Sensitization to common allergens and its association with allergic disorders at age 4 years: A whole population birth cohort study
Sensitization to common allergens and its association with allergic disorders at age 4 years: A whole population birth cohort study
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DOI：
10.1542/peds.108.2.e33
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发表时间：
2001-08-01
期刊：
影响因子：
8
通讯作者：
Hakim, E
中科院分区：
文献类型：
--
作者：
Arshad, SH;Tariq, SM;Hakim, E
背景。特应性被定义为对暴露于过敏原产生免疫球蛋白E抗体的遗传倾向，并通过皮肤点刺试验对常见过敏原的反应进行评估。虽然人们普遍认为，特应性是过敏性疾病（如哮喘、鼻炎和湿疹）的一个重要危险因素，但特应性对这些疾病的影响程度仍存在争议。我们的目的是描述对常见过敏原致敏的患病率，并调查在4岁出生队列中，特应性（由皮肤点刺试验对1种或1种以上常见过敏原阳性定义）与哮喘、鼻炎和湿疹的关联程度。在14个月期间（1989-1990年）招募了1456名出生儿童。这些孩子以前在1岁和2岁时就被发现过。在4岁时，对1218名儿童进行了审查，并进行了访谈或邮寄问卷调查，以了解过敏性疾病（哮喘、鼻炎和湿疹）的存在。此外，对981名儿童进行了12种常见过敏原的皮肤点刺试验。过敏原为尘螨（Dermatophagoides pteronyssimus）、草花粉混合物、猫、狗、互花孢菌、植物枝孢菌、牛奶、鸡蛋、大豆、cod、小麦和花生。平均轮径大于阴性对照至少3mm被视为阳性。该分析仅限于981人（占原始人群的67%），他们也对标准电池进行了皮肤点刺试验。采用Chi(2)检验检验各种过敏性疾病与皮肤试验阳性之间的单变量相关性。采用多元logistic回归分析，获得每种过敏原致敏对变应性疾病独立影响的校正优势比（ORs）和95%置信区间（CIs），并对其他过敏原致敏的影响进行校正。为了确定有多少过敏性疾病可归因于特应性，我们估计了人群归因风险。这是用公式计算的：P(R - 1)，其中R是考虑的过敏性疾病的OR， P是患有该疾病的儿童的特应性比例。4岁时进行皮肤刺痛测试的儿童除过敏性疾病患病率较高外，在大多数特征上与其他人群相似。981例患者中有276例（28.1%）出现过敏性疾病（哮喘、鼻炎和湿疹）。192例（19.6%）患儿为特应性（对一种或多种过敏原有阳性反应）。与食物过敏原（3.5%）相比，吸入性过敏原致敏相对常见（19.2%）。屋尘螨（11.9%）、草花粉（7.8%）和猫（5.8%）是最常见的阳性反应。对四种最常见的过敏原（屋尘螨，草花粉，猫和A交替）的测试可以检测出94%的特应性儿童。对4种最常见过敏原的致敏与过敏性疾病的存在密切相关。强效过敏原（如屋尘螨）的影响最大，其效果是分级的。例如，50%对屋尘螨过敏的儿童患有哮喘，而对猫过敏的儿童为44%，对草花粉过敏的儿童为42%，对草花粉过敏的儿童为32%。总体而言，68.4%对室内尘螨敏感的儿童患有哮喘、湿疹和/或鼻炎。草花粉、猫、花蚜分别为64.9%、66.7%和57.4%。养猫家庭对猫过敏的儿童比例不高于有猫家庭（有猫家庭5.1%[19/374]，无猫家庭6.2%[36/580]，差异无统计学意义[NS]）。同样，有狗和没有狗的家庭对狗的敏感性也没有差异（有狗的家庭：1.8%[5/282]；没有狗的家庭：2.8% [19/673]；NS）。在这个年龄段，男孩比女孩更常发生特应症（男性：497例中有112例[22.5%]，女性：484例中有80例[16.5%];OR: 1.47, 95% CI: 1.07-2.02）。大多数过敏原均为男性优势，但只有屋尘螨（男性：75/497 [15.1%]vs女性：42/484 [8.7%];OR: 1.87; CI: 1.25-2.79）和草花粉（男性：51/497 [10.3%]vs女性：26/484 [5.4%];OR: 2.01; CI: 1.23-3.29）具有统计学意义。过敏原致敏对哮喘的独立影响仅观察到屋尘螨，OR为8.07 （CI: 4.60-14.14）。鼻炎的最高独立风险是草花粉致敏（OR: 5.02; CI: 2.21-11.41），湿疹的最高独立风险是花生致敏（OR: 4.65; CI: 1.02-21.34）。大多数儿童（98/192）对bbb1变应原致敏。随着皮肤点刺试验阳性反应次数的增加，观察到儿童过敏性疾病的风险呈分级效应。这种效果在所有过敏性疾病（哮喘、湿疹和鼻炎）中都是一致的。皮肤试验对4种或4种以上过敏原反应阳性的儿童中，近80%患有哮喘、湿疹和/或鼻炎，而非特应性儿童的这一比例为20%。哮喘患儿的特应性患病率为44%。OR为4.56，计算人群归因风险为35%。鼻炎患儿中有55%为特应性，鼻炎的OR为5.85。因此，46%的鼻炎病例可归因于特应性。湿疹的人群归因风险为32%（湿疹患儿的特应性患病率为43%，湿疹发展的OR为3.86）。特应性与4岁时哮喘、鼻炎、湿疹密切相关，呈直接线性关系。然而，过敏性疾病的比例归因于特应性
Background. Atopy is defined as the genetic propensity to develop immunoglobulin E antibodies in response to exposure to allergens and assessed by skin prick test responses to common allergens. Although it is generally agreed that atopy is an important risk factor for allergic diseases such as asthma, rhinitis, and eczema, the extent to which atopy accounts for these diseases is controversial.Objective. We aim to describe the prevalence of sensitization to common allergens and investigate the degree of association of atopy (as defined by positive skin prick test to 1 or more common allergens) to asthma, rhinitis, and eczema in a birth cohort at the age of 4 years.Methods. A birth cohort of 1456 children was recruited over a 14-month period (1989-1990). These children have been seen previously at 1 and 2 years of age. At 4 years, 1218 children were reviewed and an interview was administered or postal questionnaire was completed for the presence of allergic diseases (asthma, rhinitis, and eczema). Additionally, in 981 children, skin prick tests with a battery of 12 common allergens were performed. Allergens were house dust mite (Dermatophagoides pteronyssimus), grass pollen mix, cat, dog, Alternaria alternata, Cladosporium herbarum, cow's milk, hen's egg, soya, cod, wheat, and peanut. A mean wheal diameter of at least 3 mm greater than the negative control was taken as positive. This analysis is confined to the 981 (67% of the original population) who also had skin prick tests to the standard battery.chi (2) tests were used to test the univariate association between each allergic disease and positive skin test. Multiple logistic