变应性鼻炎患者变应原特异性免疫治疗引起免疫耐受的机制研究

目的 探讨变应原特异性免疫治疗引起变应性鼻炎(AR)患者免疫耐受形成的机制.方法 螨过敏AR患者50例,分为免疫治疗组30例和药物治疗组20例,设正常对照组20例.免疫治疗组于治疗前及治疗后3个月、1年、2年采集血清标本.药物治疗组于治疗前和治疗后3个月采集血清标本；正常对照组入组后采集血清标本.采用酶联免疫吸附(EL...     

免疫治疗对变应性鼻炎患者鼻分泌物中螨变应原特异性IgG1和IgG4抗体水平的影响

目的检测变应性鼻炎患者和健康人群鼻分泌物中螨变应原特异性IgG1和IgG4抗体水平,以了解变应原特异性IgG亚型抗体在人群鼻分泌物中的分布和免疫治疗对抗体浓度的影响.方法利用负压吸引法收集健康人群、变应性鼻炎未治疗组和免疫治疗组患者的鼻分泌物,采用间接非竞争生物素-链亲和素酶联免疫法检测鼻分泌物中粗制螨变应原、螨纯化变应原Der fⅠ和Der fⅡ各变应原特异性IgG1和IgG4亚型抗体浓度.结果变应性鼻炎患者鼻分泌物中螨粗制变应原特异性IgG1和IgG4抗体浓度均高于健康人(Z=-3.623、-3.061,P均<0.01);免疫治疗组患者IgG1和IgG4抗体浓度均高于非治疗组(Z=-2.453、-3.408,P均<0.01).免疫治疗组变应性鼻炎患者鼻分泌物中螨纯化变应原Der fⅠ特异性IgG4抗体水平较健康人群增高(Z=-3.518,P<0.01);而免疫治疗组Der f Ⅱ特异性IgG1和IgG4抗体水平均高于健康人(Z=-2.366、-2.936,P均<0.01)和未治疗组(Z=-2.366、-2.937,P均<0.01).IgG1和IgG4亚群抗体中,螨粗制抗原、Der fⅠ和Der f Ⅱ特异性抗体水平相互间具有相关性;三类变应原特异性IgG1和IgG4抗体间存在相关性;免疫治疗组患者鼻分泌物中螨粗制变应原IgG1和IgG4抗体与血清中特异性IgE抗体间具有相关性. 结论健康人群和变应性鼻炎患者均具有对其环境变应原产生特异性IgG1和IgG4抗体的能力,而变应性鼻炎患者具有更高的反应性,能产生高于健康人的特异性IgG亚型抗体,而变应原特异性免疫治疗能显著增加鼻分泌物中IgG1和IgG4抗体的水平.鼻分泌物中IgG1和IgG4抗体的增加可能是免疫治疗有效的机制之一.     

Correlation between nasal polyposis and perennial allergy exemplified by house dust mite and house dust allergy

A total of 139 patients with nasal polyps were investigated by a standardized history, intradermal skin test and nasal challenge to house dust mite allergy. The aim of the study was to assess the disputed role of perennial allergy in patients with nasal polyps using allergens to the house dust mite as an example. Using our diagnostic criteria we found allergy to house dust mite in 28% of all cases. We found this diagnosis in 44.8% of patients aged 10-39. We recommend, especially in this age group, an allergy test, if necessary with the appropriate therapy. Test correlations are illustrated in 174 patients who have been examined by the above methods. Good reproducibility was found by the nasal challenge, which led to the right diagnosis in 92%, compared with 81% by a standardized history. Therefore, it can be considered to be the key to the diagnosis of allergy.     

