哮喘联盟

   摘要
   背景：普遍认为在患有过敏性鼻炎及哮喘的患者中，避免接触特定的致敏物质可以改善哮喘症状的控制情况并减少对药物的需求。虽然大部分哮喘或鼻炎患者对空气中的过敏原敏感，但是做出社区医疗诊断与管理决策通常不包括获得患者致敏物质的详细病史或进行皮肤点刺试验（skin prick tests）。因此，管理决策常常依赖于经验，要么不建议避免接触过敏原的建议，要么给出建议，也不是针对患者的过敏情况。
   方法：我们设计了一项实效性、开放的随机对照试验，在确认诊断为哮喘和/或鼻-结膜炎的成人患者中，比较常规治疗与针对过敏干预（有完整的过敏史、皮肤点刺试验与避免过敏的个体化建议），来探索在全科医疗中，过敏评估以及个体化建议是否能增强哮喘及鼻炎患者的幸福感。12个月后的结局指标评估采用盲法。。主要的结局指标包括哮喘及鼻炎的症状，疾病特异性健康相关生活质量，一般生活质量以及肺功能。
   结果：被分配立即或推迟做皮肤点刺试验的患者在基线人口统计学特征或疾病特征方面没有显著差异。在12个月里，两组间在症状、生活质量以及肺功能未发现显著差异。（所有P > 0.05)。
   结论：在社区医疗已经诊断为哮喘和/或鼻炎的成年患者中，针对皮肤点刺试验采集完整的过敏史并给予避免过敏的个体化建议，对12个月后患者的症状、生活质量与肺功能并无改善。

 

(罗维佳 张红萍 王刚  四川大学华西医院中西医结合科呼吸病组 610041 摘译)
（Allergy 2015; 70: 203–211）
 

Pragmatic randomized controlled trial of a structured allergy intervention for adults with asthma and rhinitis in general practice
 

H. Smith, D. Horney, S. Goubet, C. Jones, A. Raza, P. White & A. Frew
 

Allergy 2015; 70: 203–211
 

ABSTRACT
BACKGROUND: It is widely believed that in patients with allergic rhinitis and asthma, avoidance of specific triggers can help improve symptom control and reduce need for medication. Whilst most patients with asthma or rhinitis are sensitized to airborne allergens, primary care diagnostic and management decisions are often made without either obtaining a detailed history of the patient’s allergic triggers or performing skin prick tests. Thus, management decisions are empirical and allergen avoidance advice is either not given or, if given, not tailored to the patient’s sensitivities.
METHOD: To ascertain whether allergy assessment and tailored advice in general practice for patients with asthma and rhinitis enhance well-being, we conducted a pragmatic, open, randomized controlled trial of allergy intervention (structured allergy history and skin prick testing and appropriate advice on allergy avoidance) versus usual care in adult patients with a working diagnosis of asthma and/or rhino-conjunctivitis. Outcomes were assessed after 12 months by an observer who was blinded to allocation. The main outcome measures were asthma and rhinitis symptoms, disease- specific health-related quality of life, generic quality of life and lung function.
RESULTS: There were no significant differences in baseline demographics or disease characteristics between patients assigned to immediate or delayed skin prick testing. No significant differences were observed between groups for any measures of symptoms, quality of life or lung function at 12 months (all P > 0.05).
CONCLUSION: Amongst adults with known asthma and/or rhinitis in primary care, taking a structured allergy history with skin prick tests and giving tailored advice on allergy avoidance made no difference to their symptoms, quality of life or lung function as measured twelve months later.