WAO News and Notes - Medical Reviews
Volume 6, Issue 1 Reviews - January 2009
Announcing the WAO Web Site's new look at www.worldallergy.org
Medical Journal Reviews

Reviewed by Gary Hellerman, PhD, in collaboration with Richard F. Lockey, MD, WAO Web Chief Editor.

1. Cigarette smoke combined with Toll-like receptor 3 (TLR3) signaling triggers exaggerated epithelial RANTES (regulated upon activation, normal T-cell-expressed and -secreted)/CCL5 expression in chronic rhinosinusitis (CRS).
Patients with CRS often suffer acute bacterial infections suggesting that a defect in innate immunity might be associated with the disease. In this study, epithelial cells from middle turbinate biopsies of 9 healthy persons and 11 CRS patients were cultured. The cells were exposed to cigarette smoke extract (CSE) or medium then stimulated with lipoteichoic acid (TLR2 agonist), lipopolysaccharide (TLR4) or double-stranded RNA (TLR3), and analyzed for TLR-2, -3 and -4 expression. CSE alone stimulated RANTES production 35-fold in CRS patients but not in healthy controls. The greatest increase in RANTES (12,115-fold) was seen in nasal epithelial cells treated with CSE and double-stranded RNA (dsRNA) compared to a 1500-fold increase in cells from healthy controls. IL-1β, IL-6 and IL-8, TNF-α, HBD2 and MCP-2 were all synergistically increased by CSE plus dsRNA. Exacerbations of CRS may be more severe in smokers because of CSE-induced excess RANTES production. Editor's comment: Although the mechanism whereby RANTES might contribute to CRS in viral infection is unclear, the large increase in CSE-induced RANTES seen here merits further study in vivo. Yamin M, et al. J Allergy Clin Immunol 2008; 122:1145-1153.

香烟及Toll样受体3(TLR3)信号转导加重慢性鼻鼻窦炎患者(CRS)上皮细胞RANTES/CCL5的过度表达.

CRS患者常发生急性细菌感染,提示该病可能伴有内源性免疫缺陷。本研究中,将9名健康对照及11名CRS患者中鼻道活检标本的上皮细胞进行培养。被培养的上皮细胞先暴露于香烟提取物(CSE)或培养基制,然后用脂磷壁酸(TLR2激动剂),脂多糖(TLR4)或双链RNA(TLR3)刺激这些细胞,分析TLR-2,-3,-4的表达。单纯CSE刺激后CRS患者RANTES的产量呈35倍增高,但对健康对照者没有影响。用CSE以及双链RNA(dsRNA)刺激后鼻上皮细胞RANTES增加最多(12,115倍),而健康对照只有1500倍增高。CSE及dsRNA有协同作用,可以增高IL-1β, IL-6 以及 IL-8, TNF-α, HBD2及 MCP-2。CSE-诱导下RANTES的过度表达,使得吸烟的CRS患者病情恶化可能更为严重。编者点评:虽然还不知道RANTES是通过何种机制引起病毒感染后的CRS,但本研究发现CSE诱导RANTES表达显著增加,因此值得进一步开展体内研究。 Yamin M, et al. J Allergy Clin Immunol 2008; 122:1145-1153.

2. The asthma-mental health nexus in a population-based sample of the United States.
This study examines the likelihood of having current asthma in an adult cross-section of the U.S. population with perceived mental health problems. The Behavioral Risk Factor Surveillance System (BRFSS) survey was used to assess mental health and to place subjects into one of five categories from 0 days per month of poor mental health to 22 to 30 days per month. Asthma status was assigned by asking subjects if a physician had ever told them they have asthma and whether they have asthma now. Other factors considered included overall health status, urban environment, age, gender, smoking status, obesity, exercise, socioeconomic level, ethnicity and marital status. The entire BRFSS database of 355,710 subjects was screened using a multinomial logistic regression model to determine correlation between mental health and asthma. Women reported worse mental health than men, and any history of smoking correlated with a reduction in mental health, as also did poor overall health, lack of exercise, and obesity. The odds of having asthma showed a "dose response" as the number of days of poor mental health per month increased from 1.38 for ≤ 1 week of poor mental health to 2.75 for ≥ 3 weeks per month. Editor's comment: A relationship between asthma and mental health has been proposed for many years and this study adds significant information to the analysis, but the exact mechanism remains elusive. Chun TH, et al. Chest 2008; 134:1176-1182.

