吸入激素联合奥马珠单抗治疗中重度儿童过敏性哮喘合并过敏性鼻炎自身前后对照试验

背景 国外研究显示奥马珠单抗对≥6岁儿童中重度过敏性哮喘疗效肯定,目前缺乏中国哮喘儿童临床数据.目的 评价奥马珠单抗治疗过敏性哮喘合并过敏性鼻炎儿童的有效性和安全性.设计自身前后对照试验.方法 纳入符合中重度过敏性哮喘合并过敏性鼻炎诊断、年龄6～18岁、能够承受16周疗程费用、使用奥马珠单抗前血清IgE 75～1500...     

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.     

High prevalence and young onset of allergic rhinitis in children with bronchial asthma

Bronchial asthma and allergic rhinitis often co-exist, and rhinitis is a major risk factor for the development of asthma. However, the reported incidence of allergic rhinitis in asthmatic children varies widely. The aim of this study was to elucidate the incidence of allergic rhinitis, the onset age of chronic upper and lower airway symptoms, and the correlation of these two symptoms in asthmatic children. A cohort of 130 consecutive children (ages 2–10) with asthma was evaluated. A questionnaire regarding upper and lower airway symptoms was filled out by the parents. Objective diagnosis of allergic rhinitis was also made on the basis of rhinoscopy, nasal cytology, nasal challenge, and specific serum IgE (CAP-RAST). Persistent nasal symptoms were present in 83.8% of the asthmatic children. The incidence of allergic rhinitis was 77.7% based on the objective findings. The mean onset age of asthma was 2.8 yr, and that of rhinitis was 2.9 yr. Nasal symptoms started as early as the first year of life in 8.9% of the children. In children with comorbid asthma and allergic rhinitis, rhinitis preceded in 33.7%, asthma preceded in 31.7%, and both started in the same year in 26.7%. In 7.9%, rhinitis was asymptomatic. Concomitant exacerbation of the upper and lower airways occurred in 34.6% of the total 130 children. These results demonstrate that allergic rhinitis manifested early in life in the majority of the asthmatic children. Persistent nasal symptoms in infancy may point to subsequent development of asthma and possible early intervention.     

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目的比较3~14岁哮喘和变应性鼻炎患儿吸入性致敏原分布特征的异同。方法2004-10—2005-10,北京儿童医院对527例哮喘和620例变应性鼻炎患儿进行吸入性致敏原皮肤点刺试验(skin prick test,SPT),分析比较检出阳性的致敏原在两组病例中的分布特征。结果哮喘和变应性鼻炎患儿SPT阳性检出率分别为77·8%和78·9%(χ2=0·823,P>0·05)。户尘螨、粉尘螨、交链孢霉、猫上皮、艾蒿是两种疾病主要致敏原。哮喘患儿户尘螨、粉尘螨、混合霉菌的阳性率分别为64·6%、59·8%、8·8%,均高于变应性鼻炎患儿(49·5%、47·9%、3·9%,均P<0·05)。变应性鼻炎患儿杂草花粉和艾蒿的阳性率分别为25·6%、26·0%,均高于哮喘患儿(19·3%、19·3%,均P<0·05)。40·2%的哮喘和46·2%的变应性鼻炎为单致敏原阳性。尘螨霉菌混合致敏及尘螨宠物混合致敏在哮喘和变应性鼻炎中最为常见。结论尘螨、霉菌、夏秋季花粉和宠物是3~14岁哮喘和变应性鼻炎患儿主要吸入性致敏原,两病具有相似的致敏原分布特征,但尘螨及霉菌过敏多见于哮喘,夏秋季花粉过敏多见于变应性鼻炎。     

