WAO News and Notes - Medical Reviews
Volume 5, Issue 11 Reviews - November 2008
Medical Journal Reviews

Reviewed by Prof. Richard F. Lockey, MD, WAO Web Editor-in-Chief, and Guest Editor Mark Glaum, MD PhD

1. EFFECT OF PHARMACOTHERAPY ON RATE OF DECLINE OF LUNG FUNCTION IN COPD - RESULTS FROM THE TORCH STUDY
This study investigates the effects of combined salmeterol (S) 50 μg plus fluticasone propionate (F) 500 μg (SF), either S or F alone or placebo (P), on the rate of post-bronchodilator FEV1 decline in patients with moderate or severe COPD. 5,343 of 6,112 patients in the TORCH Study were included in the analysis of randomized, DBPC data. Spirometry was measured every 24 weeks for three years and there were 26,539 on-treatment observations. The adjusted rate of decline in FEV1 was 55 ml/year for P, 42 ml/year for S, 42 ml/year for F, and 39 ml/year for SF (95% confidence interval, 7-25; P <0.001). Rates of decline were similar among the active treatment arms. Decline rates were the greatest in current smokers and patients with a lower body mass index. Treatment with SF or S or F reduces the rate of decline in FEV1 in patients with moderate to severe COPD. Editor's comment: Treatment with S, F, or SF decreases the decline in FEV1 in COPD. Celli BR, et al., Am J Respir Crit Care Med 2008;178:332. (editorial: a Suissa, pp. 322)

药物治疗对COPD患者肺功能下降的影响-TORCH研究的结果

本研究比较了联合使用沙美特罗(S)50ug与丙酸氟替卡松(F)500ug(SF),或者单独使用S或F或安慰剂,对中重度COPD患者支气管扩张剂吸入后FEV1的影响的差异。对TORCH研究的6112名患者中的5343名进行了随机双盲安慰剂对照分析。3年内每24个星期测定肺功能,有26,539次治疗中观察。调整后的FEV1降低值为安慰剂组每年降低55ml,S组每年降低42ml,F组42ml/年,SF组39ml/年(95%CI,7-25;P <0.001)。降低速度在有效治疗组是相似的。吸烟者以及低体重指数的患者其FEV1降低速率最大。用SF联合治疗或单用S或F治疗缓解了中重度COPD患者FEV1的下降。编者点评:用S,F或SF治疗减少了COPD患者FEV1的下降。Celli BR, et al., Am J Respir Crit Care Med 2008;178:332. (editorial: a Suissa, pp. 322)

2. A 4-YEAR TRIAL OF TIOTROPIUM (T) IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
This randomized, DBPC trial compared four yrs of therapy with either T or placebo (P) in patients with COPD permitted to use all respiratory medications except inhaled anticholinergic agents. A total of 5993 patients (mean age, 65±8 yrs) with a mean FEV1 of 1.32±0.44 liters after bronchodilation (48% of predicted value) participated. 2987 were assigned to T and 3006 to P. Mean absolute improvements in FEV1 in the T group were maintained compared to P (P <0.001). After day 30, the differences between the two groups in the rate of decline in the mean FEV01 before and after bronchodilation were not significant. The mean absolute total score on the St. George's Respiratory Questionnaire (SGRQ) was lower in the T group at each time point throughout four yrs. At four yrs and 30 days, T was associated with a reduction in the risks of exacerbations, related hospitalizations and respiratory failure. The authors conclude that T is associated with improvements in lung function, quality-of-life (QOL), and exacerbations during a four yr period but does not reduce the rate of decline in FEV1. Editor's comment: T is an excellent medication to treat COPD. Tashkin DP, et al., N Engl J Med 2008;359:1543.

