牛奶过敏是学龄期儿童支气管高反应性和气道炎症的预测因子
2010/09/14
摘要
背景：已经有研究发现，牛奶过敏（CMA）与学龄期儿童哮喘发生率增加相关。然而，有关牛奶过敏的基础人群的前瞻性研究，以及气道炎症和支气管高反应性（BHR）的相关研究尚较少。
目的：本文旨在评价CMA是否为儿童后期出现BHR和气道炎症的一个危险因素。
方法：我们对118名CMA儿童进行了前瞻性研究，邀请这些儿童到医院就诊。参与研究的儿童平均年龄为8.6岁，检测呼出气一氧化氮（FeNO）水平，采用组胺进行支气管激发试验。在相同的队列中，选取94名患者和80名对照者。
结果：与对照儿童相比，有CMA病史的学龄期儿童其FeNO水平较高(p=0.0009) ，对组胺能产生明显的支气管反应(p=0.027)。分层分析显示，仅IgE阳性CMA存在显著差异。多重logistic回归分析显示，IgE阳性CMA（优势比3.51；95％CI：1.56-7.90；p=0.002）和出生第一年有喘息史（优势比2.81；95％CI：1.16-6.84；p=0.023）是FeNO增加的独立解释因素；IgE阳性CMA（优势比3.37；95％CI：1.03-10.97；p=0.044）和父母吸烟（优势比3.41；95％CI：1.14-10.22；p=0.028）是BHR增加的独立解释因素，但是IgE阴性CMA与FeNO和BHR无显著相关性。CMA组，在妇产医院时就早期接触CM的儿童其BHR较轻（p=0.002）。
结论：与对照儿童相比，有IgE阳性CMA病史的儿童，预示着学龄期存在气道炎症，表现为较高的FeNO，对组胺能产生较强的支气管反应。与IgE阴性的CMA儿童相反，IgE阳性CMA是学龄期FeNO增加和BHR增强的预测因子。非常早期的CM暴露与BHR相关性较小。
（苏楠 审校）
Clin Exp Allergy. 2010 Jul 4. [Epub ahead of print]
Cow’s milk allergy as a predictor of bronchial hyperresponsiveness and airway inflammation at school age
Malmberg LP, Saarinen KM, Pelkonen AS, Savilahti E, Mäkelä MJ.
Department of Allergy, Skin and Allergy Hospital, Helsinki, Finland.
Abstract
Background Cow’s milk allergy (CMA) has been found to be associated with an increased incidence of asthma at school age.
However, prospective population-based studies of CMA and the development of airway inflammation and bronchial hyperresponsivess (BHR) are lacking. Objective The aims of this study was to evaluate CMA as a risk factor for BHR and airway inflammation presented later in childhood.
Methods We followed prospectively 118 children with CMA and invited them to a clinical visit at a mean age of 8.6 years including the measurement of exhaled nitric oxide (FE(NO)) and bronchial challenge with histamine. Ninety-four patients and 80 control subjects from the same cohort participated.
Results At school age, children with a history of CMA had higher FE(NO) levels (P=0.0009) and more pronounced responsiveness to histamine (P=0.027) than their controls. Stratified analysis showed a significant difference only in IgE-positive CMA. Multinomial logistic regression analysis showed that IgE-positive CMA [odds ratio (OR) 3.51; 95% confidence intervals (CI) 1.56-7.90; P=0.002] and a history of wheeze during the first year of life (OR 2.81; 95% CI 1.16-6.84; P=0.023) were independent explanatory factors for increased FE(NO), and IgE-positive CMA (OR 3.37; 95% CI 1.03-10.97; P=0.044) and parental smoking (OR 3.41; 95% CI 1.14-10.22; P=0.028) for increased BHR, whereas for IgE-negative CMA, no associations with FE(NO) or BHR were found. In the CMA group, those exposed to CM very early at the maternity hospital, had less BHR (P=0.002).
Conclusions Compared with their controls, children with a history of IgE-positive CMA show signs of airway inflammation, expressed as higher FE(NO), and more pronounced bronchial responsiveness to histamine at school age. In contrast to IgE-negative CMA, IgE-positive CMA is a significant predictor of increased FE(NO) and BHR at school age. Very early exposure to CM was associated with less BHR.
