营养素与特应性疾病

特应性疾病又称IgE介导的变态反应性疾病，如花粉症、哮喘和湿疹。近年来特应性疾病的患病率呈明显增加趋势，许多学者认为在过去的20—40年里导致特应性疾病增加的原因之一是饮食结构的改变。流行病学和免疫学研究发现，在胎儿和生命早期，通过调控饮食或补充某种营养素可能降低特应性疾病的发生。本文就近年来国内外有关营养素对特应性疾病影响的研究进展做一综述，重点介绍维生素、矿物质、类脂类等营养素对特应性疾病影响的流行病学证据及其作用机制。     

白三烯与特应性皮炎研究进展

特应性皮炎（Atopicdermatitis，AD）是一种慢性复发性皮肤病，可发生于任何年龄，以儿童为多见。常发生于有个人或家族特应性病史者。据报道，约10％的儿童为AD患儿，其中近80％最终将发展为过敏性鼻炎或支气管哮喘。     

饮食非过敏因素与特应性疾病

一、概述 1923,Coco和Cooke．以“特应性（Atopy）”,描述人体中的一些超敏现象（包括过敏性鼻炎和支气管哮喘）。近一、二十年来,哮喘、变应性鼻炎和特应性湿疹的患者人数一直持续上升,故深入探求此类疾病的发病机理,对于有效防治此病具有重要意义。     

特应质与支气管哮喘遗传学进展

特应质与支气管哮喘皆与变态反应有关 ,三者目前尚无特异性诊断学标志。哮喘是一种由免疫机制参与的气道炎症过程 ,与患者特应质有密切关联。研究特应质与哮喘的遗传学标志 ,从基因水平将其区分开来对二者的诊断和治疗都有十分重要的意义。现从遗传学角度看 ,两者皆为多基因参与的易感性 ,是既有区别又有关联的两种个体状态。环境因素决定了特应质与哮喘易感者的表现型。本文综述了近年特应质与哮喘遗传学研究进展 ,探讨了特应质与哮喘在遗传学方面的区别与联系。     

居室尘埃内毒素暴露与支气管哮喘及特应性疾病的关系

支气管哮喘(简称哮喘)与过敏性鼻炎等特应性疾病的患病率正不断上升,其发病的具体机制尚未完全清晰,主要是宿主免疫系统和环境相互作用的结果.内毒素是革兰阴性菌细胞壁上特有的结构,在外环境中内毒素几乎无处不在.内毒素对哮喘及特应性疾病而青是一把“双刃剑”,早期生活暴露于内毒素可能对疾病的发展具有保护作用;然而,暴露于高水平的内毒素环境不利于疾病的控制.     

居室尘埃内毒素暴露与支气管哮喘及特应性疾病的关系

支气管哮喘（简称哮喘）与过敏性鼻炎等特应性疾病的患病率正不断上升,其发病的具体机制尚未完全清晰,主要是宿主免疫系统和环境相互作用的结果。内毒素是革兰阴性菌细胞壁上特有的结构,在外环境中内毒素几乎无处不在。内毒素对哮喘及特应性疾病而言是一把＂双刃剑＂,早期生活暴露于内毒素可能对疾病的发展具有保护作用;然而,暴露于高水平的内毒素环境不利于疾病的控制。     

特应质与支气管哮喘遗传学进展

特应质与支气管哮喘皆与变态反应有关，三者目前尚无特异性诊断学标志。哮喘是一种由免疫机制参与的气道炎症过程，与患者特应质有密切关联。研究特应质与哮喘的遗传学标志，从基因水平将其区分开来对二者的诊断和治疗都有十分重要的意义。现从遗传学角度看，两者皆为多基因参与的易感性，是既有区别又有关联的两种个体状态。环境因素决定了特应质与哮喘易感者的表现型。本文综述了近年特应质与哮喘遗传学研究进展，探讨了特应质与哮喘在遗传学方面的区别与联系。     

IgE在儿童呼吸道变态反应疾病中的分布

应用Pharmacia UniCAP100E荧光酶联免疫检测系统对209例支气管哮喘（简称哮喘）、过敏性鼻炎、咳嗽变异性哮喘等患者进行9项特异性IgE（sIgE）测定，对其中132例同时进行总IgE（TIgE）检测，结果报道如下。     