为期4年用噻托溴铵治疗COPD

该随机,双盲安慰剂对照试验比较用T或安慰剂给COPD患者为期4年的治疗,允许他们使用除吸入性抗胆碱药以外的其它任何药物。共有5993名患者参加(平均年龄,65±8岁),支气管扩张剂后平均FEV1为1.32±0.44升(占预计值48%)。给2987名患者用T,3006名患者用P。30天后,两组支气管扩张剂使用前后FEV1的降低率无显著差异。4年中任何时候圣约翰呼吸问卷(SGRQ)的平均绝对总分在T组都低一些。4年30天时,T组哮喘恶化、住院以及呼吸衰竭的危险更低。作者的结论是T与肺功能改善,生活质量(QOL)提高,哮喘恶化减少相关,但并不延缓FEV1的降低。编者点评:T是治疗COPD的好药。Tashkin DP, et al., N Engl J Med 2008;359:1543.

3. ALLERGEN IMMUNOTHERAPY (AI): WHAT CAN AND CANNOT BE MIXED?
Grass pollen allergens are most susceptible to proteases. Fungal and insect allergenic extracts contain the highest levels of proteases and should be separated from pollen extracts, particularly grass extracts, unless otherwise indicated by the manufacturer. Grass allergens can be mixed with U.S. manufactured dust mite extracts at concentrations for optimal therapeutic outcomes. These mite extracts contain relatively low protease content since they are derived from 99% pure mite bodies as compared to European extracts which contain higher levels of protease because they are derived from spent cultures. An AAAAI committee investigated the stability of an extract containing standardized dust mite, cat hair, short ragweed pollen, and timothy grass pollen. The optimal concentration for immunotherapy retained potency for up to one year when stored at 2ºC to 8ºC. A figure is included indicating which extracts should or should not be mixed with others. Editor's comment: This is a short, easily understood treatise on allergen extracts and compatibility in a mixed vaccine. Esch RE, J Allergy Clin Immunol 2008;122:659.

变应原免疫治疗(AI):哪些能被混合,哪些不能

牧草花粉变应原对蛋白酶最敏感。真菌以及昆虫变应原提取物含有的蛋白酶最多,应该与花粉变应原提取物分开使用,尤其是牧草花粉,除非厂家特别说明可以混合使用。牧草花粉可以与美国生产的尘螨提取物混合,浓度可以达到最佳治疗浓度。这些螨提取物的蛋白酶含量相对低,因为其来源为99%纯化的尘螨尸体;而欧洲的尘螨提取物来源为用过的培养物,因此蛋白酶水平更高。AAAAI委员会研究了含有标准尘螨、猫毛、短豚草花粉以及梯牧草花粉的提取物的稳定性。免疫治疗最佳浓度的溶液其效价能在2-8度环境中保存近1年。本文有表格说明哪些变应原提取物能够混合。编者点评:这是一篇对变应原提取物及混合疫苗兼容性的简短易懂的文章。Esch RE, J Allergy Clin Immunol 2008;122:659.

4. WHEEZING RHINOVIRUS (RV) ILLNESSES IN EARLY LIFE PREDICT ASTHMA (A) DEVELOPMENT IN HIGH-RISK CHILDREN
259 children (one parent was required to have a positive aeroallergen skin test and A) were followed prospectively from birth to six years of age during which time the etiology and timing of specific viral wheezing respiratory illnesses were assessed using nasal lavage, culture, and multiplex reverse transcriptase-polymerase chain reaction. Viral etiologies were identified in 90% of wheezing illnesses. From birth to age three yrs, respiratory syncytial virus (RSV) (OR, 2.6), RV (OR, 9.8), or both, (OR, 10) were associated with increased A risk at six yrs. In year one, both RV wheezing (OR, 2.8) and aeroallergen sensitization (OR, 3.6) independently increased A risk at age six yrs. By age three yrs, wheezing with RV (OR, 25.6) was more strongly associated with A at age six yrs than aeroallergen sensitization (OR, 3.4). Nearly 90% (26 of 30) of children who wheezed with RV in year three had A at six yrs of age. Wheezing in infancy and early childhood associated with RV infections are the most significant predictors of subsequent A at age six in a high-risk birth cohort. Editor's comment: RV infection in early life is associated with a risk for asthma. Jackson DJ, et al., Am J Respir Crit Care Med 2008;178:667.

