirus-affected children (p = 0.033 for both). Prospectively designed clinical trial is needed to test the hypothesis that prednisolone reduces symptoms in picornavirus-affected wheezing children.     

The influence of parental educational level on the development of atopic sensitization,wheezing and eczema during the first year of life

Several studies have investigated the association between socioeconomic status and the occurrence of allergies. Nevertheless, the results remain contradictory. The aim of this study was to evaluate the associations between parental education and the occurrence of atopic sensitization, recurrent wheezing and eczema during the first year of life, differentiating between atopic and non‐atopic disorders based on specific serum IgE. We conducted an aetiological study in 690 children, based on a prospective birth cohort project in which environmental and health information was gathered using questionnaires. At the age of 1 yr a blood sample was taken for quantification of specific IgE. Adjusted odds ratios and 95% confidence intervals were computed as measures of association between the outcomes and parental education. Parental educational level was positively associated with the occurrence of atopic sensitization (OR: 2.1; 95% CI: 1.0–4.4) and eczema (OR: 1.9; 95% CI: 1.1–3.4), but negatively with the occurrence of recurrent wheezing (OR: 0.4; 95% CI: 0.2–0.8) in the first year of life. Atopic recurrent wheezing was positively associated with the education of the parents, whereas non‐atopic recurrent wheezing was negatively associated. When maternal and paternal education were considered separately, only maternal education had a significant influence. Our results suggest that aspects associated with a high maternal educational level may play an important role in the development of atopic disorders.     

具有喘息症状或过敏性疾病的年幼儿皮肤点刺试验结果分析

目的：通过分析0~5岁儿童变应原皮肤点刺试验结果,了解具有喘息症状的可疑哮喘及过敏性疾病症状的患儿对吸入变应原过敏反应的特点,为儿童哮喘及过敏性疾病的早期诊断提供依据。方法：选择2010年9月1日至12月31日长沙市某社区0~5岁具有喘息症状或过敏性疾病症状的患儿共102例为变应原筛查组;对照组选择同年龄组无喘息及过敏性疾病史的儿童94例。两组均进行变应原皮肤点刺试验。结果：变应原筛查组皮肤点刺试验阳性率61.8%（63/102）明显高于对照组的9.6%（9/94）,差异有统计学意义（P<0.05）;反复喘息合并过敏性鼻炎者的皮肤点刺试验阳性率明显高于单纯喘息组（P<0.05）;喘息次数与皮肤点刺试验阳性率呈正相关（r=0.91,P<0.05）;对螨虫的皮肤点刺试验阳性率（24.2%）明显高于其他过敏原（3.5%）,差异有统计学意义（P<0.05）;粉尘螨的皮肤点刺阳性率（50.0%）明显高于屋尘螨（14.7%）,差异有统计学意义（P<0.05）。结论：早期儿童喘息可能是发生过敏性哮喘的重要因素;变应原皮肤点刺试验是诊断过敏性疾病的重要依据,并有助于评估喘息患儿对吸入性变应原的过敏反应特点。     

Total serum IgE and outcome in infants with recurrent wheezing

OBJECTIVE—To investigate the relation between total serum IgE at 0.5-3 and 3-6 years, and the risk of allergic sensitisation and persistent wheezing up to 8 years of age.
METHODS—Prospective follow up study of 45 infants with highly recurrent wheezing, no allergic symptoms, and negative skin tests.
RESULTS—In the last follow up year, 15 children still suffered from wheezing. Five wheeze-free and four episodically wheezing children had become sensitised. No association was found between early (0.5-3 years) IgE z scores and the recurrence of wheezing during follow up, or atopic sensitisation. IgE z scores at 3-6 years were significantly higher in children with positive skin tests (p = 0.013), but were still not associated with recurrence of wheezing.
CONCLUSIONS—In subjects with frequent early wheezing and no signs of atopy, early total serum IgE measurements are not predictive of outcome.

     

The impact of early lifestyle factors on wheezing and asthma in Austrian preschool children

AIM: This study investigated the influence of early lifestyle factors on the prevalence of asthma and wheezing in preschool children in Tyrol, Austria. METHODS: A cross-sectional questionnaire survey was performed in 1761 preschool children to obtain information on wheezing and asthma in the light of early lifestyle factors. RESULTS: Factors independently associated with an increased risk for wheezing in the past 12 months included high parental education (OR: 1.5, 95% CI: 1.1-2.1) and parental hay fever (OR: 1.5, 95%CI: 1.1-2.2). Risk factors for doctor-diagnosed asthma (DDA) were early pet contact (OR: 2.2, 95% CI: 1.1-4.8) and parental asthma (OR: 3.0, 95%CI: 1.0-9.1), whereas breastfeeding decreased the risk (OR: 0.5, 95% CI: 0.2-1.0). Boiling the pacifier/sucker daily increased the risk for wheezing in the past 12 months (OR: 1.4, 95%CI: 1.0-2.0) and revealed a tendency towards DDA (OR: 1.9, 95% CI: 0.9-4.0). CONCLUSION: In preschool children, we established an independent association between wheezing in the past 12 months, DDA and boiling frequency of the pacifier/bottle sucker during infancy. The impact of pacifier boiling frequency on atopic diseases on the basis of the hygiene hypothesis needs further investigation.     

