Clinical and Immunological Evaluation of Children with Allergic Disease

NIH儿科过敏诊所为NIAID过敏和免疫学临床奖学金计划的住院医生提供了关于哮喘、过敏性鼻炎、食物过敏、特应性皮炎和荨麻疹等儿科过敏性疾病的医疗培训和连续临床经验。在上个财政年度，病人护理人次超过350次，累计增加260名新病人。NIH儿科过敏诊所也为过敏性炎症障碍儿童的研究提供了临床资源。 除了过敏性疾病的标准诊断测试，包括皮肤点刺测试、放射过敏原(RAST)测试、斑贴测试和肺功能测试外，该诊所还整合了其他方法来评估患有过敏性疾病的儿童。为了评估肺功能，我们采用了脉冲振荡法，这是一种测量肺阻力和弹性的非侵入性、不依赖于努力的技术。它与年龄较大的儿童的标准肺功能测试一起使用，并单独用于年仅两岁的婴儿。一篇综述脉冲振荡法在儿童哮喘患者中的临床应用的手稿正在准备出版。 通过咨询NHLBI肺科服务，已经进行了运动挑战肺功能测试。与法援署的其他调查人员一起，已经获得呼气冷凝液和呼出的一氧化氮的测量，用于诊断和研究目的。 研究人员采集了血液用于实验室研究，以测量过敏性疾病的标志物，开发从血液中培养肥大细胞的方法，并确定细胞因子和信号特征。特别是，对44名非特应性患者和153名特应性临床患者的血清类胰蛋白酶水平进行了测定。非特应性皮肤病患者类胰蛋白酶水平的中位数和95%预测区间分别为3.44、0.64~6.77和3.56、0.98~10.80。这项研究最近发表在《过敏和临床免疫学杂志》(2009年8月9日在线版)上，确定了特应性和非特应性儿童的标准血清参考类胰蛋白酶的值。在特应症患者中，性别和种族与类胰蛋白酶有统计学意义的相关性，但与种族、总IgE水平、体重/体重百分位数或湿疹状态无关。 用于与推荐医生交流和进行纵向分析的患者文件被输入NIAID数据库系统Crimson。

The NIH Pediatric Allergy Clinic has provided residents in the NIAID Allergy and Immunology Clinical Fellowship Program with medical training and continuity clinic experience in pediatric allergic diseases including asthma, allergic rhinitis, food allergy, atopic dermatitis and urticaria. During the past fiscal year, patient care visits exceeded 350, with a total accrual of 260 new patients. The NIH Pediatric Allergy Clinic also provides clinical resources for the study of children with allergic inflammatory disorders. In addition to standard diagnostic testing for allergic diseases, which includes skin prick testing, radioallergosorbent (RAST) testing, patch testing and pulmonary function testing, the clinic has integrated other modalities in the evaluation of children with allergic diseases. To evaluate lung function we have emplotyed impulse oscillometry, a non-invasive, non-effort dependant technique that measures lung resistance and elasticity. This is being used in conjunction with standard pulmonary function testing in older children and by itself in infants as young as two years old. A manuscript reviewing the clinical application of impulse oscillometry in pediatric patients with asthma is being prepared for publication. Through consultation with the NHLBI pulmonology service, exercise challenge pulmonary function testing has been performed. In conjunction with other investigators in the LAD, expired breath condensate and exhaled nitric oxide measurements have been obtained for diagnostic and research purposes. Research blood has been collected for laboratory studies to measure markers of allergic diseases, develop approaches to culture mast cells from blood, and determine cytokine and signaling profiles. In particular, serum tryptase levels were measured in 44 non-atopic and 153 atopic clinic patients. Median and 95% prediction intervals of tryptase levels for non-atopics were 3.44, 0.64-6.77 and 3.56, 0.98-10.80 for atopics. This study, recently published in the Journal of Allergy and Clinical Immunology (9 August 2009 on-line) establishes normative serum reference tryptase values in atopic and non-atopic children. Among atopics, a statistically significant association with tryptase was found for gender and race but not for ethnicity, total IgE levels, weight/weight percentile or eczema status. Patient documentation for communication with referring physicians and for longitudinal analysis is entered into CRIMSON, the NIAID database system.