高危儿童早期鼻病毒感染性喘息可以预示哮喘发生

259名儿童(父母中的一个有阳性气传变应原皮试结果以及哮喘)从出生到6岁进行随访,期间对某些病毒性喘息性呼吸道疾病的病原及发病时间进行评估,方法使用鼻灌洗,培养,以及多重RT-PCR实验。从出生到3岁,呼吸道合孢病毒(RSV) (OR, 2.6), 鼻病毒(OR, 9.8),或两者 (OR, 10)与6岁时发生哮喘相关。一岁时,鼻病毒感染相关的喘息(OR, 2.8)以及气传变应原致敏(OR, 3.6)是6岁出现哮喘的独立危险因素。三岁时,鼻病毒相关的喘息(OR, 25.6)与6岁哮喘的相关性强于气传变应原致敏(OR, 3.4)。几乎90%(26 of 30)三岁时有鼻病毒相关的喘息的患儿在6岁时发生了哮喘。高危人群中,婴儿及幼儿早期与鼻病毒感染相关的喘息是6岁时发生哮喘的最显著的预测因子。编者点评:早期RV感染与哮喘危险相关。Jackson DJ, et al., Am J Respir Crit Care Med 2008;178:667.

5. BODY MASS AND GLUCOCORTICOID (GC) RESPONSE IN ASTHMA (A)
45 non-smoking adults, 33 with and 12 without A underwent characterization of lung function, BMI, and spirometric response to prednisone. Dexamethasone (DEX, 10-6 M) -induced mitogen-activated protein kinase phosphatase-1 (MKP-1) and baseline tumor necrosis factor (TNF)-α expression were evaluated by PCR in peripheral blood mononuclear cells (PBMCs) and bronchoalveolar lavage cells. DEX-induced PBMC MKP-1 expression was reduced in overweight/obese vs lean patients with A (P = 0.01). PBMC TNF-α; expression increased as BMI increased in A (P = 0.01). The PBMC log (TNF-α):DEX-induced MKP-1 ratio also increased as BMI increased in A (P =0.004). In bronchoalveolar lavage cells, DEX-induced MKP-1 expression was also reduced in overweight/obese versus lean patients with A (P = 0.05). Similar findings were not observed in control subjects. The authors conclude that in vitro biomarkers of GC insensitivity increase in both the lung and peripheral blood as body mass increases in A. Editor's comment: Obesity may lead to reduce efficacy of GC in A subjects. Sutherland ER, et al., Am J Respir Crit Care Med 2008;178:682.

体重及哮喘(A)的糖皮质激素(GC)应答。

45名不吸烟成人,33名有A, 12名没有A,观察肺功能,BMI,以及用强的松后的肺功能反应情况。PCR法测定外周血单个核细胞(PBMCs)用地塞米松(DEX, 10-6 M)诱导的丝裂原活化蛋白激酶磷酸酶(MKP-1)以及基线肿瘤坏死因子(TNF)-α表达。DEX诱导的PBMC MKP-1表达在超重肥胖哮喘患者低于体型苗条的哮喘患者(P =3D 0.01)。哮喘患者PBMC 的TNF表达随体重增加而增加(P =3D 0.01)。PBMC log(TNF-α) :DEX-induced MKP-1这个比值也随体重而增加(P =3D0.004)。支气管灌洗液细胞中,DEX-induced MKP-1表达在肥胖超重的哮喘患者也低于苗条的哮喘患者(P =3D 0.05)。对照组没有相似的表现。作者的结论是肺内及外周血中提示GC不敏感的体外检测指标随着哮喘患者体重的增加而升高。编者点评:肥胖可能导致哮喘患者GC的有效性降低。Sutherland ER, et al., Am J Respir Crit Care Med 2008;178:682

6. ARG 1 IS A NOVEL BRONCHODILATOR RESPONSE GENE
The authors genotyped 844 single nucleotide polymorphisms (SNPs) in 111 candidate genes in 209 children and their parents participating in the Childhood Asthma (A) Management Program. The association of these SNPs with acute response to inhaled β-agonists (bronchodilator response [BDR]) was screened using a novel technique. Genes that had SNPs with median power in the highest quartile were then taken for replication analyses in three other asthma cohorts. Evidence for association from the four A cohorts was combined, and SNPs from ARG 1 were significantly associated with BDR. The authors conclude that ARG 1 is a novel gene for acute BDR in both children and adults with A. Editor's comment: The arginase 1 gene (ARG1) is a potential β-agonist response gene. Litonjua AA, et al., Am J Respir Crit Care Med 2008;178:688.