高脂饮食与儿童哮喘或反复喘息关联性的系统评价和Meta分析

目的探讨高脂饮食与儿童哮喘或反复喘息的关联性。方法纳入研究对象为基于社区、学校和医疗机构的儿童,暴露因素为高脂饮食,观察与哮喘和反复喘息结局相关性的横断面研究和队列研究。计算机检索PubMed、Embase、Clinical trials、Central、Web of Science数据库、维普数据库、万方数据库和中国知网,检索截止日期为2018年4月1日。对纳入的文献行文献筛选、资料提取及方法学质量评价,横断面研究采用AHRQ评价工具,队列研究采用NOS评价工具。应用stata软件行Meta分析。结果12篇观察性研究（n=17 622）进入本文分析,年龄3~17岁。9篇为横断面研究（AHRQ 评分5篇8分,3篇7分,1篇6分）,3篇为队列研究（NOS评分2篇8分,1篇7分）。①儿童哮喘风险高脂较非高脂饮食人群高78%［敏感性分析后OR=1.78 (95%CI：1.44~2.21),P<0.001］,儿童哮喘与西方化的饮食习惯（OR=1.79, 95%CI: 1.28~2.51）、单一高脂食物（OR=1.86,95%：1.26~2.68）密切相关。②儿童反复喘息风险高脂饮食较非高脂饮食人群高33%［敏感性分析后OR=1.33 (95%CI：1.16~1.51),P<0.001］。Egger回归提示纳入文献不存在发表偏倚。结论高脂饮食与儿童哮喘和反复喘息密切联系。     

喘息婴幼儿鼻咽分泌物嗜酸粒细胞与血清特异性IgE的关系分析

目的 探讨婴幼儿喘息时鼻咽分泌物涂片中嗜酸粒细胞计数及与血清特异性IgE的关系.方法 选择2002-2004年收治的1个月～3岁的喘息及支气管肺炎患儿223例,分为3组,其中反复喘息(包括婴幼儿哮喘和喘息发作≥2次)组76例,毛细支气管炎组65例,支气管肺炎(无喘息症状)组82例.吸取鼻咽分泌物1ml进行嗜酸粒细胞计数,并测定血清特异性IgE的水平.结果 反复喘息组鼻咽分泌物嗜酸粒细胞计数明显高于其他两组,差异有统计学意义(P=0.000);反复喘息组血清食物变应原(fx5E)的阳性检出率及吸入性变应原(Phadiatop)阳性检出率均明显高于其他两组,差异有统计学意义(P=0.000),毛支组和支气管肺炎组之间差异则无统计学意义;血清特异性IgE与鼻咽分泌物嗜酸粒细胞计数之间存在显著正相关;鼻咽分泌物嗜酸粒细胞水平在同时存在喘息和特应性的患儿最高,在既没有喘息也无个人特应性的患儿最低,有喘息或血清IgE一项者介于两组之间.结论 鼻咽分泌物嗜酸粒细胞计数方法操作简单、无创、快速,费用低,且能在一定程度上反映哮喘的病理特征,与血清特异性IgE之间呈正相关,可以在临床进一步推广应用.     

Domestic allergen and endotoxin exposure and allergic sensitization in Cyprus

We investigated the relationship between domestic allergen and endotoxin exposure and allergic sensitization among children in Cyprus. We skin prick tested 128 children aged 15-16 yr (random samples of 85 children with self-reported asthma and 43 healthy controls) and measured their domestic exposure to endotoxin and allergens (mite, cat, and dog). We analyzed the data using multivariate logistic regression (adjusting for gender, area of residence and parental history) and presented the outcomes as odds ratios (OR) and 95% confidence intervals (CI). Among this selected population, 19% of children were sensitized to mite, 15% to cat and 7% to dog. Male gender (OR 2.74, 95% CI 1.18-6.38, p = 0.02), maternal history of allergic disease (OR 3.53, 95% CI 1.13-11.00, p = 0.03), increasing endotoxin (OR 1.58, 95% CI 1.00-2.49, p = 0.05) and residence in the district of Nicosia (OR 2.48, 95% CI 1.01-6.08, p = 0.05) were independent associates of allergic sensitization. Factors associated with mite sensitization were increasing Der p 1 and endotoxin exposure (OR 1.28, 95% CI 1.01-1.62, p = 0.04 and OR 1.76, 95% CI 1.01-3.08, p = 0.05, respectively) and living in an urban area (OR 6.80, 95% CI 1.37-33.67, p = 0.02). Sensitization to domestic pets was associated only with paternal allergic disease (cat: OR 5.68, 95% CI 1.57-23.56, p = 0.02; dog: OR 13.5, 95% CI 1.79-101.73, p = 0.01), but not with pet ownership or specific allergen or endotoxin exposure. In conclusion, mite allergen exposure was associated with sensitization to mite, but there was no association between cat and dog allergen exposure and specific sensitizations. Surprisingly, in this area, increasing endotoxin exposure was associated with an increased risk of sensitization.