广州地区儿童呼吸道变态反应性疾病常见变应原的流行病学分析

目的 了解广州地区呼吸道变态反应性疾病儿童常见变应原,为预防和治疗儿童变应性疾病提供科学依据.方法 选择2006年2月至2007年3月在广州医学院第一附属医院儿科门诊符合支气管哮喘(简称哮喘)和(或)变应性鼻炎(简称鼻炎)的广州地区5岁以上患儿183例,其中男132例,年龄(8.2-4-0.2)岁;女51例,年龄(7.8士0.4)岁;哮喘并鼻炎者105例,哮喘患儿58例,仅鼻炎患儿20例.所有对象均进行皮肤变应原点刺试验(SPT)及血清总IgE、特异性IgE和嗜酸粒细胞计数.结果 在人选的183例患儿中,SPT阳性(≥1个变应原阳性)157例(85.8%),各变应原阳性率为5.5%～75.4%,变应原中以屋尘螨致敏的阳性率最高,达79.8%,其次为粉尘螨与热带螨,分别为72.7%与65.0%,其余变应原阳性率依次为:狗毛48.6%,美洲大蠊47.0%,猫毛34.4%,德国小蠊29.5%,霉菌类19.7%,花粉类15.9%,艾蒿7.7%,豚草5.5%.螨过敏阳性患儿有146例,常合并其他一种或多种变应原阳性(115例,78.8%),而螨过敏阴性患儿(37例,20.2%)中仅有11例(29.7%)合并其他一种或多种变应原阳性(x2=33.099,P<0.001),差异有统计学意义.各年龄组发病率特点:高龄组(>7岁)SPT阳性率为82.3%,高于低龄组(≤7岁)(79.3%),两组间SPT阳性率的差异有统计学意义(P<0.05).在吸入变应原种类的比较中,高龄组在螨类过敏阳性率、猫毛与狗毛阳性率、蟑螂阳性率均高于低龄组,差异有统计学意义(P<0.05);两组在霉菌类及花草类阳性率的差异无统计学意义.哮喘并鼻炎、哮喘、鼻炎3组患儿均以螨类过敏最为常见,3组间除蟑螂SPT阳性率差异有统计学意义外(P<0.05),螨类、动物皮毛类、霉菌及花草类的变应原阳性率差异均无统计学意义.结论 过敏性因素是儿童呼吸系统变态反应性疾病发病的重要诱发因素,在广州地区哮喘和(或)鼻炎儿童可以通过SPT检查明确过敏原,最常见的变应原是屋尘螨、粉尘螨及热带螨.随着年龄增长,呼吸道变态反应性疾病患儿对吸入性变应原更为敏感.鼻炎、哮喘、哮喘并鼻炎患儿有共同的变应原.研究不同年龄段变态反应性疾病患者的变应原特征,有助于对疾病的早期诊断和早期干预.     

Prevalence of respiratory and atopic disorders among children in the East and West of Germany five years after unification.

Living conditions in eastern Germany have changed rapidly since unification in 1990 and little is known about how these changes affect the prevalence of atopic diseases. This study describes methods and prevalences of a large epidemiological project investigating determinants of childhood asthma and allergies in eastern (Dresden and Leipzig) and western (Munich) Germany in 1995/1996. Community based random samples of 9-11 yr old children in Dresden (n=3,017) and Munich (n=2,612), and of 5-7 yr old children in Dresden (n=3,300), Leipzig (n=3,167) and Munich (n=2,165) were studied by parental questionnaires, bronchial challenges with hypertonic saline, skin examination, skin-prick tests, and measurements of specific and total serum immunoglobulin (Ig)E using Phase II modules of the International Study of Asthma and Allergies in Childhood (ISAAC). In 9-11 yr old children, the prevalence of physician diagnosed asthma (7.9% versus 10.3%; p<0.01) and bronchial hyperresponsiveness (15.7% versus 19.9%; p<0.05) was lower in Dresden than in Munich. No difference between Munich and Dresden was observed in the prevalence of diagnosed hay fever, skin test reactivity to > or = 1 allergen, and increased levels (>0.35 kU x L(-1)) of specific IgE against inhalant and food allergens. Symptoms and visible signs of atopic eczema tended to be more prevalent in Dresden. Similar East-West differences between the three study areas were seen in the younger age group. These findings are in line with recently observed increases in the prevalence of hay fever and atopic sensitization, but not of asthma and bronchial hyperresponsiveness, among 9-11 yr old children in Leipzig.     

