The effect of Kawasaki disease on childhood allergies - a sibling control study
The effect of Kawasaki disease on childhood allergies - a sibling control study
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DOI：
10.1111/j.1399-3038.2011.01149.x
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发表时间：
2011-08-01
影响因子：
4.4
通讯作者：
van Bever, Hugo
中科院分区：
文献类型：
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作者：
Liew, Woei Kang;Lim, Chee Wen Terence;van Bever, Hugo
目的：川崎（KD）是一种多系统炎性血管炎，广泛存在T辅助细胞1型免疫激活。我们假设患有KD的儿童发生过敏性疾病的风险较低。研究设计：这是一项横断面研究，招募有KD病史的儿童，以及良好的兄弟姐妹对照。所有儿童均接受标准化核心ISAAC问卷调查，进行过敏、体格检查和皮肤点刺试验评估。采用McNemar试验评价川崎对变态反应的影响。多因素分析采用混合效应Logistic回归模型校正年龄和性别的潜在混杂效应。结果：186名儿童（93对KD同胞）完成了上述评估。与对照组相比，过敏性鼻炎在KD患者中更常见（粗OR 2.40; 95% CI 1.11-5.62，p = 0.024）。考虑到年龄和性别的潜在混杂效应后，该效应进一步增强（校正OR = 2.90; 95%CI 1.27-6.60）。12个月以上发生KD的儿童有更多的过敏性鼻炎（粗OR 4.00，95% CI 1.29-16.44，p = 0.012），“任何”过敏（粗OR 3.75，95% CI 1.19-15.52，p = 0.019）和热带拟步行虫致敏（粗OR 2.57，95% CI 1.02-7.28，p = 0.043）。有趣的是，KD病程未导致冠状动脉异常的儿童有更多的过敏性鼻炎，（粗OR 8.50，95% CI 2.02-75.85，p = 0.003）和“任何”过敏结论：川崎可能是儿童过敏性疾病的危险因素。我们推测KD更常发生在有免疫失衡风险的儿童中，最初有异常的炎症反应，随后有更多的过敏表现。
Objective: Kawasaki disease (KD) is a multisystem inflammatory vasculitis of childhood, with widespread T-helper cell type 1 immune activation. We hypothesize that children who suffered from KD will have a lower risk of developing allergic diseases.Study design: This was a cross-sectional study, recruiting children with a history of KD, together with well sibling controls. All children underwent the standardized core ISAAC questionnaire for allergy, physical examination and skin prick test evaluation. McNemar's test was employed to evaluate the effect of Kawasaki disease on allergy. Multivariable analysis based on mixed-effects logistic regression model was used to adjust for potential confounding effect of age and gender.Results: One hundred and eighty-six children (93 KD sibling pairs) completed the above evaluation. Allergic rhinitis was more common in patients with KD (crude OR 2.40; 95% CI 1.11-5.62, p = 0.024) when compared with controls. The effect was further intensified after accounting for the potential confounding effect of age and gender (adjusted OR = 2.90; 95% CI 1.27-6.60). Children in whom KD occurred beyond the age of 12 months had more allergic rhinitis (crude OR 4.00, 95% CI 1.29-16.44, p = 0.012), 'any' allergies (crude OR 3.75, 95% CI 1.19-15.52, p = 0.019) and Blomia tropicalis sensitization (crude OR 2.57, 95% CI 1.02-7.28, p = 0.043) when compared with their sibling controls. Interestingly, children in whom KD course resulted in no coronary artery abnormalities have more allergic rhinitis (crude OR 8.50, 95% CI 2.02-75.85, p = 0.003) and 'any' allergies (crude OR 5.00, 95% CI 1.41-26.94, p = 0.011), when compared with their sibling controls.Conclusion: Kawasaki disease may be a risk factor for subsequent allergic diseases. We postulate that KD occurs more frequently in children at risk of immune disequilibrium, with an abnormal inflammatory response initially, and subsequently more allergic manifestations.