美国基于人群的抽样调查发现哮喘-精神疾病的关系

本研究是针对美国成年人群的横断面研究,旨在调查哮喘合并明显精神疾病的可能性。研究采用行为危险因素监测系统(BRFSS)来评价精神疾病,将患者分为5大类,其精神状态不佳的时间从每个月1天到每个月22-30天。通过询问患者是否医生曾经给他们诊断哮喘或是否患者现在就有哮喘来了解患者的哮喘状态。其它同时考虑的因素包括总体健康状态,城市环境,年龄,性别,吸烟的情况,肥胖,运动,社会经济水平,种族以及婚姻情况。对355,710例研究对象的完整的BRFSS数据进行了多变量逻辑回归分析,来评价精神疾病与哮喘的关系。数据显示,女性哮喘患者的精神状态比男性差,女性吸烟史与精神状态降低相关,总体健康情况也不佳,且缺乏运动,并且相对肥胖。每个月精神不佳的时间从≤ 1周到≥ 3周而增加时,哮喘的危险系数从1.38增至2.75,显示出‘剂量反应’的特点。编者点评:多年以来一直有人提出哮喘与精神健康存在某种关系本研究对此提供了重要信息,但确切机制还不明了。 Chun TH, et al. Chest 2008; 134:1176-1182.

3. Relationship between gastroesophageal reflux disease (GERD) and COPD in UK primary care.
Patients with a first diagnosis of GERD or COPD were identified from the UK General Practice Database and the incidence of combined GERD/COPD in the diagnosed group over a five-year follow-up was compared with that in a matched healthy cohort. Medication use, comorbidities, demographics and lifestyle factors were also examined. The relative risk of COPD in GERD patients was 1.17 while the risk of GERD in COPD patients was 1.46. Older patients (≥ 70 years) with GERD were 3.7 times as likely as controls to be diagnosed with COPD. A prior diagnosis of asthma was also associated with increased risk of COPD in GERD patients (odds ratio, 10.9). Editor's comment: The complex interrelationship between GERD, asthma and COPD needs to be examined carefully when assessing a patient's diagnosis and medication requirements. García-Rodríguez LA, et al. Chest 2008; 134:1223-1230.

UK初级医疗中,胃食管反流与COPD的关系

从UK 的全科医疗病例库中选出初诊为GERD或COPD 的患者,随访5年,与匹配的健康对照组比较GERD合并COPD的发病率。同时也评价了用药情况,其它并发症,人口统计学资料以及生活方式等因素。GERD患者发生COPD的危险为1.17,而COPD患者发生GERD的危险是1.46。高龄GERD患者(? 70 years)被诊断COPD的危险是对照组的3.7倍。曾被诊断哮喘的GERD患者COPD危险增高(危险比,10.9)。编者点评:当评价患者的诊断及用药时,要认真考虑GERD,哮喘以及COPD的复杂关系。 García-Rodríguez LA, et al. Chest 2008; 134:1223-1230.

