孟鲁司特治疗儿童支气管哮喘的临床疗效观察

目的孟鲁司特联合布地奈德气雾剂吸入治疗合并过敏性鼻炎的轻、中度哮喘儿童临床疗效的前瞻性研究。方法将80例合并有过敏性鼻炎的轻、中度哮喘儿童随机分为治疗组和对照组。治疗组在吸入布地奈德气雾剂的同时加用孟鲁司特片,对照组则在吸入布地奈德气雾剂基础上加安慰剂,其余治疗相同。两组布地奈德气雾剂递减至最适有效剂量(无哮喘症状体征,β2激动剂吸入量无增加,呼气峰流速达预计值的80%以上,或变异率小于20%),并进行统计学分析。结果治疗组在加用孟鲁司特前后布地奈德吸入量减少差异有统计学意义(P<0.05),对照组在加用安慰剂前后布地奈德吸入量减少差异有统计学意义(P<0.05),而且两组比较差异亦有统计学意义(P<0.05)。结论孟鲁司特片联合布地奈德气雾剂治疗儿童合并过敏性鼻炎的哮喘,不仅能明显缓解哮喘和鼻炎的症状,还可以减少糖皮质激素、β2激动剂吸入量,取得了满意的疗效且无明显的不良反应。     

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目的观察布地耐德(BUD)联用福莫特罗(FOM)与单用双倍剂量BUD干粉吸入疗法对轻度持续性哮喘患儿的有效性和安全性,探讨儿童轻度持续性哮喘的理想治疗方案。方法选取2005-01—2005-06在广州医学院附属第一医院呼研所专科门诊就诊的轻度持续哮喘患儿50例,采取开放、随机、平行对照方法把50例患儿分为两组,分别吸入BUD联用FOM(B+F组)或双倍剂量BUD(Double B组)8周,药物均用都保干粉吸入装置吸入。8周的观察期内由患儿或家长记录哮喘日记,包括日间和夜间症状评分、无症状天数、其它平喘药物(包括应急用速效β2-受体激动剂、长效缓释茶碱、口服长效β2-受体激动剂、全身用糖皮质激素)使用情况,同时以简易峰流速仪监测其呼气峰流速值(PEF)作为主要肺功能指标。结果B+F组和Double B组在治疗8周后,日间症状及PEF均较治疗前明显改善,无症状天数明显增加,差异具有统计学意义(均P<0.05);与治疗前比较,B+F组在治疗8周后夜间症状评分明显下降(P<0.05),而Double B组治疗前后比较差异无统计学意义(P>0.05);两组间日间症状评分、夜间症状评分、无症状天数及PEF治疗前及治疗后比较差异均无统计学意义(均P>0.05)。两组间病情反复发作次数、需联合应用速效β2-受体激动剂次数及口服强的松、长效缓释茶碱或口服长效β2-受体激动剂的天数均无统计学意义(均P>0.05)。结论低剂量吸入糖皮质激素(ICS)联用长效β2-受体激动剂(LABA)与单用双倍剂量ICS治疗儿童轻度持续性哮喘的疗效相当。但从减少或避免ICS潜在的全身性副反应方面考虑,联用低剂量ICS+LABA可能是更好的选择。     

孟鲁司特治疗儿童支气管哮喘的临床疗效观察

目的孟鲁司特联合布地奈德气雾剂吸入治疗合并过敏性鼻炎的轻、中度哮喘儿童临床疗效的前瞻性研究。方法将80例合并有过敏性鼻炎的轻、中度哮喘儿童随机分为治疗组和对照组。治疗组在吸入布地奈德气雾剂的同时加用孟鲁司特片，对照组则在吸入布地奈德气雾剂基础上加安慰剂，其余治疗相同。两组布地奈德气雾剂递减至最适有效剂量（无哮喘症状体征，β2激动剂吸入量无增加，呼气峰流速达预计值的8096以上，或变异率小于20％），并进行统计学分析。结果治疗组在加用孟鲁司特前后布地奈德吸入量减少差异有统计学意义（P〈0．05），对照组在加用安慰剂前后布地奈德吸入量减少差异有统计学意义（P〈0．05），而且两组比较差异亦有统计学意义（P〈0．05）。结论孟鲁司特片联合布地奈德气雾剂治疗儿童合并过敏性鼻炎的哮喘，不仅能明显缓解哮喘和鼻炎的症状，还可以减少糖皮质激素、β2激动剂吸入量，取得了满意的疗效且无明显的不良反应。     