Audiological findings in pediatric perineal allergic rhinitis (house dust mite allergy) patients

Allergic rhinitis is the type 1 hypersensitivity reaction of the nasal mucosa and its primary mediator is Ig E. It is most frequently observed in children and adolescents. Our purpose in this study is to investigate the impact of allergy on hearing functions in children with perineal allergic rhinitis (house dust mite allergy). 50 perineal allergic rhinitis (house dust mite allergy) patients (33 male, 17 female patients, aged between 6 and 15, average age 10.4) and 20 control patients (12 male, 8 female, aged between 6 and 15, average age 11.2) underwent high frequency pure tone audiometry, acoustic reflex, otacoustic emission (OAE) and auditory brainstem potentials to assess their auditory functions. No statistically significant difference was detected between the study group and the control group with respect to their hearing thresholds (250–16,000 Hz). No statistically significant difference was detected as a result of the comparison between the study group and control group in terms of their signal–noise ratios at Distortion Product OAE in all frequencies (996–8,004 Hz). No statistically significant difference was detected between the study group and the control group in terms of the 1st, 3rd and 5th wave latencies and 1–3, 3–5 and 1–5 inter-peak values. This study is the first study where the audiological functions of the pediatric perineal allergic rhinitis (house dust mite allergy) patients were assessed. No significant difference was detected between the group of pediatric perineal allergic rhinitis (house dust mite allergy) patients and the control group with respect to their audiological functions.     

免疫治疗对变应性鼻炎患者鼻分泌物中螨变应原特异性IgG1和IgG4抗体水平的影响

目的检测变应性鼻炎患者和健康人群鼻分泌物中螨变应原特异性IgG1和IgG4抗体水平，以了解变应原特异性IgG亚型抗体在人群鼻分泌物中的分布和免疫治疗对抗体浓度的影响。方法利用负压吸引法收集健康人群、变应性鼻炎未治疗组和免疫治疗组患者的鼻分泌物，采用间接非竞争生物素一链亲和素酶联免疫法检测鼻分泌物中粗制螨变应原、螨纯化变应原Der f Ⅰ和Der f Ⅱ各变应原特异性IgG1和IgG4亚型抗体浓度。结果变应性鼻炎患者鼻分泌物中螨粗制变应原特异性IgG1和IgG4抗体浓度均高于健康人(Z=-3．623、-3．061，P均＜0．01)；免疫治疗组患者IgG1和IgG4抗体浓度均高于非治疗组(Z=-2．453、-3．408，P均＜0．01)。免疫治疗组变应性鼻炎患者鼻分泌物中螨纯化变应原DerfI特异性Igc,4抗体水平较健康人群增高(Z=-3．518，P＜0．01)；而免疫治疗组DerfⅡ特异性IgG1和IgG4抗体水平均高于健康人(Z=-2．366、-2．936，P均＜0．01)和未治疗组(Z：-2．366、-2．937，P均＜0．01)。IgG1和IgG4亚群抗体中，螨粗制抗原、Der f Ⅰ和Der f Ⅱ特异性抗体水平相互间具有相关性；三类变应原特异性IgG1和IgG4抗体间存在相关性；免疫治疗组患者鼻分泌物中螨粗制变应原IgG1和IgC4抗体与血清中特异性IgE抗体间具有相关性。结论健康人群和变应性鼻炎患者均具有对其环境变应原产生特异性IgG1和IgG4抗体的能力，而变应性鼻炎患者具有更高的反应性，能产生高于健康人的特异性IgG亚型抗体，而变应原特异性免疫治疗能显著增加鼻分泌物中IgG1和IgC4抗体的水平。鼻分泌物中IgG1和IgG4抗体的增加可能是免疫治疗有效的机制之一。     

Tropomyosin sensitization in house dust mite allergic patients

The growing popularity and frequency of consumption of seafood is accompanied by an increasing number of adverse reactions reported in literature. Allergic reactions to seafood can generate a variety of symptoms ranging from a mild oral allergy syndrome to keen anaphylactic reactions. Tropomyosin, the major shellfish allergen is regarded to be responsible for clinical cross-reactivity to inhaled house dust mites. The aim of the study was to investigate the prevalence of sensitization to tropomyosin in house dust mite allergic patients in southern Bavaria and to compare the results with allergic symptoms. Sera of house dust mite allergic patients (positive skin prick test, allergen-specific IgE and intranasal provocation) were screened for IgE antibodies to tropomyosin (Der p 10). Patients were contacted by phone to evaluate allergic symptoms when consuming seafood. IgE antibodies to house dust mite tropomyosin (Der p 10) could be found in 4 out of 93 sera (4.3%). Two of these four patients (50%) showed itching and swelling of oral mucosa accompanied by bronchial obstruction after consumption of shrimp. Two patients had no problems when eating seafood. None of the seronegative patients complained about any health problems during or after consumption of seafood. In conclusion, cross-reactivity to tropomyosin in house dust mite allergic patients in southern Bavaria, Germany is rarer than suspected. Beside the direct allergic reactions, a further part of reactions to seafood must therefore be ascribed to other mechanisms such as intoxication or intolerance to, e.g. additives in the food product.     

