苏州大学附属儿童医院支气管哮喘及过敏性鼻炎患儿皮肤点刺试验结果分析

目的　应用皮肤点刺试验了解支气管哮喘及过敏性鼻炎患儿的主要过敏原, 为其预防、 诊断、 治疗提供依据。方法　选取于2015年8月至2017年7月在苏州大学附属儿童医院门诊诊断为支气管哮喘及过敏性鼻炎的2252例患儿进行皮肤点刺试验检测过敏原,并对其性别、 疾病种类数据采用SPSS 21.0软件进行分析。结果　2252例患儿进行皮肤点刺试验, 1390例阳性, 阳性率61.7%。男女比例1.75∶1, 男性阳性率（925/1433, 64.5%）高于女性阳性率（465/819, 56.8%）, 差异有统计学意义（P＜0.05）。支气管哮喘患儿阳性率为65.3%（607/929）, 过敏性鼻炎患儿阳性率为58.8%（664/1129）, 支气管哮喘合并过敏性鼻炎患儿阳性率61.3%（119/194）。支气管哮喘阳性率高于过敏性鼻炎, 差异有统计学意义（P＜0.05）。过敏原以粉尘螨（60.3%）、 屋尘螨（43.4%）最常见, 其次是草花粉、 猫毛。结论　苏州大学附属儿童医院的支气管哮喘、 过敏性鼻炎患儿最常见过敏原为螨类; 皮肤点刺试验可为过敏性疾病的诊断提供依据。     

A clinical evaluation in children of the Pharmacia ImmunoCAP system for inhalant allergens

Background The Pharmacia ImmunoCAP system (CAP) for assaying serum IgE specific antibodies was evaluated in a clinical setting against skin-prick test (SPT) perfonncd using Dome/Hollister-Steir allergen extracts. The five cotnmon inhalant allergens D. pteronyssinus. D. farinae, mould mix, grass mix and cat epithelium were tested concurrently by both methods in 167 children aged 7.5–12 years. The specific SPT for D. pteronyssinus and D. farinae were also tested against the CAP house dust mite (HDM) mix. Objective The purpose of the study was to determine the sensitivity and specificity of the Pharmacia ImmunoCAP system Tor detecting serum IgE specific antibodies to inhalant allergens in a clinical setting, using the SPT result as the ‘gold standard’. Methods The SPTs were performed using Dome/Hollister-Steir allergen extracts. The serum IgE specific antibodies were quantitated using the radioimmunoassay version of the Pharmacia ImmunoCAP system. A history of allergic disease was assessed using a validated questionnaire. Results SPT gave more positive reactions than CAP with the exception of cat epithelium. The concordance between SPT and CAP results was 91% over all the tests. The concordance with SPT was slightly higher for the specific CAP for D. pteronyssinus and D. farinae (93% and 95% respectively) than for the CAP HDM mix (86% and 90% respectively). There was a higher proportion of positive results for both SPT and CAP in the 115 children defined as having a history of allergic disease. Using SPT defined allergy as the gold standard, the sensitivity of the CAP system was 87% for the two specific house dust mites but was lower for cat epithelium (67%), mould mix (59%) and grass mix (46%). The sensitivity of the CAP system improved for D. pteronyssinus (96%) and the HDM mix (91%) when tested in subjects defined as having a history of allergy associated disease. The specificity of the CAP system showed less variation between allergens and ranged from 90–99%. Conclusion The results of this study of children aged 7.5–12 years demonstrate that, for the inhalent allergens tested, the Pharmacia ImmunoCAP system perfoms well in the setting of known allergic disease.     

Profilin-mediated food-induced allergic reactions are associated with oral epithelial remodeling

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根据炎症特征对非变应性鼻炎进行分型的初步研究

目的研究非变应性鼻炎(non-allergic rhinitis,NAR)患者鼻腔与下气道的炎症特征,探讨根据炎症特征对NAR进行分型的方法及意义。方法收集2010年6月～2011年6月就诊的NAR患者117例,同期选取162例作为健康对照组。经皮肤点刺实验、鼻部和肺部症状视觉模拟量化评分(VAS)、鼻灌洗检测、诱导痰检测、血常规、鼻激发试验、支气管激发试验等炎症相关指标检查,评价鼻腔及气道炎症特征。根据鼻部及气道炎症特征对NAR进行分型并分析其临床意义。结果与健康对照组相比,NAR患者鼻灌洗、诱导痰、血嗜酸性粒细胞EOS、鼻激发和支气管激发阳性率均显著增高(P均<0.01)。鼻灌洗与诱导痰嗜酸性粒细胞(EOS)增高存在明显相关性(r=0.531,P=0.000),鼻激发与支气管激发等级存在相关性(r=0.190,P=0.040)。117例NAR患者中,鼻EOS增高39例(33.3%),鼻激发反应性增高50例(42.7%),EOS及激发均无异常28例(23.9%)。依上述特征,将NAR分为非特异型(A组)、EOS增高型(B组)和高反应型(C组)3组。结论 NAR患者鼻部以EOS增高及高反应性为主要炎症特征的全身炎症疾病,与下气道各炎症相关指标的增高以及血EOS增高存在明显的一致性。根据鼻部炎症特征提出的NAR分型方法有充分的临床和实验室依据,为NAR的诊断提供了更为科学和临床实用的方法,为进一步研究不同类型NAR发病机理以及根据NAR类型制定不同的治疗方案提供了理论依据。     

