Induction of atopic dermatitis by inhalation of house dust mite
Induction of atopic dermatitis by inhalation of house dust mite
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DOI：
10.1016/s0091-6749(96)70259-2
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发表时间：
1996-05-01
影响因子：
14.2
通讯作者：
vanderMeer, JB
中科院分区：
文献类型：
--
作者：
Tupker, RA;DeMonchy, JGR;vanderMeer, JB
背景：屋尘螨在特应性皮炎中的致病作用仍有争议。最近的研究表明，屋尘螨过敏原与预处理皮肤的强烈表皮接触可诱导脱屑。然而，在与屋尘螨的自然接触过程中是否满足这些条件尚不确定。在过去，过敏原吸入已被认为是诱发过敏性皮炎的恶化。本研究的目的是探讨是否可以诱导过敏性皮炎患者吸入屋尘螨。方法：20例过敏性皮炎患者进行支气管挑衅屋尘螨。以双盲、随机、安慰剂对照的方式，用四种浓度的标准化屋尘螨提取物进行激发试验。进行肺量测定，并在每次激发剂量之前和之后测量FEV。瘙痒或红斑的严重程度或本地化的变化recorded.Results：在9的20例特应性皮炎支气管挑战屋尘螨诱导明确的皮肤症状后1.5至17小时。在3名患者中观察到非受累部位的瘙痒性肉芽肿性病变以及现有病变的加重。3例患者仅出现恶化，另外3例患者仅出现新发病变。在9例屋尘螨吸入性皮炎患者中，有8例皮肤症状出现在早期支气管反应之前。所有屋尘螨引起的皮炎患者都有哮喘史，作为一个群体，他们的平均血液总IgE水平高于“阴性裙反应者”。一名患者在安慰剂激发日出现支气管炎性红斑，之前没有支气管收缩反应。在屋尘螨激发日出现皮肤反应的患者数量明显高于安慰剂日出现皮肤反应的患者数量（p = 0.011 [Prescott检验]）。在吸入屋尘螨后出现早期支气管反应的特应性皮炎患者亚组中，呼吸途径可能与皮炎的诱导和加重有关，有哮喘病史，血液总IgE水平升高。此外，这些结果表明支气管反应和裙部反应之间可能存在因果关系。
Background: The pathogenetic role of house dust mite in atopic dermatitis remains controversial. Recent studies have shown that intensive epicutaneous contact of house dust mite allergen with premanipulated skin may induce dematitis. It is, however, uncertain whether such conditions are met during natural contact with house dust mite. In the past, allergen inhalation has been suggested to induce exacerbation of atopic dermatitis. The aim of this study was to investigate whether dermatitis could be induced in patients with atopic dermatitis by inhalation of house dust mite.Methods: Twenty patients with atopic dermatitis underwent bronchial provocations with house dust mite. Challenge tests were performed with four concentrations of a standardized house dust mite extract in a double-blind randomized, placebo-controlled fashion. Spirometry was performed, and FEV, runs measured before and after each challenge dose. Changes in severity or localization of itching or erythema were recorded.Results: In nine of 20 patients with atopic dermatitis bronchial challenge with house dust mite induced unequivocal skin symptoms after 1.5 to 17 hours. Pruritic erythematous lesions on noninvolved sites together with exacerbations of existing lesions were seen in three patients. Three patients had an exacerbation only, and three other patients had new lesions only. In eight of nine patients with house dust mite inhalation-induced dermatitis, skin symptoms were preceded by an early bronchial reaction. All patients with house dust mite-induced dermatitis had a history of asthma, and as a group they had a higher mean blood total IgE la el compared with the ''negative skirt responders.'' One patient had pruritic erythema on the placebo challenge day, without a preceding bronchoconstrictive reaction. The number of patients who had a skin response on the house dust mite challenge day was significantly higher than the number of patients who had a skin response on the placebo day (p = 0.011 [Prescott's test]).Conclusions: The respiratory route may be relevant in the induction and exacerbation of dermatitis in a subset of patients with atopic dermatitis who have early bronchial reactions after house dust mite inhalation, a history of asthma, and an elevated blood total IgE level. Furthermore, these findings suggest a possible causal relationship between bronchial reactions and skirt reactions.