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。     

A 10-year prognosis for childhood allergic rhinitis

The prognosis of allergic rhinitis was studied in 154 children aged 3-17 years at diagnosis by means of a detailed questionnaire administered 8-11 years later. The symptoms had completely disappeared in only 15 (10%) patients. The conjunctival symptoms, however, had disappeared or were controlled successfully by topical drug therapy in almost all, and 77 (50%) were managing without medication for allergic rhinitis. Twenty-five (23%) of the 110 children with seasonal allergic rhinitis had a perennial disease at follow-up, in contrast to seven (16%) of 44 with perennial allergic rhinitis originally who had only seasonal symptoms at follow-up. Asthma or wheezing had developed in 29 cases (19%) and was more common (p less than 0.01) among those with perennial allergic rhinitis (15 of 44) than among those with seasonal allergic rhinitis (14 of 110). No significant association was found between age at onset of symptoms, family history of atopic disease or type of treatment for allergic rhinitis and allergic rhinitis still present at follow-up or development of asthma during the observation period.     

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??Abstract?? Objective To investigate if there is an association between caesarean section and allergic rhinitis as well as asthma in Suzhou children and whether the association is affected by family history of allergies. Methods This study was based on the epidemiological investigation of asthma among children aged 0-14 years from Pingjiang area of Suzhou city in 2010. From 540 asthmatic children we selected 427 children aged 5 to 14 years?? 290 males and 137 females ?? the average age being ??8.46±2.3??years. Another 427 non-asthmatic children were chosen by 1:1 matching by the same sex and age with the asthma children ?? A total of 854 cases were chosen as the study population??Then analyze the survey data by using Chi-square test and Logistic regression analysis. Results Of the 854 children?? 388 were delivered by cesarean section??allergic rhinitis 158 cases??asthma 191 cases?? and 466 by vaginal??allergic rhinitis 146 cases??asthma 236 cases????After adjusting for potential confounders??caesarean section was associated with an increased risk of allergic rhinitis??OR=1.66??95%CI 1.21??2.29????Specifically??while approximately 2.6-fold higher odds of allergic rhinitis was observed in children with a family history of allergies??OR=2.58??95%CI 1.46??4.56????no association was observed in children without a family history of allergies??OR=1.42??95%CI 0.95??2.13????Children born by cesarean section had no higher risk of asthma than those delivered vaginally??OR=0.91??95%CI 0.68??1.22??. Conclusion The association of caesarean section and allergic rhinitis appears more remarkable in children with family history of allergies??However??caesarean section is not associated with asthma in childhood.     

儿童螨过敏性鼻炎的免疫治疗

目的:探讨舌下脱敏治疗对螨虫致敏过敏性鼻炎患儿的疗效。方法:回顾性研究2014年3月至2019年9月就诊于首都医科大学附属北京儿童医院耳鼻咽喉头颈外科门诊490例螨虫致敏过敏性鼻炎患儿,并依据患儿的临床情况,将其分成低龄儿童组、脱敏治疗时长组、个体化剂量调整组及多重过敏疗效评估组,记录患儿在首诊、治疗12个月、24个月...     

自然杀伤细胞在儿童过敏性哮喘和(或)鼻炎中的变化

目的探讨自然杀伤细胞(nature killer cells,NK)在过敏性哮喘和(或)鼻炎患儿中的变化。方法选择2009年8月—2010年12月在儿科门诊和病房诊断明确、3～14岁过敏性哮喘和(或)变应性鼻炎发作且未用药物治疗的患儿45例,正常对照儿童30例,采用乳酸脱氢酶释放法检测外周血NK细胞杀伤活性,流式细胞技术测定外周血NK细胞数量,应用免疫磁珠分选技术纯化NK细胞,分别采用标准刺激剂(离子霉素+佛波酯)和尘螨试剂刺激NK细胞,流式细胞技术检测NK细胞内γ-干扰素(IFN-γ)和白介素(IL-4)的表达情况。结果过敏性哮喘和(或)鼻炎患儿与对照组比较,NK细胞数量减少,差异有统计学意义(P=0.015);NK细胞活性下降,差异有统计学意义(P=0.023)。在尘螨刺激下,NK细胞内IFN-γ和IL-4表达均升高,但IL-4升高幅度较IFN-γ强,导致IFN-γ/IL-4比值显著降低,差异有统计学意义(P<0.05)。结论在过敏性哮喘和(或)鼻炎发作患儿中,NK细胞数量与活性均下降;在尘螨刺激下,NK细胞内IFN-γ/IL-4比值升高,导致NK细胞向NKⅡ型细胞方向失衡。推测NK细胞的数量、功能变化及...     