面罩储雾罐经鼻吸入糖皮质激素同步治疗小儿变应性鼻炎并哮喘

目的 探讨采用面罩储雾罐方式给药,经鼻吸入布地奈德(BUD)气雾剂同步治疗小儿变应性鼻炎并哮喘的临床疗效与成本.方法 将72例中～重度变应性鼻炎并轻一中度持续性哮喘的患儿随机分为实验组和对照组,实验组经面罩储雾罐鼻吸入BUD气雾剂400g/d,对照组经口吸入BUD干粉剂400μg/d联合使用BUD鼻喷雾剂256μg/d.进行哮喘和鼻炎的症状评分,监测第1秒时间肺活量(FEV1)、晨起呼气峰流速值(PEF),并进行治疗成本比较.结果 经过12周的临床观察,实验组和对照组的鼻炎症状评分明显下降(F=6.529和7.014,P均<0.01),两组的哮喘症状评分不断减低(F=4.132和4.950,P均<0.01),实验组和对照组的肺通气功能指标PEF(L/min)逐渐升高(F=2.750和3.282,P均<0.05).但两组间的症状评分、FEV1和PEF在入选时与治疗后的多次随访中比较,差异无统计学意义.实验组鼻腔干燥等副反应的发生率(5.6%)低于对照组(19.4%),但差异无统计学意义.平均治疗费用:实验组(244.0±12.8)元,对照组(403.2±17.6)元,差异有统计学意义(P<0.01).结论 面罩式储雾罐经鼻吸入糖皮质激素可同时有效控制小儿变应性鼻炎和哮喘,并有依从性高、副作用少、花费低等优点,适用于轻～中度持续性哮喘合并变应性鼻炎患儿.     

孟鲁司特治疗儿童中重度哮喘疗效观察

目的　观察孟鲁司特治疗儿童中重度哮喘的疗效和安全性。方法　将 88例 4～ 14岁哮喘患儿随机分为治疗组和对照组。治疗组在吸入激素的基础上加用孟鲁司特 (商品名 :顺尔宁 ) (4～ 6岁 4mg ,1次 /d ;6～ 14岁 5mg ,1次 /d) ,疗程 6周 ,治疗期间监测最大呼气流量 (PEF)、第 1秒末用力呼气量 (FEV1) ,记录患儿日间哮喘症状评分 ,夜间憋醒次数 ,咳嗽分数 ,吸入 β2 受体激动剂的使用喷数 ,无症状天数及药物副作用。疗程结束时对两组进行临床疗效判定。结果　治疗组肺功能有明显改善 (χ2 =2 5 .14　P <0 .0 1)。日夜间PEF均值治疗 1周后即显著上升 ;治疗后 6周日夜间PEF改善率为 12 .1%和 11.2 % ,对照组为 4 .7%和 5 .9% ,两组比较 ,差异均有显著性 (P <0 .0 5 )。治疗组 β2 爱体激动剂用量减少 5 7.2 % ,无症状天数增加 3d/周。结论　孟鲁司特治疗中重度哮喘起效迅速 ,临床控制率高 ,肺功能改善明显 ,无严重不良反应 ,患儿依从性好     

