食品和吸入性变应原致敏在成人嗜酸性粒细胞性食管炎中的作用
2016/10/09
摘要
背景：经常对嗜酸性粒细胞性食管炎（EoE）患者进行IgE介导的食物过敏评价。然而，识别IgE介导的成人食物过敏的临床相关性尚不清楚。
目的：要确定嗜酸性粒细胞性食管炎（EoE）与食物或吸入性过敏原致敏性的相关是否代表具有显著临床和生物学特征的EoE的不同表型。
方法：从2008到2013年，在威斯康星大学医院和诊所里的成人过敏门诊，病历回顾诊断出257例EoE病人。对病人的记录进行了审查以此来获得疾病的严重程度、内镜检查结果、病理报告、过敏试验、医疗管理和病人报告的结果。
结果：通过皮肤点刺试验和/或血清IgE来评价食物过敏占到病例的93%。至少对一种食物过敏的患者占到54%，与非食物过敏的患者相比，他们更可能报告具有合并哮喘、过敏性鼻炎、湿疹和/或食物过敏。87%的患者有吸入性过敏原致敏。临床特点包括：EoE症状、疾病严重、内镜检查、外周血嗜酸性细胞增多，和患者报告的临床结局，食品过敏患者和非食品过敏患者之间没有区别。然而，在内镜，吸入性过敏原敏感的患者与非过敏原致敏患者相比，更可能有狭窄和不太可能表现出粘液戒指症 。
结论：患有嗜酸性粒细胞性食管炎(EoE) 和IgE介导的食物过敏的成人与非食物敏感患者在表型上没有明显不同。在鉴别嗜酸性粒细胞性食管炎(EoE)成人患者的食物敏感性上还没有明确的临床应用。需要进一步的研究来确定是否吸入性过敏原的敏感性是一种独特的表型。
（杨冬 审校）
Ann Allergy Asthma Immunol. 2016 Aug 30. pii: S1081-1206(16)30531-2. doi: 10.1016/j.anai.2016.08.008. [Epub ahead of print]
Role of food and aeroallergen sensitization in eosinophilic esophagitis in adults.
Olson AA1, Evans MD2, Johansson MW3, Kim CH1, Manthei DM1, Gaumnitz EA4, Mathur SK5.
Author information
Abstract
BACKGROUND:Evaluation of IgE-mediated food sensitivity is frequently performed for patients with eosinophilic esophagitis (EoE). However, the clinical relevance of identifying IgE-mediated sensitivity to foods in adults is unclear.
OBJECTIVE:To determine whether EoE associated with food or aeroallergen sensitivity represents a phenotype of EoE with distinct clinical or biological features.
METHODS:A medical record review identified 257 patients with a diagnosis of EoE evaluated in the adult allergy clinic at the University of Wisconsin Hospital and Clinics from 2008 to 2013. Patient records were reviewed to capture measures of disease severity, endoscopy results, pathology reports, allergy testing, medical management and patient-reported outcomes.
RESULTS:Evaluation of food sensitization with skin prick testing and/or serum IgE was performed for 93% of patients. Sensitization to at least 1 food was identified in 54% of patients who were more likely to report concomitant asthma, allergic rhinitis, eczema, and/or food allergy compared with nonfood sensitive patients. Aeroallergen sensitivity was identified in 87% of patients tested. Clinical characteristics, including EoE symptoms, disease severity, endoscopic findings, peripheral eosinophilia, and patient-reported outcomes, did not differ between food sensitive and non-food sensitive patients. However, on endoscopy, aeroallergen sensitive patients were more likely to have strictures and less likely to exhibit felinization compared with non-aeroallergen sensitized patients.
CONCLUSION:Adults with EoE and IgE-mediated food sensitivity are not phenotypically different than non-food sensitive patients. There is no clear clinical utility in identifying food sensitivity in adults with EoE. Further studies are needed to determine whether aeroallergen sensitivity represents a distinct phenotype of EoE.
Ann Allergy Asthma Immunol. 2016 Aug 30. pii: S1081-1206(16)30531-2. doi: 10.1016/j.anai.2016.08.008. [Epub ahead of print]
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慢性鼻窦炎与勃起功能障碍：一项基于人群的研究
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