儿童过敏性鼻炎-哮喘综合征诊治进展

过敏性鼻炎和支气管哮喘是儿童常见的呼吸道过敏性疾病,发病率逐年上升.既往认为两者是完全独立的疾病,而近年的研究表明两者从病因学、发病机制、病理学变化以及治疗方面高度相似,故提出“过敏性鼻炎-哮喘综合征”这一新的概念,是指同时发生临床或亚临床的过敏性鼻炎和支气管哮喘症状,二者需整体看待,进行联合诊断和治疗,从而极大程度减少了误诊,并减少药物的重复使用,提高临床疗效.该文就儿童过敏性鼻炎-哮喘综合征诊治进展作一综述.     

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.     

脓毒性休克患儿心肌酶及高密度脂蛋白胆固醇水平变化的临床意义

目的 探讨心肌酶及高密度脂蛋白胆固醇与小儿脓毒性休克病情严重程度及预后的关系.方法 2006年1月至2011年3月我科收治脓毒性休克患儿共52例,分为重度脓毒性休克组(27例)和轻度脓毒性休克组(25例).入院时检测脓毒性休克患儿的肌酸激酶同工酶(creatine kinase-MB,CK-MB)、α-羟丁酸脱氢酶(α-hydroxybutyrate dehydrogenase,α-HBDH)、乳酸脱氢酶(lacficdehydrogenase,LDH)及高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)含量,并与健康体检儿童(正常对照组)32例进行对比分析.轻、重度脓毒性休克组患儿于入院后第1、2、4、7、10、15天动态监测以上指标,同时密切观察脓毒性休克患儿的病情变化,记录死亡情况和治愈出院时间.结果 轻、重度感染性休克组患儿入院时血清CK-MB[ (32.084±4.595) U/L、(61.481±5.639) U/L]较对照组[(21.675±3.453) U/L]明显升高;α-HBDH/LDH(0.694±0.080、0.884±0.079)较对照组(0.443±0.065)明显升高;HDL-C[ (0.646±0.067) mmol/L、(0.310±0.124) mmol/L]较对照组[(1.012±0.156) mmol/L]明显降低,3组间比较差异有统计学意义(P均＜0.01).重度脓毒性休克组死亡5例,轻度组无死亡病例.重度脓毒性休克组患儿较轻度组在CK-MB恢复时间[(9.82±1.76)d vs (4.68±1.22)d]、α-HBDH/LDH恢复时间[(7.23±1.38)d vs (3.76±0.83)d]、HDL-C恢复时间[(12.14±2.21)d vs (6.48±1.33)d]及住院时间[(15.09±2.69)d vs (7.40±1.58)d]方面明显延长,两组比较差异均有统计学意义(P均＜0.01).结论脓毒性休克患儿血清CK-MB、α-HBDH/LDH越高,HDL-C越低,其病情越重,恢复时间越长,预后越差.     

口鼻呼出气一氧化氮检测在儿童支气管哮喘控制评估及过敏性鼻炎诊断中的应用

目的 探讨口呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)与鼻呼出气一氧化氮(nasal nitric oxide,nNO)检测值和儿童支气管哮喘(简称哮喘)控制水平的关系,以及对过敏性鼻炎的诊断价值.方法 以上海市儿童医院呼吸科门诊就诊的5～12岁哮喘和/或过敏性鼻炎患儿,...     

