Defining childhood atopic phenotypes to investigate the association of atopic sensitization with allergic disease
Defining childhood atopic phenotypes to investigate the association of atopic sensitization with allergic disease
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DOI：
10.1111/j.1398-9995.2005.00890.x
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发表时间：
2005-10-01
期刊：
影响因子：
12.4
通讯作者：
Arshad, SH
中科院分区：
文献类型：
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作者：
Kurukulaaratchy, RJ;Matthews, S;Arshad, SH
目的：虽然特应性过敏在儿童时期很常见，但其与临床过敏性疾病的关系仍不完全清楚。因此，我们试图通过定义基于过敏的特应性表型来探索这种关系。方法：在出生时招募儿童(n=1456)，并在1、2、4和10岁时进行回顾。分别在4岁(n=980)和10岁(n=1036)进行常见变应原皮肤点刺试验(SPT)，其中肺功能(n=981)、支气管激发(n=784)和血清IgE(n=953)试验在10岁时进行。根据致敏模式确定SPT患儿(n=823)的特应性表型。16.5%的慢性儿童特应性疾病(4岁和10岁)和11.2%的延迟性儿童特应性疾病(仅10岁)。从未出现过过敏性疾病，如哮喘、湿疹和鼻炎，发病率虽小，但可识别。在过敏原致敏的受试者中，空气过敏原在整个童年时期占主导地位，而不是食物过敏。慢性儿童特应症患者的终生患病率最高，并伴有持续性喘息、湿疹和鼻炎，空气变应原致敏的患病率增加，一些持续性食物致敏的证据，10岁时脐带血Ig E显著高于从未特应症患者(P=0.006)，总Ig E(P<；0.001)和支气管高反应性(P<；0.001)均高于其他表型。儿童过敏症最常见的类型是慢性敏感化，与早期、持续性和临床上显著的过敏性疾病有关。目前公认的儿童过敏症进行曲可能会过度简化儿童特应症和过敏性疾病的自然病史。
Aims: Although atopic sensitization is common in childhood, its relationship to clinical allergic disease remains incompletely understood. We therefore sought to explore this relationship by defining sensitization based atopic phenotypes.Methods: Children were recruited at birth (n = 1456) and reviewed at 1, 2, 4 and 10 years. Skin prick testing (SPT) to common allergens was done at 4 (n = 980) and 10 years (n = 1036) with lung function (n = 981), bronchial challenge (n = 784) and serum IgE (n = 953) testing at 10. Atopic phenotypes were defined, by sensitization pattern, for children with SPT at both 4 and 10 years (n = 823).Results: Of phenotyped children, 68.0% were never atopic, 4.3% early childhood atopic (only atopic at age 4), 16.5% chronic childhood atopics (at 4 and 10 years) and 11.2% delayed childhood atopics (only at 10). Never atopics showed small but identifiable prevalence of allergic diseases such as asthma, eczema and rhinitis. Amongst allergen-sensitized subjects, aeroallergen predominated over food sensitization throughout childhood. Chronic childhood atopics showed highest prevalence of lifetime plus persistent wheeze, eczema and rhinitis, increased prevalence of aeroallergen sensitization, some evidence of persistent food sensitization, significantly greater cord IgE than never atopics (P = 0.006), plus higher total IgE (P < 0.001) and bronchial hyper-responsiveness (P < 0.001) at 10 years than other phenotypes.Conclusions: A proportion of childhood eczema, rhinitis and asthma is nonatopic. The commonest childhood pattern of atopy is chronic sensitization, associated with early, persisting and clinically significant allergic disease. The currently accepted childhood 'Allergic March' may oversimplify the natural history of childhood atopy and allergic disease.