孟鲁司特钠单用于轻度持续哮喘患儿疗效和安全性的随机双盲安慰剂对照试验

目的：研究孟鲁司特钠单用于治疗5~14岁轻度持续哮喘患儿的疗效和安全性。方法：采用安慰剂随机双盲对照试验,对首诊诊断为轻度持续哮喘患儿,采用调查问卷方式采集患儿基线数据,经过2周安慰剂洗脱期,随机分为治疗组和对照组,分别睡前咀嚼口服孟鲁司特钠或安慰剂5 mg·d-1,疗程均为12周。在入组后4、8和12周记录哮喘日记卡内容：日间和夜间哮喘症状评分、β2受体激动剂使用频率、最大呼气峰流速（PEF）、因哮喘急性发作而需急诊或住院治疗的次数等;于治疗后12周检测肺功能指标：FEV1%预计值、FEF25%~75%。结果：2009年9月至2010年9月上海交通大学附属第一人民医院儿科哮喘专科门诊的轻度持续哮喘患儿安慰剂组纳入42例,孟鲁司特钠组纳入89例,至观察终点安慰剂组35例,孟鲁司特钠组77例进入分析。与安慰剂组相比,孟鲁司特钠组的PEF明显改善（P<0.05）;每周日间和夜间哮喘症状平均评分、每月因哮喘发作而需急诊或住院就诊率和每周平均β2受体激动剂使用次数均下降,差异有显著统计学意义（P<0.01）;治疗后12周孟鲁司特钠组FEV1%、FEF25%~75%较安慰剂组显著提高（P<0.05）;研究期间两组患儿均未观察到不良反应事件。结论：孟鲁司特钠单独用于轻度持续性哮喘患儿具有良好的疗效,不良反应少,患儿依从性高。     

布地奈德/福莫特罗干粉吸入剂治疗支气管哮喘的疗效

目的 探讨布地奈德/福莫特罗干粉吸人剂治疗儿童支气管哮喘的疗效、依从性和安全性.方法 采用随机、开放、平行对照研究方法,44例支气管哮喘患儿分为A组(布地奈德/福莫特罗干粉吸入剂,30例)和B组(布地奈德干粉吸入剂加福莫特罗干粉吸入剂,14例).A组使用单个吸入器吸入布地奈德/福莫特罗干粉吸入剂[80μg(布地奈德)/4.5μg(福莫特罗)/吸],1吸/次,2次/d,共12周;B组每天分别使用2个吸入器吸入布地奈德干粉吸入剂(100μg/吸)和福莫特罗干粉吸入剂(4.5μg/吸),1吸/次,2次/d,共12周.观察二组患儿每天症状评分、视觉近似评价量尺(VAS量尺)、最大呼气峰流速[最大呼气流量(PEF)占预计值%]、肺功能[一秒钟用力呼气量(FEV1)占预计值%]和不良事件发生情况.采用SPSS 11.0软件进行统计学分析.结果 用药后,二组哮喘患儿的临床症状均改善.治疗8、12周A组改善明显,与B组比较差异显著(Z=-2.223,-2.042 Pa<0.05);治疗8、12周VAS量尺评分A组降低较B组明显(Z=-3.877,-3.536 Pa<0.05);PEF占预计值%和FEV1占预计值%二组均有改善,A组在治疗4周PEF占预计值%改善快于B组(Z=-2.602 P<0.05).A组在治疗12周FEV1占预计值%改善优于B组(Z=-1.966 P<0.05),二组均无明显不良事件发生.结论 布地奈德/福莫特罗干粉吸入剂和布地奈德干粉吸入剂加福莫特罗干粉吸人剂联合治疗哮喘患儿都具有良好的疗效和安全性,但布地奈德/福莫特罗干粉吸入剂起效更快,使用更方便,患儿依从性更好.     

小儿变应性鼻炎173例疗效分析及随访

目的 探讨小儿变应性鼻炎(AR)的疗法与疗效、预后的关系.方法 2001-2006年将广东省揭阳市人民医院收治的173例AR患儿随机分成对照组,吸入糖皮质激素组(IC组),口服孟鲁司特钠组(MT组),吸入糖皮质激素加孟鲁司特钠组(I-M组).对照组予口服酮替芬＜3岁每次0.5ng,每日2次,≥3岁每次1mg,每日1～2次.IC组在对照组治疗基础上,吸入丙酸氟替卡松定量气雾荆,每次125μg,每日1次,采用带有活辩的储雾罐辅助吸入,若患儿能够配合,嘱其闭口,用鼻呼吸,充分吸入罐内药雾.MT组在对照组治疗基础上,口服盂鲁司特钠每天1次,每次5mg.I-M组为IC组与MT组治疗的组合.疗程均为3个月.分别于治疗2周、3个月后评价疗效.疗程结束后1年比较各组AR复发率及哮喘发生率.结果 治疗2周后,4组总有效率差异无统计学意义(P＞0.05).治疗3个月后,总有效率I-M组高于IC组和MT组(P均＜0.05),显著高于对照组(P＜0.01);IC组和MT组高于对照组(P均＜0.05),而IC组与MT组之间差别无统计学意义(P＞0.05).治疗结束1年后AR加重或复发及哮喘发生率I-M组低于IC组及MT组(P＜0.05),显著低于对照组(P＜0.01),IC组和MT组低于对照组(P＜0.05),而IC组与MT组之间差异无统计学意义(P＞0.05).四组副反应发生率差异无统计学意义(P＞0.05).结论 酮替芬在短期内控制AR症状有良效.但2周后如果疗效不佳应考虑加用其它药物.联合用药有协同效果.使用带有活瓣的储雾罐用鼻吸入丙酸氟替卡松加服孟鲁司特钠和酮替芬疗效最佳,且可减少AR复发及发生哮喘.     