Parasitic worms and allergies in childhood: Insights from population studies 2008–2013

The last few decades have seen a marked increase in the global prevalence of allergic diseases particularly among children. Among the factors attributed to this rise has been reduced exposure to pathogens during childhood leading to insufficient maturation of the regulatory arm of developing immune systems. Over the years, a number of epidemiological studies have observed an inverse relationship between parasitic worm (helminth) infections and allergies. The purpose of this review is to highlight insights from population studies conducted among children published between 2008 and 2013 that explore the complex dynamics between helminth infections and allergies. These insights include the effect of anthelmintic treatment on allergic responses, an elucidation of immune mechanisms and an examination of helminth‐induced immunoglobulin E cross‐reactivity. A better understanding of the relationship between helminths and allergies is imperative as research directions move toward harnessing the therapeutic potential of helminths and their products in the treatment of allergic disorders.     

过敏性鼻炎及哮喘患者吸入性过敏原调查

目的 通过对百色市呼吸道变态反应性疾病过敏性鼻炎、哮喘患者进行吸入性过敏原检测及分析,筛查该市常见吸入性过敏原.方法 采用皮肤点刺诊断试剂盒,对210例儿童患者和200例成人患者的吸入性过敏原进行检测分析.结果 儿童患者中过敏原阳性检出209例(占99.52％),以户尘螨、犬毛、蟑螂过敏原的阳性率最高,分别检出146例(占69.52％)、131例(占62.28％)、127例(占60.48％);成人患者中过敏原阳性检出192例(占96.00％),以粉尘螨、户尘螨和芒果花粉过敏原的阳性率最高,分别检出124例(占62.00％)、113例(占56.50％)、89例(占44.50％).结论 户尘螨、犬毛、蟑螂及粉尘螨、户尘螨、芒果花粉分别与该市儿童及成人患者呼吸道变态反应性疾病有关.     

海南省蜉蝣过敏原临床致敏性

目的了解海南省临床蜉蝣过敏情况,为过敏性鼻炎的流行病学研究及临床诊断、治疗和预防提供依据。方法对500例过敏性鼻炎患者用蜉蝣过敏原进行前臂皮肤点刺试验,然后随机选择20例蜉蝣点刺阳性患者进行蜉蝣过敏原鼻黏膜激发试验。结果 500例皮肤点刺试验中,蜉蝣阳性者占58.6%（293/500）,20例阴性对照者皮肤点刺均为阴性100%（20/20）;20例蜉蝣皮肤点刺阳性患者中过敏原鼻黏膜激发试验阳性者为20例（100%）,20例阴性对照未见阳性反应。结论皮肤点刺和过敏原鼻黏膜激发试验结果相符合,蜉蝣为海南省重要过敏原。     

在过敏原皮肤试验中重复使用点刺针的合理性分析

目的比较进行过敏原皮肤点刺试验时，重复使用点刺针的合理性。方法选取40例接受过敏原皮肤试验的患者，分别于每人左右臂进行多次试验（多种变应原点刺液只用1根点刺针刺入皮肤）和单次试验（每一种点刺液分别使用1根点刺针刺入皮肤）。设安慰剂和组胺阳性对照。在进行常见7种吸入性过敏原皮肤点刺试验之后，测量风团直径，比较2种操作方法结果的真实性和2种操作方法成本的差异。结果多次试验组假阳性率为62．5％，其中产生（＋）的假阳性率为52．0％，产生（＋＋）的假阳性率为36．0％，产生（＋＋＋）的假阳性率为12，0％。但是单次试验组假阳性率为0，2组比较差异有统计学意义（P〈0．01）。结论只用1根点刺针进行多种过敏原皮肤点刺试验虽节约成本，但是假阳性率高。     

Food allergy severity predictions based on cellular in vitro tests

ABSTRACT

Introduction

Food allergy is increasing in prevalence and the severity of allergic reactions is unpredictable. Identifying food-allergic patients at high risk of severe reactions would allow us to offer a personalized and improved management for these patients.