哮喘联盟

摘要
   对同时存在职业相关性鼻炎和哮喘的患者进行充分鉴别诊断可能会有所收益。本病例阐述了采用综合方法确认职业性鼻炎（OR）和职业性哮喘（OA）的优势和重要性。一名38岁女性自2004年起作为技术人员在一个动物实验室工作，该患者经常与大鼠接触，2007年首次出现鼻炎和结膜炎症状。针对大鼠提取物的皮肤针刺试验呈强阳性。吸入特异性过敏原评价鼻和支气管反应性。暴露10分钟后，该患者出现鼻炎和结膜炎症状，其第1秒用力呼气体积下降27.5%，声学反射检测的鼻腔体积下降80%。过敏原暴露后，收集诱导痰液和鼻腔灌洗液进行检查，结果显示嗜酸性粒细胞增多（分别为11%和20%）。患者被诊断为过敏性OA和OR，并建议该患者停止与大鼠的接触。对于主诉有职业相关性鼻炎和哮喘症状的患者，综合方法能确诊OA和OR。

（苏楠  审校）
Can Respir J. 2012 Nov;19(6):385-7.


 

Integrated approach to diagnosis of associated occupational asthma and rhinitis.

Nguyen SB, Castano R, Labrecque M.

Abstract
Patients with coexisting work-related rhinitis and asthma would benefit from an adequate and simultaneous recognition of both diseases. The present case illustrates the advantages and importance of using an integrated approach to confirm a diagnosis of occupational rhinitis (OR) and occupational asthma (OA). A 38-year-old woman, who worked as an animal laboratory technician since 2004, first noticed the appearance of rhinitis and conjunctivitis symptoms in 2007 when she was exposed to rats. A skin-prick test with rat extract was strongly positive. A specific inhalation challenge with parallel assessment of nasal and bronchial responses was conducted. After 10 min of exposure, she developed rhinitis and conjunctivitis symptoms, her forced expiratory volume in 1 s dropped by 27.5% and her nasal volume, measured by acoustic rhinometry, decreased by 80% from baseline values. After allergen exposure, induced sputum and nasal lavage examination demonstrated an increase in eosinophils (11% and 20%, respectively). A diagnosis of associated allergic OA and OR was confirmed and she was advised to stop working with rats. A systematic and parallel diagnostic approach enables confirmation of a diagnosis of OA and OR in patients complaining of work-related rhinitis and asthma symptoms.

Can Respir J. 2012 Nov;19(6):385-7.