Prevalence of and risk factors for asthma in off-reserve Aboriginal children and adults in Canada

Only a few studies have investigated asthma morbidity in Canadian Aboriginal children. In the present study, data from the 2006 Aboriginal Peoples Survey were used to determine the prevalence and risk factors for asthma in Canadian Aboriginal children six to 14 years of age and adults 15 to 64 years of age living off reserve. The prevalence of asthma was 14.3% in children and 14.0% in adults. Children and adults with Inuit ancestry had a significantly lower prevalence of asthma than those with North American Indian and Métis ancestries. Factors significantly associated with ever asthma in children included male sex, allergy, low birth weight, obesity, poor dwelling conditions and urban residence. In adults, factors associated with ever asthma varied among Aboriginal groups; however, age group, sex and urban residence were associated with ever asthma in all four Aboriginal groups. The prevalence of asthma was lower in Aboriginal children and higher in Aboriginal adults compared with that reported for the Canadian population. Variation in the prevalence of and risk factors for asthma among Aboriginal ancestry groups may be related to genetic and environmental factors that require further investigation.     

Prevalence of atopic disorders in rheumatic diseases

Objectives

The aim of this study was to assess the point prevalences of hay fever, asthma, and atopic dermatitis in OA, RA, and AS, and to compare with healthy controls.

Methods

A total of 935 patients and healthy controls were included. Demographic and clinical features were recorded, and a questionnaire assessing the existence of atopic disorders like asthma, hay fever, and atopic dermatitis in all groups was applied. “Either atopy” implied that an individual was either diagnosed with or had symptoms of one or more of these disorders, such as asthma, hay fever, or atopic dermatitis.

Results

When compared to the controls, only patients with AS had an increased risk for hay fever (OR 1.52, 95 % CI 1.00–2.41). Patients with RA had increased risks for hay fever, atopic dermatitis, and either atopy compared to the patients with OA (2.14, 95 % CI 1.18–3.89; 1.77, 95 % CI 1.00–3.18; and 3.45, 95 % CI 1.10–10.87, respectively). Steroid use had no effect on the prevalence of atopic disorders in patients with RA.

Conclusions

Patients with OA, RA, and AS seem to have similar risks for asthma, atopic dermatitis, and either atopy to healthy controls. However, the prevalence of hay fever may increase in AS. Patients with RA have a higher risk of atopy than patients with OA.     

Prevalence of and factors associated with underdiagnosis of pediatric asthma in Batumi,Georgia

Background and objectiveA recent survey in Batumi, Georgia showed a low prevalence of asthma in children (1.8%). A potential explanation is underdiagnosis of asthma. To investigate this, we conducted a follow up to the survey with the objective of estimating the level of childhood asthma underdiagnosis and to describe factors related to it.MethodsSubjects included 437 survey participants who had a history of asthma-like symptoms and no diagnosis of asthma. All children underwent clinical examination (spirometry, skin prick tests, FeNO measurement) to identify new cases of asthma. The distribution of host and environmental factors was compared between the group with newly identified asthma and a group of 59 children with previously known asthma (diagnosed asthma).ResultsClinical investigation identified 107 cases of undiagnosed asthma. The corrected asthma prevalence estimate was 5.1% (95%CI: 4.4%–5.9%) suggesting that 65% of asthma cases were undiagnosed. Compared to children with diagnosed asthma, children with undiagnosed asthma were younger (8.2 ± 1.6 vs. 9.3 ± 2.1; p = 0.0005), had less frequent history of allergic disorders (38.3% vs. 64.4%; p = 0.001), and a lower prevalence of parental asthma (1.8% vs. 8.4%; p = 0.04). The groups did not differ in terms of environmental characteristics except for more exposure to passive smoking in the undiagnosed asthma group (p = 0.01). Multivariate analysis confirmed results of simple analyses.ConclusionIn Batumi, 65% of children with asthma remain undiagnosed. Older age of a child, coexisting allergic disorders, and parental asthma seem to facilitate diagnosis. Implementation of current diagnostic guidelines should improve diagnostic accuracy of pediatric asthma in Batumi.     

