FOOD HYPERSENSITIVITY IN THE PATHOGENESIS OF ATOPIC DISORDERS

食物过敏在特应性鼻炎发病中的作用 皮炎（AD）和其他特应性疾病多年来一直备受争议。 在20世纪30年代，Engman描述了一个对小麦敏感的孩子， 小麦摄入后湿疹样皮肤变化，但仅在 不受封闭敷料保护，表明食物诱导的 瘙痒和抓挠在皮炎的发展。 更 最近的研究重新引起了人们对食物作用的兴趣 过敏症在特应性皮炎（AD）和其他疾病发病机制中的作用 特应性疾病 然而，关于疾病定义的问题， 研究设计和控制的充分性不确定的重要性 食物在AD和其他特应性疾病（如哮喘）的发病机制中的作用。 主要假设是食物过敏反应表现为 可以识别的即时和晚期成分 临床（客观物理发现的发展）和通过检测 肥大细胞和嗜碱性粒细胞的介质特征， 循环血液 在发生晚期反应的患者中， 涉及细胞类型，并可通过血清 嗜酸性粒细胞阳离子蛋白和髓过氧化物酶。 第二个假设是晚期反应（超过12小时） 在挑战之后）被其他研究者检测到是人为的， 可能是由于研究的开放性和缺乏 衡量结果的客观性。 因此，在接受 长期、双盲、安慰剂对照激发研究，无 症状评分或行为观察评分的差异将 在安慰剂周和活性周之间检测到。

The role of food hypersensitivity in the pathogenesis of atopic dermatitis (AD) and other atopic diseases has been debated for years. In the 1930s, Engman described a wheat-sensitive child who developed eczematoid skin changes following wheat ingestion, but only on areas unprotected by occlusive dressing, suggesting a role for food-induced pruritus and scratching in the development of the dermatitis. More recently studies have renewed interest in the role of food hypersensitivity in the pathogenesis of atopic dermatitis (AD) and other atopic disorders. However, questions with respect to disease definition, study design, and adequacy of controls left uncertain the importance of food in the pathogenesis of AD and other atopic diseases, such as asthma. The primary hypothesis is that food hypersensitivity reactions exhibit both immediate and late-phase components that may be recognized clinically (development of objective physical findings) and by detection of mediators characteristic of mast cells and basophils in the circulating blood. In patients having late-phase reactions additional cell types are involved and may be detected by elevation of serum eosinophil cationic protein and myeloperoxidase. A secondary hypothesis is that the late reactions (more than 12 hours after challenge) detected by other investigators are artefactual, possibly due to the open nature of the studies and the lack of objectivity of the measured outcomes. Thus, in patients undergoing a prolonged, double-blinded, placebo-controlled challenge study, no differences in symptom scores or behavioral observation scores will be detected between placebo weeks and active weeks.