ARG1 是新的支气管扩张应答基因

作者给儿童哮喘管理项目的209名儿童及其父母的111个候选基因的844个单核苷酸多肽位点(SNPs)进行基因分型。采用新技术筛查这些SNP与吸入β-激动剂后气管反应性(气管舒张反应 [BDR])的关系。将在统计力度上处于最高四分位中等强度的SNP位点的基因用在其它三个哮喘队列研究中给予复制分析。合并4组队列研究的资料,发现ARG1的SNPs与BDR显著相关。作者的结论是ARG1是哮喘患儿及成年哮喘患者的新的速发支气管扩张反应基因。编者点评:精氨酸酶1基因(ARG1)可能是一个β-激动剂应答基因。

7. EFFECTS OF DOG OWNERSHIP IN EARLY CHILDHOOD ON IMMUNE DEVELOPMENT AND ATOPIC DISEASES
275 children at increased risk of developing allergic diseases were evaluated to age three yrs for pet ownership, blood cell cytokine responses, and atopy. Can f 1, Fel d 1, endotoxin, ergosterol, and muramic acid were measured in settled dust from 101 homes. Dog exposure at birth was associated with decreased atopic dermatitis (AD) (P = 0.004) and wheezing (W) (P = 0.005) in year three. The rates of AD and W in year three were relatively high in children who acquired dogs after birth. The prevalence of dog sensitization between the two groups did not vary according to dog exposure. Can f 1 levels in bedroom dust were positively associated with IL-10 (P =0.01), IL-5 (P< 0.001), and IL-13 (P =0.0004) responses at age one and IL-5 (P=0.022) and IL-13 (P=0.015) responses at age three. Endotoxin was associated with IFN-γ (P=0.002) and IL-13 (P=0.01) responses at age three but not at age one, and similar relationships were found for muramic acid. Exposure to dogs in infancy, and especially around the time of birth, is associated with changes in immune development. Reductions in W and atopy are not explained by exposure to endotoxin, ergosterol, or muramic acid. Editor's comment: The means by which dog ownership at birth may prevent atopic disease remains an enigma. Bufford JD, et al., Clin Exp Allergy 2008;38:1635.

童年早期养狗对免疫系统发生及特应性疾病的影响

调查275名过敏性疾病高危儿童在3岁前是否饲养宠物,血细胞因子的表达以及特应性情况。测定101个家庭屋尘土中的Can f 1, Fel d 1,内毒素,麦角脂醇,以及胞壁酸。出生时暴露在有狗的环境中降低了三岁时特应性皮炎(AD) (P =3D 0.004)及喘息(W) (P =3D 0.005)的发生。而出生后再养狗增加了三岁时AD及W的发生。两组儿童因暴露于狗过敏原而发生致敏的概率没有差异。卧室尘土中Can f 1的水平与1岁时Il-10(P =3D0.01) IL-5 (P< 0.001), 以及 IL-13 (P =3D0.0004)的应答正相关,与3岁时IL-5 (P=3D0.022)及IL-13 (P=3D0.015)的应答正相关。内毒素水平与三岁时IFN-γ (P=3D0.002)及IL-13 (P=3D0.01)的应答相关,但与一岁时两个因子的应答没有关系;胞壁酸的情况与此相似。婴儿时期暴露于狗过敏原,尤其时出生前后的暴露,与免疫系统发生相关。W以及特应性的发生率的降低无法用内毒素,麦角脂醇,或者胞壁酸暴露来解释。编者点评:出生时养狗如何预防特应性疾病的发生还是一个迷。Bufford JD, et al., Clin Exp Allergy 2008;38:1635.