Atopy,but not obesity is associated with asthma severity among children with persistent asthma

Background and Objective: Obesity is associated with an increased risk of asthma in children. Atopic sensitization is a major risk factor for asthma including severe asthma in children. It is unclear if obesity is associated with worse asthma control or severity in children and how its effects compare to atopy. We sought to examine relationships of weight status and atopy to asthma control and severity among a population of predominantly low income, minority children and adolescents with persistent asthma. Methods: A cross-sectional analysis of 832 children and adolescents, age range 5–17 years, with persistent asthma was performed. Clinical assessments included asthma questionnaires of symptoms, asthma severity score, health care utilization and medication treatment step, lung function testing, and skin prick testing as well as measures of adiposity. Data were collected between December 2010 and August 2014 from Johns Hopkins Hospital in Baltimore, MD and Children's Hospital of Boston, MA. Results: Obesity was not associated with worse asthma control or severity in this group of predominantly low income, minority children and adolescents with persistent asthma. However, a greater degree of atopy was associated with lower lung function, higher asthma severity score, and higher medication treatment step. Conclusion: Atopy may be a more important risk factor for asthma severity than obesity among low-income minority children and adolescents with persistent asthma living in Northeastern cities in the United States.     

Sleep-related disorders in Latin-American children with atopic dermatitis: A case control study

BackgroundAtopic dermatitis (AD) has been associated with impairment of sleep. The aim of this study was to evaluate sleep disorders in AD Latin-American children (4–10 years) from nine countries, and in normal controls (C).MethodsParents from 454 C and 340 AD children from referral clinics answered the Children Sleep Habits Questionnaire (CSHQ), a one-week retrospective 33 questions survey under seven items (bedtime resistance, sleep duration, sleep anxiety, night awakening, parasomnias, sleep-disordered breathing and daytime sleepiness). Total CSHQ score and items were analysed in both C and AD groups. Spearman's correlation coefficient between SCORAD (Scoring atopic dermatitis), all subscales and total CSHQ were also obtained.ResultsC and AD groups were similar regarding age, however, significantly higher values for total CSHQ (62.2 ± 16.1 vs 53.3 ± 12.7, respectively) and items were observed among AD children in comparison to C, and they were higher among those with moderate (54.8%) or severe (4.3%) AD. Except for sleep duration (r = −0.02, p = 0.698), there was a significant Spearman's correlation index for bedtime resistance (0.24, p < 0.0001), sleep anxiety (0.29, p < 0.0001), night awakening (0.36, p < 0.0001), parasomnias (0.54, p < 0.0001), sleep-disordered breathing (0.42, p < 0.0001), daytime sleepiness (0.26, p < 0.0001) and total CSHQ (0.46, p < 0.0001). AD patients had significantly higher elevated body mass index.ConclusionLatin-American children with AD have sleep disorders despite treatment, and those with moderate to severe forms had marked changes in CSHQ.     

LABAs in asthmatic children: Highlights and new inside

International asthma guidelines recommend increasing the dose of ICS or adding leukotriene modifiers or the use of long-acting inhaled beta2-agonists (LABAs) in combination with inhaled corticosteroids (ICS) when uncontrolled asthma occurs in adult and children in treatment with low-dose inhaled corticosteroids. However, in children, the effects of this last treatment option are unclear because there are few studies on the efficacy and safety of these drugs in pediatric age. Furthermore, salmeterol is licensed for use in children over 4 years and formoterol in children of more than 6 years. Finally, recent data provides evidence that repeated bronchoconstriction induces epithelial cell stress that may lead to remodeling and these findings may have potential implications for asthma management, particularly for LABAs treatment in the future.     

