Nonatopic asthma is associated with helminth infections and bronchiolitis in poor children
Nonatopic asthma is associated with helminth infections and bronchiolitis in poor children
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DOI：
10.1183/09031936.00127606
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发表时间：
2007-06-01
影响因子：
24.3
通讯作者：
Stein, R. T.
中科院分区：
文献类型：
--
作者：
Pereira, M. U.;Sly, P. D.;Stein, R. T.
哮喘在拉丁美洲的城市中心很常见，但特应性哮喘可能不是儿童的主要表型。蠕虫感染在贫困人群中非常普遍，并且假设它们减弱过敏性哮喘，而其他因素与非特应性喘息/哮喘表型的表达有关。来自巴西南部的总共1，982名儿童完成了哮喘问卷调查，平均+/- SD年龄为10.1 +/- 0.76岁，25.6%的患者在过去12个月内有喘息，9.3%的患者表现为哮喘，13%的患者皮肤点刺试验阳性，19.1%的患者有寄生虫感染。大多数喘息或哮喘的儿童均为SPT阴性;然而，严重喘息在特应性少数人群中更为普遍。蠕虫感染与阳性SPT结果呈负相关。2岁以前的毛细支气管炎是10岁时哮喘的主要独立危险因素;高负荷蛔虫感染、哮喘家族史和SPT阳性结果也是哮喘的危险因素。大多数哮喘和喘息是非特应性表型，表明某些蠕虫可能对疾病的特应性部分的表达产生减弱作用，而病毒性细支气管炎更特异地倾向于复发性气道症状。
Asthma is common in urban centres in Latin America, but atopic asthma may not be the main phenotype among children. Helminth infections are highly prevalent in poor populations, and it was hypothesised that they attenuate allergic asthma, whereas other factors are related to the expression of a nonatopic wheeze/asthma phenotype.A total of 1,982 children from Southern Brazil with a mean +/- SD age of 10.1 +/- 0.76 yrs completed asthma questionnaires, and 1,011 were evaluated for intestinal parasites and atopy using skin-prick tests (SPTs).Wheeze in the previous 12 months was reported by 25.6%, and 9.3% showed current asthma; 13% were SPT-positive and 19.1% were positive for any helminths. Most children with either wheeze or asthma were SPT-negative; however, severe wheeze was more prevalent among the atopic minority. Helminth infections were inversely associated with positive SPT results. Bronchiolitis before the age of 2 yrs was the major independent risk factor for asthma at age 10 yrs; high-load Ascaris infection, a family history of asthma and positive SPT results were also asthma risk factors.Most asthma and wheeze are of the nonatopic phenotype, suggesting that some helminths may exert an attenuating effect on the expression of the atopic portion of the disease, whereas viral bronchiolitis predisposes more specifically to recurrent airway symptoms.