布地奈德雾化吸入联合中药内服防治儿童哮喘缓解期疗效观察

目的观察布地奈德雾化吸入联合中药内服防治儿童哮喘的疗效。方法将120例哮喘缓解期儿童随机分为联合组与西药组各60例。两组均常规健康宣传教育,布地奈德雾化吸入治疗,联合组同时加服补肾纳气散,疗程1年。测定肺活量(FVC)、第1秒用力呼气量(FEV1)、FEV1实际值占预计值百分比(FEV1%pred)、FEV1占用力肺活量百分比(FEV1/FVC)、呼气峰流速(PEF)、呼气峰流速百分比(PEF%)。结果治疗后两组FEV1、FEV1%pred、FEV1/FVC和PEF%均高于治疗前,差异有统计学意义(P<0.05);联合组治疗后FEV1、FEV1%pred、PEF%明显高于西药组,差异有统计学意义(P<0.05);治疗期间联合组和西药组急性发作分别是0.97人次和1.65人次,差异有统计学意义(P<0.05)。结论中西医结合防治儿童哮喘的效果优于单纯布地奈德治疗。     

支气管哮喘患儿缓解期不同激素吸入治疗方案与疗效的关系

目的研究支气管哮喘(哮喘)缓解期患儿糖皮质激素(GCS)不同吸入治疗方案与缓解治疗期个体依从性及疗效的关系。方法轻、中度哮喘患儿323例,采用硫酸特布他林250μg/次,3次/d;布地奈德200μg/次,2次/d吸入治疗。必要时加用口服支气管扩张剂治疗4周,临床缓解后进入为期12周的缓解期治疗;将缓解治疗患儿随机分为3组,布地奈德100μg,1次/d(A组);100μg.2次/d(B组);200μg,1次/d(C组)。分别于第4、8、12周调查吸入依从性.同时进行日间、夜间评分和(或)肺功能测定.并于第12周末对其疗效进行分析。结果中度哮喘活动期B组87%以上在4周内达到临床缓解;缓解治疗期随时间延长,虽然各组吸入依从率均逐渐降低,但以B组最明显,与A、C组比较均有显著差异(P<0.05,0.01),吸入依从率与用药剂量和用药次数均密切相关,12周结束时吸入缓解率C组明显高于A组(P<0.01);总缓解率C组明显高于A组(P<0.01)和B组(P<0.05)。结论布地奈德200μg2次/d,可有效控制轻、中度哮喘;200μg/d可使80%以上的哮喘息儿持续临床缓解。布地奈德吸入治疗应个体化。     

哮喘患儿PBMC中β_2AR和IL-12基因mRNA表达及相互关系

目的探讨β2受体(β2AR)和IL-12基因mRNA表达与儿童哮喘的相关性,白三烯受体(CysLT1-Receptor)基因表达水平与IL-12、β2AR基因表达的关系,以及儿童哮喘发作程度与β2AR和IL-12基因表达的关系。方法提取哮喘儿童外周血白细胞,调取相关基因,对电泳结果通过电泳凝胶定位成像仪成像,应用1D-凝胶分析软件进行半定量分析。结果哮喘组患儿白细胞IL-12、β2AR表达明显低于正常组(P<0.01)。哮喘发作时IL-12基因表达与β2AR基因表达呈正相关(r=0.34,P=0.001),与CysLT1-Receptor基因表达呈负相关(r=-0.92,P=0.001);β2AR与CysLT1-Receptor呈负相关(r=-0.85,P=0.003)。IL-12基因表达与哮喘发作程度无关(P=0.16);β2AR基因的表达与哮喘发作程度呈负相关(P=0.003)。结论IL-12、β2AR和CysLT1-Receptor基因在哮喘儿童外周血单个核细胞(PBMC)中的表达存在相关性。IL-12基因表达与哮喘的发作程度无关,β2AR基因表达与哮喘的发作程度呈负相关。     