经皮下特异性免疫治疗的支气管哮喘和/或过敏性鼻炎患儿全身不良反应观察及危险因素分析

目的 分析皮下特异性免疫治疗（SCIT）治疗儿童支气管哮喘和/或变应性鼻炎的全身不良反应（SR）的发生情况及危险因素。方法 回顾性分析该院儿科收治的支气管哮喘和/或变应性鼻炎患儿198例为研究对象。根据所有患儿SCIT过程中SR和局部不良反应（LR）的发生情况,分为SR组（n=31）及对照组（未发生SR及LR的患儿,n=142）,采用logistic多因素回归分析对发生SR的危险因素进行分析。结果 在对198例患儿的8 157次SCIT注射中,共有25（12.6%）例患儿发生31例次（0.38%）SR,其中Ⅰ级SR 18例次（58%）,Ⅱ级SR 10例次（32%）,Ⅲ级SR 3例次（10%）,无Ⅳ级SR。多因素logistic回归分析显示同时合并食物及吸入过敏原的多重过敏、尘螨sIgE 6级、总IgE 6级、既往LR发生史是SR的独立危险因素（P < 0.05）。结论 SCIT治疗哮喘和/或过敏性鼻炎的SR发生率低,安全性良好。对同时合并食物及吸入过敏原的多重过敏、高敏状态（尘螨sIgE 6级、总IgE 6级）、既往局部不良反应发生史者需警惕SR发生。     

Atopy patch testing in children with asthma and rhinitis symptoms allergic to house dust mite

The atopy patch test (APT) is generally used to assess immunoglobulin E (IgE) mediated sensitization to allergens in patients with atopic dermatitis, but its diagnostic role in children with respiratory allergy is still controversial. The aim of the study was to evaluate APT with house dust mite (HDM) in children with asthma and rhinitis symptoms allergic to HDM and its relevance to skin prick test (SPT) diameters and specific IgE levels. The study population consisted of 33 children, aged 8-16 yr (median: 12 yr) with asthma and 30 children with allergic rhinitis in the same age range (median: 11 yr). All patients had positive SPT results and high serum specific IgE levels for Dermatophagoides pteronyssinus APT was performed on back skin of all patients with 200 index of reactivity (IR)/ml of D. pteronyssinus allergen extracts in petrolatum (Stallerpatch) and evaluated at 72 h. Of 63 patients, 16 (25%) showed a positive patch test result. APT with HDM showed 30% (10/33) positivity among the patients with asthma and 20% (6/30) positivity among the patients with allergic rhinitis. APT presented no significant correlation with age, SPT diameter, serum total and specific IgE levels for D. pteronyssinus, nasal provocation test or pulmonary function test results. Patch testing with HDM may partly identify mite sensitive children with respiratory allergy. Positive APT results may imply that delayed hypersensitivity reactions play a role in children with asthma and rhinitis allergic to HDM.     

FcγRIIIa-V/F 158 polymorphism in Turkish children with asthma bronchiale and allergic rhinitis

Fc receptors (FcR) play an important role in immune regulation. This might be linked to the variability in immune response, therefore relating to the pathogenesis of atopic diseases. The aim of the present study was to evaluate the Fc γ RIIIa gene polymorphism in Turkish children with asthma and allergic rhinitis. The study included 364 atopic children (184 bronchial asthma, 180 allergic rhinitis) and 234 healthy subjects as the control group, aged between 5 to 16 years. Patients were recruited from outpatient clinics of allergy and general pediatric care. Plasma IgE concentrations were measured by immunoassays and skin prick test was done in children with atopic diseases. The Fc γ RIIIa gene polymorphism was determined using the polymerase chain reaction method. Distribution of V158V genotype was significantly different among patient groups compared to controls (for asthmatic children OR: 5.33, 95% CI: 2.80–10.23, p < 0.001; for allergic rhinitis OR: 3.25, 95% CI: 1.75–6.07, p = 0.001). Distribution of 158 V allele was significantly different among asthmatic children (OR: 2.20, 95% CI: 1.65–2.92, p < 0.001) and allergic rhinitis patients (OR: 1.77, 95% CI: 1.32–2.35, p < 0.001) compared to healthy controls. Our study shows that the V158V genotype in Fc γ RIIIa gene polymorphism may be a genetic risk factor for the development of atopic diseases.     

