Effects of geohelminth infection and age on the associations between allergen-specific IgE, skin test reactivity and wheeze: a case-control study
Effects of geohelminth infection and age on the associations between allergen-specific IgE, skin test reactivity and wheeze: a case-control study
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DOI：
10.1111/cea.12040
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发表时间：
2013-01-01
影响因子：
6.1
通讯作者：
Cooper, P. J.
中科院分区：
文献类型：
--
作者：
Moncayo, A. -L.;Vaca, M.;Cooper, P. J.
拉丁美洲贫困人口中的大多数儿童哮喘与空气过敏原致敏无关，这一观察结果可以通过慢性寄生虫感染或年龄的影响导致的特应性减弱来解释。目的探讨地螨感染与年龄对异位性、哮鸣的影响，以及异位性与哮鸣的关系。方法采用病例-对照研究方法，对生活在厄瓜多尔农村社区的376名719岁的受试者（149例，227例对照）进行研究。从一项大型横断面调查中确定的喘息病例，最近有喘息，对照组是那些没有喘息的随机样本。采用过敏原特异性IgE （asIgE）和皮肤点刺试验（SPT）对屋尘螨和蟑螂的反应来测定其变态反应性。测定粪便地虫病感染情况和血浆抗蛔虫IgE水平。结果抗蛔虫IgE占最近喘息的45.9%，SPT和asIgE分别为10.0%和10.5%。与儿童相比，青少年的特异反应性与喘息之间的关联更大。虽然抗蛔虫IgE与喘息(adj. OR 2.24 （95% CI 1.333.78, P = 0.003）和asIgE （adj. OR 5.34, 95% CI 2.4911.45, P < 0.001）密切相关，但与喘息的相关性与asIgE无关。有一些证据表明，与地虫病活跃者相比，未感染地虫病者的特应性与喘息之间的关联更大。结论和临床意义屋尘螨和蟑螂的特异应性是本研究人群中少数喘息病例的原因，而抗蛔虫IgE的存在是一个重要的危险因素。我们的数据仅提供了有限的证据，表明在流行地区，活跃的地蠕虫感染减弱了特应性和喘息之间的联系，或者年龄改变了这种联系。蛔虫过敏性致敏在哮喘发展中的作用，独立于特应性，需要进一步研究。
Background Most childhood asthma in poor populations in Latin America is not associated with aeroallergen sensitization, an observation that could be explained by the attenuation of atopy by chronic helminth infections or effects of age. Objective To explore the effects of geohelminth infections and age on atopy, wheeze, and the association between atopy and wheeze. Methods A case-control study was done in 376 subjects (149 cases and 227 controls) aged 719 years living in rural communities in Ecuador. Wheeze cases, identified from a large cross-sectional survey, had recent wheeze and controls were a random sample of those without wheeze. Atopy was measured by the presence of allergen-specific IgE (asIgE) and skin prick test (SPT) responses to house dust mite and cockroach. Geohelminth infections were measured in stools and anti-Ascaris IgE in plasma. Results The fraction of recent wheeze attributable to anti-Ascaris IgE was 45.9%, while those for SPT and asIgE were 10.0% and 10.5% respectively. The association between atopy and wheeze was greater in adolescents than children. Although Anti-Ascaris IgE was strongly associated with wheeze (adj. OR 2.24 (95% CI 1.333.78, P = 0.003) and with asIgE (adj. OR 5.34, 95% CI 2.4911.45, P < 0.001), the association with wheeze was independent of asIgE. There was some evidence that the association between atopy and wheeze was greater in uninfected subjects compared with those with active geohelminth infections. Conclusions and clinical relevance Atopy to house dust mite and cockroach explained few wheeze cases in our study population, while the presence of anti-Ascaris IgE was an important risk factor. Our data provided only limited evidence that active geohelminth infections attenuated the association between atopy and wheeze in endemic areas or that age modified this association. The role of allergic sensitization to Ascaris in the development of wheeze, independent of atopy, requires further investigation.