4. Clinical and molecular profile of a new series of patients with immune dysregulation, poly endocrinopathy, enteropathy, and X-linked syndrome (IPEX): Inconsistent correlation between forkhead box protein 3 (FOXP3) expression and disease severity.
IPEX is a rare disease caused by mutations in the FOXP3 gene. It is characterized by a range of symptoms including diarrhea, chronic dermatitis, diabetes and thyroiditis. FOXP3 is principally expressed on regulatory T cells but also on effector T cells and FOXP3 deficiency compromises immune tolerance. Fourteen patients with early-onset IPEX were screened for FOXP3 mutations and expression level. Seven of the patients had previously identified FOXP3 gene mutations and the other seven had novel mutations. In five of eight IPEX patients tested, FOXP3 protein levels were not affected although FOXP3 mutations were present and IgE and eosinophils were elevated. Diagnosis of IPEX should be made based on genetic analysis for FOXP3 mutations rather than on measurement of FOXP3 protein. Editor's comment: Although IPEX is relatively rare, infants with enteropathy or diabetes and elevated IgE should be genotyped for FOXP3. Gambineri E, et al. J Allergy Clin Immunol 2008; 122:1105-1112.

一组患有免疫失调节,多内分泌病,肠病,以及X-连锁综合征(IPEX)的患者的临床状况及分子基础:疾病严重性与FOXP3蛋白表达水平不一致。

IPEX<是由于FOXP3基因突变导致的罕见疾病。其特征性的表现是包括腹泻,慢性皮炎,糖尿病以及甲状腺炎在类的一系列症状。FOXP3主要表达在调节T细胞上,但效应T细胞也有表达,FOXP3的缺陷破坏了机体的免疫耐受。本研究测定了14例早发性IPEX患者的FOXP3基因突变及表达水平。其中7例患者的FOXP3突变类型是以前已经知道的,而另外7例患者出现了新的突变型。被测试的8例患者中,有5例患者FOXP3蛋白水平不受FOXP3突变的影响,血IgE及嗜酸细胞增高。诊断IPEX应该基于FOXP3突变的基因分析,而不是基于FOXP3蛋白的测定。编者点评:虽然IPEX相对罕见,有肠病或糖尿病且IgE升高的婴儿应该进行FOXP3基因分型。 Gambineri E, et al. J Allergy Clin Immunol 2008; 122:1105-1112.

5. Prevention of mast cell activation disorder-associated clinical sequelae of excessive prostaglandin D2 (PGD2) production.
Mast cell activation disorder (MCAD) produces symptoms similar to those experienced by patients with systemic mastocytosis (SM)-flushing, palpitations, light-headedness, syncope, and chest pain among others. Exercise-induced or idiopathic anaphylaxis can also mimic MCAD. This retrospective review of four patients with excessive prostaglandin D2 (PGD2) release sought to determine if MCAD was the cause. None of the patients had evidence of SM in bone marrow biopsies and histamine was not released during exacerbations. Baseline levels of PGD2 were normal to slightly elevated but increased significantly during activation episodes. Symptoms were effectively reduced by aspirin treatment. Editor's comment: Whether MCAD is an entity separate from idiopathic anaphylaxis is still controversial, but the absence of histamine release in these MCAD patients may be distinctive. Butterfield JH and Weiler CR, Int Arch Allergy Immunol 2008; 147:338-43.

预防肥大细胞活化失调-前列环素D2(PGD2)过度表达相关的临床表现

肥大细胞活化失调(MCAD)可以导致出现与系统性肥大细胞增多症相似的症状-潮红,心悸,头晕,晕厥以及胸痛。运动诱发或特发性严重过敏反应也可能类似MCAD。本综述回顾了4名有过度前列环素D2(PGD2)释放的患者,旨在明确是否MCAD是他们的病因。所有患者骨髓活检组织中没有系统性肥大细胞增多的表现,病情加重时没有组织胺的释放。PGD2的基础水平正常或轻度增高,但在活化期有显著增高。阿司匹林治疗可以有效减轻症状。编者点评:是否MCAD是独立于特发性严重过敏反应的另一个疾病仍有争议,但MCAD患者没有组织胺的释放可能是两者的区别。 Butterfield JH and Weiler CR, Int Arch Allergy Immunol 2008; 147:338-43.

