The effect of sex hormones on irritant and allergic response: possible relevance for skin testing
The effect of sex hormones on irritant and allergic response: possible relevance for skin testing
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性激素对刺激和过敏反应的影响：与皮肤测试的可能相关性
DOI：
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发表时间：
2009
影响因子：
10.3
通讯作者：
H. I. Maibach
中科院分区：
文献类型：
--
作者：
M. Farage;E. Berardesca;H. I. Maibach
主席先生，孕激素和雌激素的周期性变化决定了月经周期，这对女性身体产生了重大的生物学影响。皮肤对雌激素和孕激素有高度敏感的受体，许多皮肤病会受到雌激素和孕激素水平的影响(表1)。罕见的自身免疫性疾病，如雌激素皮炎和自身免疫性黄体酮皮炎，被认为是对内源性性激素的皮肤反应，在文献中也有报道。雌激素也被认为是免疫系统的“天然调节剂”，高水平的雌激素可以抑制过敏反应。在育龄妇女中，排卵与雌激素水平的峰值同时发生。据报道，肥大细胞脱颗粒，以及T细胞数量的减少，导致细胞免疫反应的抑制。据观察，B细胞的数量随着排卵的增加而增加。性激素影响皮肤病过敏反应的表达。月经周期时间点与症状出现的相关性有助于确定与皮肤症状相关的特定性激素。大量研究表明，在月经前期对抗原的反应性增加，以及特应性皮肤状况在月经前或月经期间恶化。在一项对143名患有湿疹的妇女的研究中，28.7%的人报告在月经前一周症状恶化。在一项对286名患有特应性皮炎的女性的研究中，报告症状周期性变化的人中，96%的人报告在月经前一周症状恶化，月经开始后迅速改善。在已发表的报告中，特应性皮炎症状经前恶化的患病率高达100%。相反，月经周期的滤泡期似乎抑制了过敏性接触性皮炎的表现。虽然大多数研究表明在排卵时过敏反应受到抑制，但其他研究表明，在月经周期的后期，过敏反应增加，或者过敏反应与月经周期根本没有关联。皮肤测试的目的是评估性激素对过敏的影响，得出了有趣的结果。Kirmaz等人。研究发现，虽然皮肤点刺试验(SPT)对组胺的反应性在整个月经周期中没有变化，但血清雌二醇与月经周期中期的SPT对过敏原的反应性呈正相关。同样，Kemmett和Tidman观察到，尽管组胺水平不变，特应性皮炎女性的最大红斑发生在月经开始时。很多因素都会影响皮肤测试结果(表2)。过敏或刺激性反应皮肤测试的最佳做法将确保关于刺激物的选择、测试地点、环境控制、批量量和浓度、输送工具、闭塞敷料的使用、评估时间、评估工具和(女性)月经周期阶段的标准化方案。还必须考虑个体差异，包括助推器效应的可能性。在Rohold等人对20名患者的研究中，尽管两次测试之间有6周的间隔(0？02<；P<；005)，但在第二次硫酸镍贴片测试中，患者的皮肤反应性增强，证实了在假定的合理恢复时间后可能会产生增强效应。个体内差异，超过四次重复斑贴测试，也被观察到差异高达100倍。总而言之，现有的研究支持坊间报道，即育龄妇女的皮肤病状况遵循症状严重程度的循环模式，这与女性性激素水平的波动有关，大多数作者观察到孕激素阶段过敏反应加剧。关于表1皮肤病临床条件中报告的与女性性激素相关的症状恶化的最终结论
SIR, The cyclical variations of progesterone and oestrogen that define the menstrual cycle represent a major biological influence on the female body. The skin has highly sensitive receptors for oestrogen and progesterone, and many dermatological conditions are affected by oestrogen and progesterone levels (Table 1). Rare autoimmune disorders known as oestrogen dermatitis and autoimmune progesterone dermatitis, believed to be cutaneous reactions to endogenous sex hormones, are also reported in the literature. Oestrogen is also postulated to be a ‘natural modulator’ of the immune system, with high oestrogen levels acting to inhibit allergic response. Ovulation occurs in conjunction with peak oestrogen levels in a woman of reproductive age. Mast cell degranulation has been reported during this phase, as well as decreases in T-cell numbers, leading to depression of cellular immune response. B-cell numbers have been observed to increase in coincidence with ovulation. Sex hormones influence the dermatological expression of allergic response. Correlation of menstrual cycle timepoints with symptom onset helps to define the particular sex hormone associated with cutaneous symptoms. Numerous studies demonstrate increased reactivity to antigens in the premenstrual phase as well as deterioration of atopic skin conditions immediately prior to or during menstruation. In a study of 143 women with eczema, 28Æ7% reported worsening of symptoms the week before menstruation. In a study of 286 women with atopic dermatitis, 96% of those who reported cyclic variations in symptoms reported deterioration of symptoms during the week preceding menses with rapid improvement after the onset of menstrual flow. The prevalence of premenstrual worsening of atopic dermatitis symptoms, in published reports, was as high as 100%. The follicular phase of the menstrual cycle, in contrast, seems to inhibit manifestation of allergic contact dermatitis. Although most studies indicate a suppressed allergic response at the time of ovulation, others show an increased sensitivity in the latter phase of the menstrual cycle or no association of allergic response with the menstrual cycle at all. Skin testing with the objective of evaluating the influence of sex hormones on allergies has yielded interesting results. Kirmaz et al. found that while skin prick test (SPT) reactivity to histamine did not vary throughout the menstrual cycle, serum estradiol was positively correlated with SPT reactivity to allergens in the middle of the menstrual cycle. Likewise, Kemmett and Tidman observed that, despite constant histamine levels, maximal erythema in women with atopic dermatitis occurred at onset of menstruation. Numerous factors can influence skin testing results (Table 2). Best practice in skin testing of allergic or irritant response would ensure standardization of protocols with regard to the choice of irritant, test site, environmental controls, batch volume and concentration, delivery vehicle, use of occlusive dressing, time to evaluation, assessment tools and (in women) menstrual cycle phase. Individual variations, including the possibility of a booster effect, must be considered as well. In a study of 20 patients by Rohold et al., heightened skin reactivity was exhibited in patients at a second nickel sulphate patch test despite a 6-week interval between tests (0Æ02 < P < 0Æ05), confirming the possibility of a booster effect after a putatively reasonable amount of time for recovery. Intraindividual variations, over four repeated patch testings, were also observed to vary as much as 100-fold. In conclusion, available research supports anecdotal reports that dermatological conditions in women of reproductive age follow a cyclic pattern of symptom severity that is associated with fluctuating levels of female sex hormones, with most authors observing a heightened allergic response in the progestinic phase. Definitive conclusions with regard to the Table 1 Dermatological clinical conditions with reported exacerbation of symptoms in association with female sex hormones
月经血流量的决定因素和评估。
影响因子：
3.3
作者：
Liang,Jinxiao;Ali,Fiza;Ramaiyer,Malini;Borahay,MostafaA
通讯作者：
Borahay,MostafaA