尘螨疫苗皮下注射治疗变应性鼻炎的疗效和安全性评估

目的 本研究旨在通过使用标准化尘螨疫苗对变应性鼻炎伴或不伴支气管哮喘的患者进行2年皮下免疫治疗,探讨尘螨皮下免疫治疗的疗效和安全性。 方法 纳入58例对尘螨过敏(单一过敏35例,多重过敏23例)的变应性鼻炎患者,伴或不伴支气管哮喘。在治疗前与治疗后的第6、12、24个月,分析症状评分、视觉模拟量表评分和生活质量评分的变化,观察记录发生的局部及全身不良反应。 结果 与治疗前相比,鼻部症状和哮喘症状评分在治疗6个月后均显著降低(P<0.05),并在2年治疗期内呈持续性下降。治疗2年后,单一过敏患者和多重过敏患者的症状评分差异无统计学意义(P>0.05)。皮下免疫治疗6、12、24个月后,鼻炎和哮喘的相关生活质量也得到了显著改善(P<0.05)。发生的不良反应以局部反应为主,未出现严重不良反应。 结论 皮下免疫治疗是针对尘螨引起的变应性鼻炎的一种安全、有效的治疗方法,对于变应性鼻炎合并支气管哮喘的患者,也能取得显著的疗效。     

舌下含服粉尘螨滴剂治疗儿童变应性鼻炎的临床疗效与安全性评估

目的比较舌下含服标准化粉尘螨滴剂治疗不同程度尘螨过敏的变应性鼻炎患儿的疗效。方法 137例尘螨过敏的患儿,按变应原皮肤点刺试验结果分为两组,＂＋＋＂、＂＋＋＋＂组为A组（62例）,＂＋＋＋＋＂组为B组（75例）,采用标准化粉尘螨滴剂进行舌下特异性免疫治疗（SLIT）1年,记录和比较两组治疗前和治疗后1年的症状评分和药物评分,同时比较两组间的疗效。应用SPSS 19.0软件对数据进行统计学分析。结果 109例尘螨患儿完成1年SLIT,两组患儿治疗前后症状评分均得到明显改善,A组尘螨过敏的患儿组治疗前后症状评分分别为（10.34±1.25）、（2.85±1.47）分,B组尘螨过敏的患儿组治疗前后症状评分分别为（11.24±1.55）、（3.74±1.66）分,组内比较差异均有统计学意义。但两组间症状评分的改善无明显差异。同样,两组患儿治疗前后药物评分均得到明显改善,A组尘螨过敏的患儿组治疗前后药物评分分别为（1.37±0.35）、（0.45±0.27）分,B组尘螨过敏的患儿组治疗前后药物评分分别为（1.56±0.42）、（0.52±0.31）分,组内差异具有统计学意义,但两组之间药物评分的改善无明显差异。结论舌下含服标准化粉尘螨滴剂可以明显改善不同程度尘螨过敏儿童变应性鼻炎患儿的鼻部症状,减少对症药物应用,不同程度尘螨过敏儿童变应性鼻炎患儿之间免疫治疗疗效无明显差异。因此舌下含服标准化粉尘螨滴剂对所有不同程度尘螨儿童变应性鼻炎患儿都有疗效。     

Nasal pharmacodynamics of brompheniramine in perennial rhinitis

This study evaluated the relationship between brompheniramine maleate and changes in nasal reactivity. Ten subjects with moderate-to-severe perennial rhinitis took brompheniramine for seven days using either a standard formulation or sustained-release preparation. Nasal aerodynamics and response to histamine were assessed at the end of the week. Despite varying doses of brompheniramine maleate (12 to 32 mg/d), there was no significant difference in nasal reactivity to histamine or in changes of nasal airflow, indicating that low doses of brompheniramine are highly effective in blocking histamine, receptors in the nasal mucosa.     