6. Evidence of a causal role of winter virus infection during infancy in early childhood asthma.
Infant bronchiolitis has been linked to later onset of asthma and most commonly associated with viral respiratory tract infections, so it is not unreasonable to suppose that the season of birth may influence the risk of asthma. To test this hypothesis, the medical histories of a group of 95,310 children from birth to about 5 ½ years of age were examined for a correlation between age at time of first winter virus infection peak and development of high-risk asthma as defined by one or more hospitalizations or ER visits or a course of corticosteroids. Infants between the ages of 118 and 126 days at the time of winter virus peak had the highest risk of significant bronchiolitis, and those 118 to 131 days old at virus peak had the greatest likelihood of developing high-risk asthma-about 30% higher than infants who were one year old at peak. The timing of the age at highest risk shifted in synchrony with variation in the date of peak virus infections. Viral bronchiolitis at about 4 months of age could produce a chronic inflammation with long-lasting effects on lung development and immune maturation. Editor's comment: The significant correlation between age at time of winter virus peak and incidence of asthma suggests a strong potential for therapeutic intervention and avoidance of infection in this group of children. Wu P, et al. Am J Resp Crit Care Med 2008; 178:1123-1129.

婴儿时期冬季病毒感染导致少儿阶段哮喘的证据

婴儿支气管炎与以后发生哮喘相关,尤为常见的是病毒性呼吸道感染,因此有理由假设出生季节可能影响哮喘发病危险。为验证这一假设,回顾了95,310 名儿童从出生到5岁半的病史,寻找出生后遇到的第一个冬季病毒感染高峰时孩子的年龄与发生高危哮喘的相关性。后者定义为一次以上住院或急诊就医或用一疗程糖皮质激素。冬季病毒感染高峰时处于118-126天日龄的婴儿发生严重支气管炎的危险最高,并且,病毒高峰时处于118-131天日龄的婴儿发生高危哮喘的可能最大-比病毒高峰时已经1岁的婴儿发生高危哮喘的可能性高出30%。最高危的年龄与病毒感染高峰日期的变化同步改变。4个月时的病毒性支气管炎导致的慢性炎症对肺发育以及免疫系统成熟有长期影响。编者点评:冬季病毒高峰时婴儿的年龄与哮喘发病率的显著相关性提示要积极对这组儿童进行治疗干预及感染预防。 Wu P, et al. Am J Resp Crit Care Med 2008; 178:1123-1129.

7. Inhaled corticosteroids (ICS) in patients with stable chronic obstructive pulmonary disease (COPD).
COPD affects 10-15 million people in the U.S. and is the fourth leading cause of death. This meta-analysis of the existing literature on the use of ICS by stable COPD patients focused on 11 randomized controlled trials involving a total of 14,426 participants. ICS use did not decrease mortality during follow-up periods of up to three years and was associated with a 34% increase in the incidence of pneumonia. However, ICS did improve quality-of-life scores for COPD but did not increase the fracture rate. The analysis suffered from some limitations in that an unequivocal distinction between pneumonia and COPD exacerbation was not always made and there was considerable diversity in the type and dosage of ICS used. Thus, it is always necessary to weigh the risks in COPD of increased respiratory infection against the benefits of improved quality of life. Editor's comment: In spite of the limitations of this meta-analysis, the results raise important questions about the use of ICS to treat stable COPD. Drummond MB, et al. JAMA 2008; 300:2407-2416.

吸入糖皮质激素(ICS)对稳定慢性阻塞性肺病患者(COPD)的影响
美国有1千万至1千5百万COPD患者,COPD是第四大死因。本文荟萃分析了现有的关于COPD患者稳定期ICS使用情况的文献,重点是11个随机对照试验,涉及14,426例患者。随访3年,发现使用ICS没有降低死亡率,且肺炎的发病率有34%的升高。然而,ICS的确改善了COPD的生活质量评分,但没有增加骨折的发病率。本研究在结果分析时有一些局限,就是肺炎及COPD恶化并不总是有明确差别且ICS的种类及剂量有很大差异。因此,有必要权衡COPD呼吸道感染增加的危险与生活质量获得的改善。编者点评:虽然这个荟萃分析有它的局限,但其结果提出了用ICS来治疗稳定期COPD存在的重要问题。 Drummond MB, et al. JAMA 2008; 300:2407-2416.