Prevalence of asthma and risk factors for asthma-like symptoms in Aboriginal and non-Aboriginal children in the northern territories of Canada

BACKGROUND:

Few studies have investigated the prevalence and risk factors of asthma in Canadian Aboriginal children.

OBJECTIVE:

To determine the prevalence of asthma and asthma-like symptoms, as well as the risk factors for asthma-like symptoms, in Aboriginal and non-Aboriginal children living in the northern territories of Canada.

METHODS:

Data on 2404 children, aged between 0 and 11 years, who participated in the North component of the National Longitudinal Survey of Children and Youth were used in the present study. A child was considered to have an asthma-like symptom if there was a report of ever having had asthma, asthma attacks or wheeze in the past 12 months.

RESULTS:

After excluding 59 children with missing information about race, 1399 children (59.7%) were of Aboriginal ancestry. The prevalence of asthma was significantly lower (P<0.05) in Aboriginal children (5.7%) than non-Aboriginal children (10.0%), while the prevalence of wheeze was similar between Aboriginal (15.0%) and non-Aboriginal (14.5%) children. In Aboriginal children, infants and toddlers had a significantly greater prevalence of asthma-like symptoms (30.0%) than preschool-aged children (21.5%) and school-aged children (11.5%). Childhood allergy and a mother’s daily smoking habit were significant risk factors for asthma-like symptoms in both Aboriginal and non-Aboriginal children. In addition, infants and toddlers were at increased risk of asthma-like symptoms in Aboriginal children. In analyses restricted to specific outcomes, a mother’s daily smoking habit was a significant risk factor for current wheeze in Aboriginal children and for ever having had asthma in non-Aboriginal children.

CONCLUSIONS:

Asthma prevalence appears to be lower in Aboriginal children than in non-Aboriginal children. The association between daily maternal smoking and asthma-like symptoms, which has been mainly reported for children living in urban areas, was observed in Aboriginal and non-Aboriginal children living in northern and remote communities in Canada.     

OX40 ligand: a potential costimulatory molecule in atopic asthma

Objective: We aimed to assess the percentage of peripheral blood B-lymphocytes expressing OX40 ligand (OX40L) in adult atopic and non-atopic asthmatic patients, and in healthy controls. Methods: This case–control study included 15 atopic asthmatic patients, 15 non-atopic asthmatic patients, and 15 healthy controls. Atopic status was determined by skin prick test reaction to the most common locally-encountered allergens. For all subjects, pulmonary function tests and measurement of total serum immunoglobulin E (IgE) levels by ELISA were performed. In addition, the percentage of B-lymphocytes expressing OX40L was assessed by flow cytometry in all three groups. Results: OX40L expression was significantly higher in atopic asthmatics than in non-atopic asthmatics and controls, but did not differ significantly between non-atopic asthmatics or controls. Among atopic asthmatics, OX40L expression correlated positively with total serum IgE levels, but not with age, disease duration, or values of forced expiratory volume in the first second. Conclusion: The over-expression of OX40L in atopic asthmatic patients appears to be linked to markers of the atopic status as total serum IgE, and signifies the vital role of OX40L in the atopic mechanism. Further large-scale studies are needed to investigate the role of OX40L in other atopic diseases and its relation to disease activity and severity.     

Asthma Prevalence and Risk Factors in Selected Head Start Sites in Chicago

Prevalence of and risk factors for asthma were examined in 1085 Head Start families at 18 Head Start sites in four high-risk community areas in 1994. A total of 13.9% of the families reported diagnosed asthma in their Head Start child and 18.8% reported that their child wheezed in the last 12 months. A total of 26.9% of respondents reported asthma in the immediate family of the child. Low birth weight (1500-2499 g), very low birth weight (<1500 g), and self-reported exposure to dampness or mold in the last 12 months were significantly associated with self-reported diagnosed asthma (OR = 1.93; 95% CI 1.17-8.73), (OR = 4.5; 95% CI 1.25-16.3), and (OR = 1.94; 95% CI 1.23-3.04), respectively. The young age of the children in Head Start, as well as the high prevalence of asthma in their families, suggest that the Head Start programs offer an unusual opportunity for asthma prevention programs.