Respiratory allergy

Allergic rhinitis (AR) and asthma are common respiratory allergic disorders which are increasing globally more in developed countries. Although much has been written about childhood asthma and guidelines published by various international and national fora, not much information is available on AR. This is most common in children, is a significant risk factor for developing asthma, is a common comorbidity with asthma and affects quality of life. This paper highlights the risk factors for developing respiratory allergy asthma and AR, linkages between them and the management issues, particularly in relation to the allergic or allergological aspects as they have important bearing on management of children suffering from respiratory allergy. Specific immunotherapy (SIT) is re-emerging as useful therapy which alone has the potential to modify the natural history of disease and prevent the ‘allergic march’. Timely diagnosis, correct management including timely referrals can ensure good quality life for those suffering from respiratory allergies.     

Marche allergique chez l’enfant,de la rhinite à l’asthme : prise en charge,place de la désensibilisation

Allergic rhinitis (AR) is a common IgE dependent disorder. AR is maybe one of the steps of the allergic march, which starts with atopic dermatitis and food allergy and includes atopic asthma. AR and asthma are frequently associated. AR is frequently under-diagnosed and undertreated although it affects quality of life and school performance. Management of AR depends on its severity and will associate environmental control (best guided by environmental investigation and skin testing of specific IgE antibodies), pharmacotherapy (with antihistamines and intranasal corticosteroids as first line drugs). At present allergen immunotherapy is considered in patients with severe AR, insufficiently controlled by pharmacotherapy and who demonstrate specific IgE antibodies to relevant allergens. Sublingual immunotherapy is well tolerated. Only immunotherapy with the right allergens has the potential to alter the natural history of the allergic march, by preventing the development of new allergen sensitizations and reducing the risk for the subsequent development of asthma. This fact might extend the indications of specific allergen immunotherapy. Patients (and parents) education is of utmost importance in the management of allergic disorders.     

儿童变应性鼻炎合并支气管哮喘协同治疗及管理研究进展

儿童变应性鼻炎和支气管哮喘常在同一个体共存,两者交互影响疾病进程及疾病严重程度。国内外研究显示给予变应性鼻炎合并哮喘患儿糖皮质激素、口服白三烯受体拮抗剂和皮下/舌下过敏原特异性免疫治疗,可协同治疗两种疾病。由于变应性鼻炎和哮喘均为慢性呼吸道疾病,需要长期随访并阶梯性调整用药,因而患儿及照护者的自主评估有助于疾病的协同管理,慢性疾病管理工具对疾病的协同管理亦是不可或缺的。重视儿童变应性鼻炎和哮喘协同治疗和管理,对提高治疗依从性,改善生活质量,减轻疾病负担有重要意义。     

Efficacy of sublingual specific immunotherapy in intermittent and persistent allergic rhinitis in children: an observational case–control study on 171 patients. The EFESO-children Multicenter Trial