8. Asthma and allergic symptoms in relation to house dust endotoxin: Phase Two of the International Study on Asthma and Allergies in Childhood (ISAAC II).
Six centers in five different countries supplied data on the incidence of asthma and atopy in 840 children, age 9 to 12 years, in relation to endotoxin levels in living room floor dust. Standardized questionnaires were used for demographics, wheezing, allergy and eczema, and atopy was defined as serum IgE reaction to one or more airborne allergens. Overall, there was an inverse relationship between exposure to dust endotoxin levels in this age group and both atopic and non-atopic asthma, but not hay fever. Editor's comment: The controversy over whether endotoxins protect against or exacerbate asthma continues, but this study provides substantial evidence of a protective effect among children in a wide range of settings. Gehring U et al. Clin Experimental Allergy 2008; 38:1911-1920.

户尘螨内毒素相关的哮喘及过敏综合征:ISAACII研究

5个不同国家6个中心提供了840名9-12岁儿童的哮喘及特应性发病率与室内地板尘螨内毒素水平的相关性的资料。用标准化问卷来采集人口统计学资料,了解喘鸣,过敏以及湿疹情况。特应性定义为具有对一种或多种气传变应原的血清IgE阳性反应。总的来说,在该年龄组,尘螨内毒素暴露水平与特应性及非特应性哮喘有相反的关系,但枯草热不是这样。编者点评:内毒素究竟对哮喘有预防作用还是恶化作用一直是争议所在,但本研究提供了大量证据证实在很多地方内毒素对儿童哮喘发生有预防作用。 Gehring U et al. Clin Experimental Allergy 2008; 38:1911-1920.

9. ERK-mediated regulation of leukotriene biosynthesis by androgens: a molecular basis for gender differences in inflammation and asthma.
Asthma is more common in males before puberty but in females afterwards suggesting a protective effect of androgens. Leukotrienes (LTs) are proinflammatory molecules synthesized by 5-lipoxygenase (5-LO) primarily by neutrophils (NPs). Isolated NPs from female blood produced more LT-B4 than those from male blood when stimulated. In female NPs, 5-LO was localized in the cytoplasm and moved to the nucleus upon stimulation. In male NPs, 5-LO was present in both cytoplasm and nucleus but the location did not change after stimulation. The nuclear localization of 5-LO is dependent on dihydrotestosterone (DHT) and DHT suppresses LT synthesis by female NPs. Extracellular-regulated kinases (ERK1/2) were more active in male NPs, and inhibition of ERKs caused 5-LO to become cytosolic and to migrate to the nucleus as in female NPs. Editor's comment: The suppressive effect of DHT on 5-LO suggests that treatment with LT antagonists such as montelukast may have to be optimized according to sex. Pergola C, et al. Proc Nat Acad Sci 2008; 105:19881-19886.

ERK介导雄激素调节白三烯生物合成:炎症及哮喘的性别差异的分子基础。

性成熟以前哮喘更常见于男性,此后则更多见于女性,提示雄激素对哮喘有保护作用。白三烯(LTs)是主要由中性粒细胞(NPs)通过5-脂氧合酶(5-LO)途径合成的促炎因子。经刺激后,从女性血中分离到的NPs比从男性血中分离到的NP3产生更多的LT-B4。女性NPs中,5-LO位于细胞质中,经刺激后转移至细胞核内。男性的NPs中,5-LO同时存在于细胞质及细胞核内,但经刺激后其位置不会转移。5-LO在细胞核内的位置取决于二氢睾酮(DHT),且DHT抑制女性NPs合成LT。细胞外调节激酶(ERK1/2)在男性的NPs中更为活跃,抑制ERKs可以引起5-LO胞浆化并转移到细胞核内,就像在女性的NPs中。编者点评:DHT对5-LO的抑制作用提示用LT拮抗剂如孟鲁司特治疗时,应根据性别优化治疗。 Pergola C, et al. Proc Nat Acad Sci 2008; 105:19881-19886.