Clin Exp Allergy. 2010 Jul 4. [Epub ahead of print]
背景：已经有研究发现，牛奶过敏（CMA）与学龄期儿童哮喘发生率增加相关。然而，有关牛奶过敏的基础人群的前瞻性研究，以及气道炎症和支气管高反应性（BHR）的相关研究尚较少。
目的：本文旨在评价CMA是否为儿童后期出现BHR和气道炎症的一个危险因素。
方法：我们对118名CMA儿童进行了前瞻性研究，邀请这些儿童到医院就诊。参与研究的儿童平均年龄为8.6岁，检测呼出气一氧化氮（FeNO）水平，采用组胺进行支气管激发试验。在相同的队列中，选取94名患者和80名对照者。
结果：与对照儿童相比，有CMA病史的学龄期儿童其FeNO水平较高(p=0.0009) ，对组胺能产生明显的支气管反应(p=0.027)。分层分析显示，仅IgE阳性CMA存在显著差异。多重logistic回归分析显示，IgE阳性CMA（优势比3.51；95％CI：1.56-7.90；p=0.002）和出生第一年有喘息史（优势比2.81；95％CI：1.16-6.84；p=0.023）是FeNO增加的独立解释因素；IgE阳性CMA（优势比3.37；95％CI：1.03-10.97；p=0.044）和父母吸烟（优势比3.41；95％CI：1.14-10.22；p=0.028）是BHR增加的独立解释因素，但是IgE阴性CMA与FeNO和BHR无显著相关性。CMA组，在妇产医院时就早期接触CM的儿童其BHR较轻（p=0.002）。
结论：与对照儿童相比，有IgE阳性CMA病史的儿童，预示着学龄期存在气道炎症，表现为较高的FeNO，对组胺能产生较强的支气管反应。与IgE阴性的CMA儿童相反，IgE阳性CMA是学龄期FeNO增加和BHR增强的预测因子。非常早期的CM暴露与BHR相关性较小。
（苏楠 审校）
Clin Exp Allergy. 2010 Jul 4. [Epub ahead of print]
Cow’s milk allergy as a predictor of bronchial hyperresponsiveness and airway inflammation at school age
Malmberg LP, Saarinen KM, Pelkonen AS, Savilahti E, Mäkelä MJ.
Department of Allergy, Skin and Allergy Hospital, Helsinki, Finland.
Abstract
Background Cow’s milk allergy (CMA) has been found to be associated with an increased incidence of asthma at school age.
However, prospective population-based studies of CMA and the development of airway inflammation and bronchial hyperresponsivess (BHR) are lacking. Objective The aims of this study was to evaluate CMA as a risk factor for BHR and airway inflammation presented later in childhood.
Methods We followed prospectively 118 children with CMA and invited them to a clinical visit at a mean age of 8.6 years including the measurement of exhaled nitric oxide (FE(NO)) and bronchial challenge with histamine. Ninety-four patients and 80 control subjects from the same cohort participated.
Results At school age, children with a history of CMA had higher FE(NO) levels (P=0.0009) and more pronounced responsiveness to histamine (P=0.027) than their controls. Stratified analysis showed a significant difference only in IgE-positive CMA. Multinomial logistic regression analysis showed that IgE-positive CMA [odds ratio (OR) 3.51; 95% confidence intervals (CI) 1.56-7.90; P=0.002] and a history of wheeze during the first year of life (OR 2.81; 95% CI 1.16-6.84; P=0.023) were independent explanatory factors for increased FE(NO), and IgE-positive CMA (OR 3.37; 95% CI 1.03-10.97; P=0.044) and parental smoking (OR 3.41; 95% CI 1.14-10.22; P=0.028) for increased BHR, whereas for IgE-negative CMA, no associations with FE(NO) or BHR were found. In the CMA group, those exposed to CM very early at the maternity hospital, had less BHR (P=0.002).
Conclusions Compared with their controls, children with a history of IgE-positive CMA show signs of airway inflammation, expressed as higher FE(NO), and more pronounced bronchial responsiveness to histamine at school age. In contrast to IgE-negative CMA, IgE-positive CMA is a significant predictor of increased FE(NO) and BHR at school age. Very early exposure to CM was associated with less BHR.
Clin Exp Allergy. 2010 Jul 4. [Epub ahead of print]
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学龄前儿童家庭空调环境和交通环境暴露与哮喘和过敏性症状之间的关系
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OX40/OX40L及IL-4在哮喘动物模型气道壁的表达