屋尘螨变应原制剂治疗变应性鼻炎的临床疗效观察

目的:评价屋尘螨变应原制剂治疗变应性鼻炎(AR)的临床疗效。方法:采用病例自身对照的方法,通过比较55例AR患者在接受2年的屋尘螨变应原制剂特异性免疫治疗前后的症状、体征积分,观察该制剂的临床疗效。结果:55例患者在完成特异性免疫治疗后的症状、体征积分较治疗前均明显减少,差异具有统计学意义(P<0.01)。结论:屋尘螨变应原制剂是治疗尘螨引起的AR的一种有效治疗方法。     

尘螨变应性鼻炎特异性免疫治疗的疗效预测指标探讨

目的 观察变应性鼻炎(AR)患者接受变应原特异性免疫治疗1年后血清总IgE(tIgE)和特异性IgE(sIgE)水平的变化,探讨皮下免疫治疗(SCIT)和舌下免疫治疗(SLIT)的疗效预测指标。 方法 以尘螨致敏的中-重度持续性AR患者完成免疫治疗1年的病例作为研究对象,采用患者自评的方式对治疗效果进行主观评价,比较治疗前后血清tIgE、屋尘螨(Dp)和粉尘螨(Df)sIgE水平的变化,并依据治疗有效与否进行分层分析。对免疫治疗前患者的基线血清IgE抗体水平与治疗效果的关系进行分析,应用ROC曲线获得具有最佳预测效果的血清指标及其最佳临界值(cut-off值)。 结果 完成1年免疫治疗的SCIT组(50例)和SLIT组(58例)患者中,有效率分别为64.0%和65.5%,两组治疗效果的差异无统计学意义(P>0.05)。免疫治疗1年后与治疗前相比较,两组血清tIgE、Dp-sIgE和Df-sIgE水平的变化均无统计学意义(P>0.05),仅SCIT组有效患者血清Dp-sIgE水平的下降有统计学意义(P<0.05)。基线血清Dp-sIgE/tIgE比值对SCIT疗效具有最佳预测效果,其最佳cut-off值为11.95%,敏感性为71.9%,特异性为83.3%。而基线血清Df-sIgE水平对SLIT疗效具有最佳预测效果,其最佳cut-off值为27.95 IU/ml(4级),敏感性为52.6%,特异性为85.0%。 结论 免疫治疗前患者的血清sIgE水平可在一定程度上对治疗效果进行预测,sIgE水平较高或sIgE/tIgE比值较大的患者更容易取得满意疗效。     

Nasal hyper-responsiveness to histamine, methacholine and phentolamine in patients with perennial non-allergic rhinitis and in patients with infectious rhinitis

Recently it has been shown that patients with atopic rhinitis and with an allergy to house dust mites have a stronger nasal response to insufflation of histamine, methacholine and phentolamine than a control group. This hyper-responsiveness could not be demonstrated in patients with perennial non-allergic rhinitis, unless the patients were selected according to the predominant symptoms in the history. Patients with rhinorrhoea ('runners') proved to be hyper-responsive to methacholine compared with normal controls. The existence of two subpopulations was emphasized by hyper-responsiveness to both histamine and methacholine in the runners group compared with the patients with a stuffy nose ('blockers'). Patients with chronic nasal infections (characterized by recurrent episodes of purulent discharge) showed no hyper-responsiveness at all, indicating that either hyper-reactivity does not play an important part in this patient population or methods to detect hyper-reactivity in this group are inadequate. In contrast to our earlier observations in patients with atopic rhinitis, increased responsiveness to phentolamine could not be detected either in the patients with perennial rhinitis or in the patients with infectious rhinitis, indicating that the possible alpha-adrenergic dysfunction found in patients with atopic rhinitis is restricted to this group.     