10. Long-term erythromycin therapy is associated with decreased chronic obstructive pulmonary disease (COPD) exacerbations.
Frequent exacerbations in COPD patients cause rapid disease progression and poor prognosis. This randomized, double-blind, placebo-controlled trial tested long-term use of erythromycin (EM) to reduce COPD excacerbations. COPD patients (n = 115) with FEV1 30% to 70 % of predicted received either placebo or 250 mg EM twice a day for one year. Most patients were using corticosteroids at the time of the study and were allowed to continue with them. Blood and sputum samples were taken for analysis of IL-6, IL-8, C reactive protein and myeloperoxidase and spirometry was done at each visit. Subjects kept a symptom diary and reported exacerbations as soon as they occurred. One year EM treatment reduced exacerbation frequency, duration and symptom severity and caused no adverse side effects. No change in FEV1, sputum inflammatory markers or bacterial colonization was seen. Editor's comment: The use of macrolide therapy seems to be indicated as a well-tolerated way to reduce COPD exacerbations. Seemungal TAR, et al. Am J Resp Crit Care Med 2008; 178:1139-1147.

长期红霉素治疗减少COPD的恶化

COPD患者若经常恶化,疾病会快速进展,预后也不好。本随机,双盲,安慰剂对照试验研究了长期用红霉素(EM)能否减少COPD的恶化。研究对象为FEV1在30-70%预计值的COPD患者(n=115),用安慰剂或250mgEM一天两次治疗一年。多数患者在研究时正用糖皮质激素,并获得同意可以继续使用。每次随访时都取血标本及痰标本测定IL-6, IL-8,C反应蛋白和骨髓过氧化酶,并且测定肺功能。研究对象做了症状日记,一有疾病恶化就记录下来。一年的EM治疗减少了症状恶化的频率,症状的持续时间以及严重度,没有引起不良副反应。FEV1,痰炎症标志或细菌定植均无变化。编者点评:有指征使用大环内酯类药物这种耐受性很好的治疗来减少COPD的恶化。 Seemungal TAR, et al. Am J Resp Crit Care Med 2008; 178:1139-1147.

11. Increased gastrointestinal permeability and gut inflammation in children with functional abdominal pain and irritable bowel syndrome (FAP/IBS).
In this study, children aged 7 to 10 years with FAP/IBS were studied to determine if symptom severity could be correlated with GI permeability and inflammation. The Pediatric Rome II criteria for FAP and IBS were used to rate the pain frequency and intensity. Gut inflammation was measured as fecal calprotectin levels and stooling patterns were recorded by diary. The subjects included 109 children with FAP/IBS and 66 controls. Calprotectin was higher in FAP/IBS patients indicative of greater gut inflammation than healthy controls. Permeability of the proximal GI and colon as measured by sugar recovery was greater in FAP/IBS subjects. No correlation was found between GI permeability and pain levels, and increased GI inflammation was associated only with increased pain-related interference with activity. Editor's comment: The results of this study suggest that the relationship between GI permeability, inflammation and abdominal pain in children is complex. Shulman RJ, et al. J Pediatr 2008; 153:646-650.

功能性腹痛及肠易激综合征(FAP/IBS)患儿的胃肠道通透性以及肠道炎症增高

本研究调查了7-10岁FAP/IBS患儿的症状严重性是否与GI通透性及炎症相关。用FAP及IBS的儿童罗马II标准对疼痛频率及强度分级。用粪便钙胃蛋白水平测定肠道炎症,每日记录粪便类型。研究对象是109名FAP/IBS患儿以及66名对照。FAP/IBS患者的钙胃蛋白更高,提示患儿的肠道炎症比健康对照组更重。通过糖吸收测到FAP/IBS患者近端GI以及结肠的通透性更高。GI通透性与疼痛水平没有相关性,胃肠道炎症更重只是与疼痛引起的活动受影响相关。编者点评:本研究的结果提示儿童GI通透性,GI炎症水平及腹痛的关系是复杂的。 Shulman RJ, et al. J Pediatr 2008; 153:646-650.

