哮喘联盟

   摘要
   目的：旨在评估特应质和变态反应对临床疟疾风险的影响
   方法：在塞内加尔的一项疟疾纵向开放队列研究中，对175例出生儿童（1个月～14岁）进行临床和免疫过敏反应横断面分析，随访长达15年。其中143例（年龄：4个月～14岁）长达15年的疟疾发病率随访数据可用。混合模型回归分析法被用于确定过敏状态对疟疾发病率的影响，并校正年龄、性别、镰状细胞性状和感染力的影响。
   主要测定项目：哮喘、过敏性结膜炎和过敏性皮炎，自出生后临床恶性疟原虫疟疾的发作人数和相应的寄生虫密度
   结果：12%的儿童有哮喘，10%的儿童患过敏性皮炎。在这两组儿童中，一旦年龄超过高峰期患儿（3～4岁），发生恶性疟原虫疟疾的风险分别增加两倍(OR 2.12 95%; CI 1.46- 3.08; p=8×10(-5))和三倍(OR 3.15; 1.56 -6.33; p=1.3×10(-3))。而且，他们的恶性疟原虫密度也更高(哮喘：平均105.3 寄生虫/μL±SE 41.0 vs 51.3±9.7; p=6.2×10(-3)，过敏性皮炎：135.4±70.7 vs 52.3±11.0; p=0.014)。过敏对非疟疾者的临床表现没有影响。过敏性结膜炎的患者的临床疟疾的风险未有增，也没有寄生虫密度的任何差异。
   结论：这些结果证明，哮喘和过敏性皮炎延迟了临床免疫反应到恶性疟原虫疟疾的发展。尽管非洲疟疾发病率减少令人鼓舞，但在某种程度上令人担心的是哪一种过敏反应的增加将加重疟疾的负担。抗组胺药的抗寄生虫作用已经明确，给过敏儿童处方抗组胺药将有可能减少临床疟疾的负担，在增加一线抗疟药物疗效的同时减轻过敏的非感染性的影响。
 

（林江涛 审校）
BMJ Open. 2013 Jul 24;3(7). pii: e002835. doi: 10.1136/bmjopen-2013-002835. Print 2013.

 

Asthma and atopic dermatitis are associated with increased risk of clinical Plasmodium falciparum malaria.
 

Herrant M, Loucoubar C, Bassène H, Gonçalves B, Boufkhed S, Diene Sarr F, Fontanet A, Tall A, Baril L, Mercereau-Puijalon O, Mécheri S, Sakuntabhai A, Paul R.
 

Abstract
OBJECTIVES: To assess the impact of atopy and allergy on the risk of clinical malaria.
DESIGN: A clinical and immunological allergy cross-sectional survey in a birth cohort of 175 children from 1 month to 14 years of age followed for up to 15 years in a longitudinal open cohort study of malaria in Senegal. Malaria incidence data were available for 143 of these children (aged 4 months to 14 years of age) for up to 15 years. Mixed-model regression analysis was used to determine the impact of allergy status on malaria incidence, adjusting for age, gender, sickle-cell trait and force of infection.
MAIN OUTCOME MEASURES: Asthma, allergic rhinoconjunctivitis and atopic dermatitis status, the number of clinical Plasmodium falciparum malaria episodes since birth and associated parasite density.
RESULTS: 12% of the children were classified as asthmatic and 10% as having atopic dermatitis. These groups had respectively a twofold (OR 2.12 95%; CI 1.46 to 3.08; p=8×10(-5)) and threefold (OR 3.15; 1.56 to 6.33; p=1.3×10(-3)) increase in the risk of clinical P falciparum malaria once older than the age of peak incidence of clinical malaria (3-4 years of age). They also presented with higher P falciparum parasite densities (asthma: mean 105.3 parasites/μL±SE 41.0 vs 51.3±9.7; p=6.2×10(-3). Atopic dermatitis: 135.4±70.7 vs 52.3±11.0; p=0.014). There was no effect of allergy on the number of non-malaria clinical presentations. Individuals with allergic rhinoconjunctivitis did not have an increased risk of clinical malaria nor any difference in parasite densities.
CONCLUSIONS: These results demonstrate that asthma and atopic dermatitis delay the development of clinical immunity to P falciparum. Despite the encouraging decrease in malaria incidence rates in Africa, a significant concern is the extent to which the increase in allergy will exacerbate the burden of malaria. Given the demonstrated antiparasitic effect of antihistamines, administration to atopic children will likely reduce the burden of clinical malaria in these children, increase the efficacy of first-line treatment antimalarials and alleviate the non-infectious consequences of atopy.
 

BMJ Open. 2013 Jul 24;3(7). pii: e002835. doi: 10.1136/bmjopen-2013-002835. Print 2013.