regression analysis was performed to obtain the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the independent effect of sensitization to each allergen on allergic disease, adjusting for the effect of sensitization to other allergens. To ascertain how much of allergic disease is attributable to atopy, we estimated the population-attributable risk. This was calculated with the formula: P(R - 1) where R is the OR for the allergic disease under consideration and P is the proportion of atopy in children with that disease.Results. Children who were skin prick-tested at 4 years were similar in most characteristics to the rest of the population, except that they had a higher prevalence of allergic disease. Allergic disorders (asthma, rhinitis, and eczema) were present in 276 (28.1%) of 981. One hundred ninety-two (19.6%) children were atopic (positive reaction to 1 or more allergens). Sensitization to inhalant allergens was relatively common (19.2%) as compared with food allergens (3.5%). House dust mite (11.9%), grass pollen (7.8%), and cat (5.8%) were the most common positive reactions. A test to the 4 most common allergens (house dust mite, grass pollen, cat, and A alternata) could detect 94% of the atopic children. Sensitization to the 4 most common allergens was strongly associated with the presence of allergic disorders. There was a graded effect with the potent allergens, such as house dust mite, having the greatest impact. For example, 50% of children sensitized to house dust mite had asthma as opposed to 44% sensitized to cat, 42% sensitized to grass pollen, and 32% sensitized to A alternata. Overall, 68.4% of children sensitized to house dust mite had asthma, eczema, and/or rhinitis. The respective figures for grass pollen, cat, and A alternata were 64.9%, 66.7%, and 57.4%. The proportion of children sensitized to cat was not higher in households with cat ownership (households with cats: 5.1% [19/374]; households without cats: 6.2% [36/580]; not significant [NS]). Similarly, no difference was seen in sensitization to dog in households with and without dogs (households with dogs: 1.8% [5/282]; households without dogs: 2.8% [19/673]; NS). Boys were atopic more often than girls at this age (male: 112 of 497 [22.5%] vs female: 80 of 484 [16.5%]; OR: 1.47, 95% CI: 1.07-2.02). Male preponderance was observed with most allergens, but this was statistically significant only for house dust mite (male: 75/497 [15.1%] vs female: 42/484 [8.7%]; OR: 1.87; CI: 1.25-2.79) and grass pollen (male: 51/497 [10.3%] vs female: 26/484 [5.4%]; OR: 2.01; CI: 1.23-3.29).An independent effect of allergen sensitization on asthma was observed only with house dust mite with an OR of 8.07 (CI: 4.60-14.14). The highest independent risk for rhinitis was sensitization to grass pollen (OR: 5.02; CI: 2.21-11.41), and for eczema, sensitization to peanut (OR: 4.65; CI: 1.02-21.34).The majority of children (98/192) were sensitized to >1 allergen. A graded effect was observed with the risk of allergic disease in the child increasing with the number of positive skin prick test reactions. This effect was consistent throughout the spectrum of allergic diseases (asthma, eczema, and rhinitis). Nearly 80% of the children with positive skin test reactions to 4 or more allergens had asthma, eczema, and/or rhinitis compared with 20%, if they were nonatopic.The prevalence of atopy in asthmatic children was 44%. With an OR of 4.56, the population-attributable risk was calculated to be 35%. Fifty-five percent of children with rhinitis were atopic, and the OR of rhinitis was 5.85. Therefore, 46% of the cases of rhinitis could be attributable to atopy. The population-attributable risk of atopy for eczema was 32% (the prevalence of atopy in children with eczema: 43%; and the OR for the development of eczema: 3.86).Conclusion. Atopy is closely associated with asthma, rhinitis, and eczema at 4 years of age, with a direct and linear relationship. However, the proportion of cases of allergic disease attributable to atopy is