哮喘联盟

   摘要
   背景：婴儿期有特异性湿疹的儿童常发展为过敏性鼻炎和哮喘，但人们对“过敏反应进行曲”的解释存在质疑，因为特异反应性疾病的发病过程看上去比其更复杂（过敏反应进行曲：特异反应性疾病从一种疾病状态发展为另一疾病状态）。
   目的：在本项前瞻性多中心研究中，对婴儿期有湿疹的儿童长期随访直至10岁，着重观察他们对过敏原的敏感性、湿疹的严重程度和4.5岁-10岁间过敏性呼吸道症状的发展。
   方法：共123例儿童被纳入研究。采用Hanifin-Rajka标准和SCORAD指数对湿疹进行描述。记录喘息发作次数，进行皮肤点刺试验和IgE试验，并填写调查问卷。4.5岁和10岁时重复上述检查，并检查过敏性鼻炎（ARC）和哮喘症状。
   结果：123例儿童中有94例完成研究。高SCORAD得分与ARC (B=9.86, P=0.01) 和哮喘(B=10.17, P=0.01)发生风险相关。对于初次随访有湿疹和喘息的婴儿，发生哮喘的优势比OR为4.05（P=0.01）。4.5岁发生ARC可导致10岁时发生哮喘的风险显著增加，OR为11.28（P=0.00）。
   结论：本研究提示婴儿期湿疹和高SCORAD得分与10岁时哮喘风险增加显著相关。婴儿期有湿疹和喘息的儿童比婴儿期单纯湿疹的儿童更容易发生哮喘。婴儿期湿疹和早发ARC似乎预示更严重的过敏性疾病，如哮喘。本研究展示了婴儿期湿疹到幼年期ARC再到儿童期哮喘发生的进程，支持“过敏反应进行曲”的说法，至少在更严重的过敏性疾病上相关。
 

（苏楠 审校）
PLoS One. 2014 Jun 10;9(6):e99609. doi: 10.1371/journal.pone.0099609. eCollection 2014.

 

Severe eczema in infancy can predict asthma development. A prospective study to the age of 10 years.
 

Ekbäck M1, Tedner M2, Devenney I1, Oldaeus G3, Norrman G4, Strömberg L5, Fälth-Magnusson K1.
 

ABSTRACT
BACKGROUND: Children with atopic eczema in infancy often develop allergic rhinoconjunctivitis and asthma, but the term "atopic march" has been questioned as the relations between atopic disorders seem more complicated than one condition progressing into another.
OBJECTIVE: In this prospective multicenter study we followed children with eczema from infancy to the age of 10 years focusing on sensitization to allergens, severity of eczema and development of allergic airway symptoms at 4.5 and 10 years of age.
METHODS: On inclusion, 123 children were examined. Hanifin-Rajka criteria and SCORAD index were used to describe the eczema. Episodes of wheezing were registered, skin prick tests and IgE tests were conducted and questionnaires were filled out. Procedures were repeated at 4.5 and 10 years of age with additional examinations for ARC and asthma.
RESULTS: 94 out of 123 completed the entire study. High SCORAD points on inclusion were correlated with the risk of developing ARC, (B = 9.86, P = 0.01) and asthma, (B = 10.17, P = 0.01). For infants with eczema and wheezing at the first visit, the OR for developing asthma was 4.05(P = 0.01). ARC at 4.5 years of age resulted in an OR of 11.28(P = 0.00) for asthma development at 10 years.
CONCLUSION: This study indicates that infant eczema with high SCORAD points is associated with an increased risk of asthma at 10 years of age. Children with eczema and wheezing episodes during infancy are more likely to develop asthma than are infants with eczema alone. Eczema in infancy combined with early onset of ARC seems to indicate a more severe allergic disease, which often leads to asthma development. The progression from eczema in infancy to ARC at an early age and asthma later in childhood shown in this study supports the relevance of the term "atopic march", at least in more severe allergic disease.

PLoS One. 2014 Jun 10;9(6):e99609. doi: 10.1371/journal.pone.0099609. eCollection 2014.