12. Effects of average childhood dairy intake on adolescent bone health.
Supplementary calcium increases bone mineral content (BMC) in children during the bone-building phase but there have been fewer studies on the effects of dairy intake on BMC. This report examined the Framingham Children's Study data in terms of dairy intake during childhood compared to BMC, area and density measured when the children were 15 to 17 years old. BMC was determined by scan over the entire body and was used rather than BMD which is subject to error in children with larger bones. Children who ate more than two servings of dairy products a day had higher BMC and bone area than those eating less. Children who ate more dairy and had more than 4 servings per day of meat or other protein had the highest BMC and area. Editor's comment: This longitudinal study of the Framingham data reiterates the importance of adequate protein (meat) and dairy products on adolescent bone health. Moore LL, et al. J Pediatr 2008; 153:667-673.

儿童时期平均牛奶摄入量对成年后骨骼健康的影响

在儿童时期骨骼生长阶段补充钙元素增加骨骼矿物质含量(BMC)。但很少有人研究奶制品对BMC的影响。本文就Framingham儿童研究资料中的数据,比较儿童期奶制品摄入与15-17岁时BMC,骨骼面积及骨骼密度的关系。通过全身扫描测定BMC,选择BMC而没有选择BMD是因为后者在骨骼较大的儿童误差比较大。每天至少吃两份奶制品的儿童BMC及骨骼面积比吃奶制品少的儿童要高。吃更多奶制品且每天吃4份以上肉食或其它蛋白的儿童BMC及骨骼面积都最高。编者点评:这个对Framingham资料的纵向研究重申了适当蛋白(肉类)及奶制品饮食对成年骨骼健康的重要性。 Moore LL, et al. J Pediatr 2008; 153:667-673.

13. Clinical and immunologic effects of H1 antihistamine preventive medication during honeybee venom immunotherapy (BVIT).
Patients undergoing BVIT are commonly given antihistamine treatment to reduce the risk of systemic allergic side effects. In this study, the effectiveness of BVIT in the presence of the histamine receptor-1 (HR1) blocker, levocetirizine (LC), was compared to placebo. BVIT patients (n = 54) were given LC from two days before BVIT to day 21 and examined for systemic allergic reactions (SARS) and allergen-specific immunity by skin test, serum Abs and cultured T cell activity. SARS were observed significantly more frequently in the placebo group with a higher use of rescue medications. The efficacy of BVIT was not altered by LC administration. Editor's comment: The potential contribution of antihistamine treatment to development of allergen tolerance needs to be better defined. Muller UR, et al. J Allergy Clin Immunol 2008; 122:1001-1007.

 蜜蜂毒液免疫治疗(BVIT)中预防性使用H1抗组胺药的临床和免疫学效应

接受BVIT的患者通常用抗组胺药治疗来降低发生系统性过敏副反应的危险。本研究比较分别用组胺受体1(HR1)阻断剂左西替利嗪(LC)及用安慰剂后BVIT的有效性。从治疗开始前2天,到治疗第21天,给BVIT患者(n=54)左西替利嗪,观察系统性过敏反应(SARS),并用皮肤试验,血清抗体及培养T细胞的活性来检验变应原特异性免疫应答。安慰剂组SARS的发生明显频繁,急救药物的使用更多。BVIT的有效性不会因使用LC而改变。编者点评:需要深入评价抗组胺药治疗对产生变应原耐受的作用。 Muller UR, et al. J Allergy Clin Immunol 2008; 122:1001-1007.

Translated by Dr. Qing Manli, Allergy Department, PUMCH, China

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