粉尘螨点刺试验与粉尘螨鼻黏膜激发实验相关性分析

目的评价目前粉尘螨过敏的常年性变应性鼻炎（AR）患者皮肤点刺试验（skin prick test,SPT）和鼻黏膜激发实验（nasal provocation test,NPT）的相关性。方法选择90例临床症状及体征符合常年性AR的患者行SPT及NPT。结果粉尘螨SPT及NPT灵敏度分别为84.6%和100%,其SPT及NPT的特异度分别为94.1%和98.0%。阳性级别在（＋＋）、（＋＋＋）和（＋＋＋＋）的SPT阳性患者,NPT阳性率分别为24.2%、30.3%和45.5%。结论 SPT为诊断AR的必要先行检查手段,NPT对于可疑变应原的确诊、鼻黏膜的非特异性高反应性的诊断及特异性免疫治疗（specific immunotherapy,SIT）具有较高价值。SPT级别强度越高,NPT阳性率越高,但SPT级别强度与NPT液浓度之间无明显相关性。     

Acoustic rhinometry in nasal provocation test in perennial allergic rhinitis

Acoustic rhinometry is one method to evaluate nasal geometry by an acoustic reflection technique. The aim of this study was to investigate the changes in acoustic rhinometry after nasal provocation in patients with exclusively perennial allergic rhinitis. In 19 patients, acoustic rhinometry and active anterior rhinomanometry were performed before and after nasal provocation test. There was a statistically significant nasal flow reduction measured by active anterior rhinomanometry after nasal provocation (p < 0.05) and a median symptom score of four points, both indicating a positive response to nasal provocation. On the other hand, there was no statistically significant change in the values of acoustic rhinometry after nasal provocation (p > 0.05). In patients with exclusively perennial allergic rhinitis, acoustic rhinometry does not seem to significantly change after nasal provocation. In contrast, active anterior rhinomanometry values decreased significantly after nasal provocation. The presented results indicate that acoustic rhinometry does not seem to be a diagnostic method superior to active anterior rhinomanometry in this context.     

Nasal provocation test with lysine-aspirin in diagnosis of nonallergic rhinitis with eosinophilia

Nonallergic rhinitis with eosinophilia is characterized by persistent nasal symptoms without allergy and by a marked eosinophil recruitment in the nasal cavities. The incidence of it is more than 15% among all types of rhinitis. A part of them is caused by nonsteroidal anti-inflammatory drugs hypersensivity. For this study 114 patients were selected on the basis of perennial rhinitis, the absence of allergy and with an eosinophil count higher than 10% of total leukocytes in nasal cytology. In all of them the nasal provocation test with lysine-aspirin was made. The clinical response was evaluated based on nasal symptoms (sneezes, itching, secretion and blockage). The nasal response was measured by acoustic rhinometry. The results of the test was positive in 19 cases, mostly in patients with nasal polyps, bronchial asthma and higher level of nasal eosinophilia (differences statistically significant). The count of nasal eosinophilia corresponded better with the decrease of nasal volume in acoustic rhinometry (r = 0,84) then with the clinical score (r = 0,52). The nasal challenge was well tolerated by almost all subjects. We conclude that the nasal challenge with lysine-aspirin is safe and can be helpful as a diagnostic test in patients with nonallergic rhinitis with eosinophilia.     

IgE reactivity profiles among house dust mite allergic patients in Bavaria

Recombinant allergen diagnostics have become increasingly important in daily allergological routine, made possible by inroads into the understanding of major and minor allergens accomplished within the last decade. Recombinant allergen diagnostics will, however, only provide correct diagnoses when sufficient knowledge of the regional IgE reactivity profile to a specific allergen source is available. A variety of studies in different European countries revealed reactivity profiles, where a sensitization to house dust mite could be recognized in more than 97 % of cases in which Der p1 and Der p2 were measured. The aim of this study was to investigate the IgE reactivity profiles of house dust mite allergic patients in southern Germany. Sera of house dust mite allergic patients (positive intranasal provocation) were screened for IgE antibodies against commercially available D pter., nDer p1, rDer p2 and rDer p10. IgE antibodies against D pter. could be found in 98 out of 98 sera (100 %). Seventy-five patients (76.5 %) reacted to nDer p1. In 72 patients (73.4 %), IgE antibodies against rDer p2 could be found, while IgE antibodies against rDer p10 were present in only 4 patients (4.1 %). Seventeen patients (17.3 %) had no IgE antibodies against nDer p1, rDer p2 and nDer p10, but displayed reactions to D pter. Knowledge of IgE regional reactivity profiles is necessary when using recombinant allergen diagnostics. In the case of our house dust mite allergic patients 17 would have remained undiagnosed based on a diagnostic method utilizing only the two major allergens nDerp1 and rDerp2.