儿童变应性鼻炎与注意缺陷多动障碍相关性研究进展

近年来国内外学者逐渐认识到儿童变应性鼻炎(allergic rhinitis,AR)与注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)之间具有一定相关性。AR患儿较正常儿童有更高的ADHD相关症状评分;ADHD儿童出现过敏性疾病,如哮喘、湿疹和特应性皮炎的风...     

Different sensitization profile for asthma, rhinitis, and eczema among 7-8-year-old children: Report from the Obstructive Lung Disease in Northern Sweden studies

Sensitization to different airborne allergens in relation to asthma, rhinitis, and eczema has been studied. A cross-sectional study was performed among 7–8-year-old children living in northern Sweden. The ISAAC-questionnaire with additional questions were sent to the parents, and 3431 (97%) participated. Two-thirds of the children were invited to undergo a skin test with 10 common airborne allergens, and 2148 (88%) participated. The prevalence rates of all three diseases were significantly higher among the children who were sensitized to any of the tested allergens. Among asthmatics, 40% were sensitized to cat, 34% to dog, 28% to horse, 23% to birch and 16% to timothy. The corresponding figures for rhinitis were: cat 49%, dog 33%, horse 37%, birch 46%, timothy 32%; and for eczema: cat 29%, dog 21%, horse 15%, birch 20%, and timothy 11%. Only a few children were sensitized to mites or moulds. The main risk factors for all three diseases were type-1 allergy and a family history of the disease. Independently from other risk factors, sensitization to dog (OR 2.4) and horse (OR 2.2) were significant risk factors for asthma. Sensitization to birch (OR 6.0), horse (OR 4.1), and timothy (OR 2.8) were significant risk factors for rhinitis, while birch (OR 2.4), dog (OR 2.0) and cat (OR 1.6) were significant risk factors for eczema. Despite a large over-lapping of the diseases the pattern of sensitization was different for asthma, rhinitis and eczema. Sensitization to cat was most common among all children, but sensitization to dog and horse was associated with the highest risk for asthma, and sensitization to birch showed the highest risk for rhinitis and eczema. The different risk factor pattern for the often coexisting diseases; asthma, rhinitis, and eczema, may indicate differences in the etiology.     

ACE gene polymorphism might disclose why some Taiwanese children with allergic rhinitis develop asthma symptoms but others do not

Although allergic asthma and allergic rhinitis have recently been considered to be a single disease, many questions remain unanswered. Why do some atopic patients develop asthma symptoms and others develop allergic rhinitis symptoms? Which factors play a role in the development of different allergic phenotypes? We hypothesized that angiotensin‐converting enzyme (ACE) gene polymorphism might play a role in the development of asthma phenotypes in children with allergic rhinitis. The study sample included 106 children with allergic rhinitis, but no asthma, and 105 age‐ and gender‐matched children with allergic rhinitis and asthma. Subjects of both groups exhibited the same systemic immunologic changes and allergen sensitivities. Controls consisted of 102 healthy children. The ACE genotype was determined by polymerase chain reaction. The serum total immunoglobulin E (IgE) level, allergen‐specific IgE sensitivity, and eosinophil count were also measured. The frequencies of the DD genotype were significantly higher in the children with both allergic rhinitis and asthma than in the children with allergic rhinitis but no asthma [p = 0.018; odds ratio (OR) = 3.257; (1.222–8.680)]. Results of this study suggest that ACE gene polymorphism DD genotype might play a role in the development of the asthma phenotype in children with allergic rhinitis.