Sublingual‐specific immunotherapy (SLIT) is considered as a valid treatment of respiratory allergies. However, there are few data on large sample size regarding its clinical role in ‘real life’ in term of reduction of symptoms, rescue medications and prevention of asthma in patients suffering from allergic rhinitis (AR) especially in children. We performed a multicenter, case–control study to evaluate the effect of SLIT in children (age 6–18 yr) with intermittent or persistent AR. 171 children (27% girls and 73% boys) with AR due to seasonal or perennial allergens were enrolled in a multicenter case–control study. Cases (n = 90) were defined as patients with intermittent (64%) or persistent (36%) AR who were treated for at least two consecutive years with specific SLIT with the related allergen extracts (SLITone^® ALK‐Abellò). Controls (n = 81) were defined as sex‐age‐ and type of allergen matched AR children who were never treated with specific immunotherapy and had no asthmatic symptoms at the beginning of observation period. Main outcomes of the study were the rhinoconjunctivitis symptom score (SS) (sneezing, rhinorrea, nasal itch, congestion, ocular itch and watery eyes) with a ranging scale from 0 (=no symptoms) to 3 (=severe symptoms) and the medication score (MS) evaluating symptomatic drug intake (antihystamine and inhaled corticosteroids). SS and MS were evaluated at the end of the observational period in relation with the period, considering the last 12 months, in which patients suffered the highest symptoms levels (i.e., peak of relevant pollen season (seasonal AR) or during the period of maximum allergen exposure in case of perennial AR). Secondary outcome of the study was the development of asthma symptoms during the observation period. SS (mean ± SD) was 4.5 ± 2.5 in cases and 9.0 ± 3.0 in controls (?50%) (p = 0.0001). MS (mean ± SD) was 2.5 ± 1.9 and 3.6 ± 2.1 in the case and control groups, respectively (?31%) (p = 0.0001). At the end of the observation period asthma symptoms were present in 14 subjects in the case group (15%) and in 20 children (24%) in the control group (p = 0.13). New skin sensitizations appeared in 6% of cases (n = 2) and in 36% (n = 12) of the controls (p = 0.001). The EFESO trial shows that a 2‐yr once daily SLIT treatment in children with intermittent or persistent AR is associated with lower symptom and medication scores in comparison with subjects treated with symptomatic drugs only.     

Neonatal hyperbilirubinemia and childhood allergic diseases: a systematic review

Studies have found a link between neonatal hyperbilirubinemia (NNH) and/or neonatal phototherapy (NPT) and childhood allergic diseases. The present systematic review was conducted to provide updated evidence and to provide direction regarding future research. A systematic search of the published literature was carried out. Observational studies including children up to 12 yr of age were included. Data extraction was carried out using a standardized data extraction form that was designed and pilot tested a priori. The analysis was carried out with the statistical software RevMan (version 5.2) [Protocol is registered at PROSPERO: CRD42014009943]. Of 79 citations retrieved, a total of 7 good quality studies (n = 101,499) were included in the final analysis. There was a significant increase in the odds of asthma and allergic rhinitis (AR) after NNH [asthma, OR 4.26 (95% CI 4.04–4.5); AR, OR 5.37 (95% CI 4.16–6.92)] and after NPT [asthma, OR 3.81 (95% CI 3.53–4.11); AR, OR 3.04(95% CI 2.13–4.32)]. A similar increase in the trend was noted for late onset of asthma after NNH [OR 4.1 (95% CI 2.82–5.94)], and hospitalization due to asthma after NPT [OR 3.56 (95% CI 2.93–4.33)]. The GRADE evidence generated was of ‘low quality’. The current evidence finds a significant increase in the odds of childhood allergic diseases after NNH and/or NPT. As observational studies were included, the evidence generated was of ‘low quality’. Future studies should try to elucidate the pathophysiologic link between NNH and/or NPT and childhood allergic diseases.     

Aeroallergen sensitisation patterns of children aged 5 years and younger with asthma and/or allergic rhinitis in Istanbul

Aim of the studyThe purpose of the study was to determine the aeroallergen sensitisation patterns of children aged 5 years and younger with asthma (AS) and/or allergic rhinitis (AR) in Istanbul, Turkey.MethodsThis cross-sectional observational study was conducted between January and December 2018 in the outpatient clinic of a hospital department of pediatric allergy. Patients, who had regular outpatient controls, full clinical and laboratory records, positive skin prick test results, and were willing to participate in the study, were included.ResultsIn total, 148 children aged 5 years or younger who had positive skin prick test results were included in the study. The male/female ratio and the mean age at onset of symptoms were 87/61 and 2.13 ± 1.33 (0.4–4.5) years, respectively. Of the 148 patients, 63 (42.6%) had AS, 11 (7.4%) AR, and 74 (50.0%) had both AS and AR. The age of the patients, age at symptom onset, male/female ratio, number of allergen sensitivities, total IgE levels, total eosinophil levels, and skin prick test results for aeroallergens did not differ between the patients with AS, AR, and AS + AR. House dust mite (HDM) was the most common aeroallergen in patients, while the cockroach was the least common aeroallergen. The severity of asthma and control levels were not found to be associated with aeroallergen sensitisation in children.ConclusionOne out of every four atopic children aged 5 years or younger is sensitised to aeroallergens. The most common sensitisation is to house dust mites. Weed aeroallergen may be related to severity of asthma in children aged 5 years or younger in Istanbul. We speculate that HDM and weed allergens could be used in the diagnostic or treatment strategies for the management of asthmatic children aged 5 years or younger.     

过敏性鼻炎的诊断与治疗新进展

介绍过敏性鼻炎（AR）的诊治新进展。遗传和环境因素被认为是AR的病因学因素,AR与哮喘常相伴发生。1999年世界卫生组织出台的“过敏性鼻炎及其对哮喘的影响”指南（ARIA）及过敏症报告,提供了规范的诊断方法及治疗指南,强调了AR对哮喘的影响,并对AR进行了新的分类。最常用的诊断试验包括皮肤试验及检测特异性血清lgE抗体（放射性过敏原吸附试验）。而标准化的鼻部激发试验（nasal provocation testing,NPT）在鉴别AR与非AR应用中,是一个十分有效且安全的方法。AR的治疗一般包括避免接触变庙原、药物治疔、侍疫疗法及手术疗法等。     

Allergy march of Chinese children with infantile allergic symptoms: a prospective multi-center study

Background:Allergy march refers to progression of allergic diseases from infantile food allergy to the development of asthma and allergic rhinitis (AR).Evidence come mostly from studies in European countries.This study aimed to investigate allergy march in Chinese children with infantile food protein allergy (FPA) with a special focus on the effect of different formula interventions.Methods:From 2008 to 2010,153 infants diagnosed with FPA were recruited in five tertiary hospitals across China.They were randomly treated with amino-acid-based formula or soy-protein-based formula for a period of 3 months.Long-term follow-up was performed when they reached early school age,using questionnaires,physical examinations,and serum-specific immunoglobulin E.Results:The overall follow-up rate was 73.20％.In patients who reached their early school years,the prevalence of physician-diagnosed AR and asthma were 43.75％ and 23.21％,respectively.Only 40％ of the subjects remained positive for food sensitizations upon follow-up.Twenty-six subjects receiving aeroallergen screening tests in infancy all proved negative,but upon follow-up,65.57％ were sensitized to aeroallergens (P=0.005).No significant difference between the effects of amino-acid-based formula and soy-protein-based formula on children's allergy march was observed.Conclusions:A high proportion (47.32％) of Chinese infants with early allergic symptoms developed respiratory allergies by their early school years.Most food-sensitized infants outgrew their condition several years later,but then aeroallergen sensitization often occurred.Amino-acid-based formula showed no advantages over soy protein-based formula with respect to arresting the allergy march.     

Obesity and the prevalence of allergic diseases in schoolchildren

Although the association between obesity and bronchial asthma (BA) has been gaining more attention, few studies have been conducted concerning the relationship between obesity and other allergic diseases. The objective of this study was to determine whether and how childhood obesity is associated with allergic diseases other than BA, such as atopic dermatitis (AD), allergic rhinitis (AR), allergic conjunctivitis (AC), and either AR or AC (AR/AC). A questionnaire was administered to the parents of 50,086 Japanese schoolchildren. Associations between childhood obesity and the various allergic diseases were evaluated by univariate and multivariate logistic models. Significant associations were found between higher body mass index (BMI) and AD (p = 0.03), and lower BMI and AC (p < 0.0001), and AR/AC (p < 0.0001). There was a significantly higher prevalence of BA in girls with obesity (p = 0.009) than in those without obesity. Significantly lower prevalence of AC (p = 0.01) and AR/AC (p = 0.002) among children with obesity, and AR (p = 0.04) and AR/AC (p = 0.0004) among boys with obesity were observed than those without obesity. Those who were obese and had AD were significantly more likely to have severe symptoms (p = 0.01). Overall, childhood obesity has positive associations with BA prevalence and AD severity, whereas it has negative associations with AR and AC prevalence, especially among boys. Changes in the immunologic balance accompanied by obesity might have different effects on each type of allergic disease. Exploring the mechanisms by which childhood obesity affects allergic status should lead to new management options for childhood allergy.