8. SUBLINGUAL IMMUNOTHERAPY (SLIT) IN YOUNGSTERS: ADHERENCE IN A RANDOMIZED CLINICAL TRIAL
204 youngsters (6-18 yrs) with hayfever participated in a SLIT randomized controlled trial with grass pollen extract or placebo for two yrs. The primary outcome, i.e., change in mean daily total rhinoconjunctivitis symptom score in the second grass pollen season was negative. Adherence to medication intake was assessed by weighing the study medication. Participants who completed the follow-up and used ≥80% of the prescribed medication were considered adherent. 154 youngsters completed the study. The number and reasons for drop-outs did not differ between treatment groups. Drop-out was affected by age, evaluation of the treatment effect and medication instructions. Non-adherence to medication intake was influenced by the severity of the disease before the trial. However, the ineffectiveness of SLIT could not be explained by non-adherence. Editor's comment: Non-adherence to the study protocol did not explain the outcome in this negative SLIT study. Röder E, et al., Clin Exp Allergy 2008;38:1659.

舌下免疫治疗随机临床试验中年轻人的依从性

204名枯草热年轻患者(6-18岁)参与了牧草花粉提取物或安慰剂的随机临床试验。主要终点为第二个花粉季节平均日间鼻结膜症状积分为负数。用药依从性的评估依据研究药品的用量。完成所有随访并且使用了不低于80%的研究药品的患者属于依从性好的患者。154名年轻患者完成了这项试验。治疗组与安慰剂组退出的数量及原因没有差异。退出受到年龄、疗效评价以及用药指导的影响。用药不依从受到试验开始前疾病严重性的影响。然而,不依从不能解释为何SLIT无效。编者点评:未依从研究方案无法解释SLIT研究的阴性结果。Röder E, et al., Clin Exp Allergy 2008;38:1659.

9. ARE FISH OIL SUPPLEMENTS SAFE IN FINNED FISH (FF)-ALLERGIC PATIENTS?
Many manufacturers label fish oil supplements with the warning "avoid this product if you are allergic to fish". Six FF-sensitive subjects, as determined by a positive history and skin tests, were selected. They were skin tested with two different fish oil supplements and given an oral challenge of each supplement one hour apart. All patients with positive skin tests to at least one FF had negative skin tests to both fish oil supplements. All tolerated the fish oil challenge. This pilot study indicates that FF-sensitive patients tolerate fish oil supplements. Editor's comment: These data indicate that food labeling for FF-allergic subjects is not necessarily accurate. Mark BJ, et al., Allergy and Asthma Proc 2008:29:528.

对有鳍鱼过敏(FF)的患者用鱼油替代治疗是否安全?

很多生产商在鱼油替代治疗的产品上标注“鱼过敏者禁用”的字样。6个病史及皮肤试验阳性FF患者,用两种不同的鱼油替代物进行皮肤试验,先后一小时分别用两种替代物进行口服激发试验。所有对至少一种FF有阳性皮试结果的患者对两种鱼油替代物的皮试均阴性。所有患者都能耐受鱼油替代物的激发试验。本前瞻性研究表明FF敏感的患者耐受鱼油替代品。编者点评:这些数据显示FF过敏患者慎用的食物标签不一定正确。Mark BJ, et al., Allergy and Asthma Proc 2008:29:528.

10. GOOD PROGNOSIS, CLINICAL FEATURES, AND CIRCUMSTANCES OF PEANUT AND TREE NUT REACTIONS (PTNR) IN CHILDREN TREATED BY A SPECIALIST ALLERGY CENTER
785 children were followed for 3640 patient-years for PTNR. The prognosis for children with PTNR is good with a low frequency and severity of subsequent reactions and need for epinephrine (E). School age children are at highest risk for a recurrent reaction, which occurs most commonly at home. The fact that few reactions occur in school is attributed to informed school training by professionals with expertise in food allergy. Contact PTNR were always mild. A three-fold reduction in the use of E in subsequent vs the index reaction is reported. Index reactions were mild in 66% (516), moderate in 29% (224) and severe in 5% (45). Ninety percent had the same/reduced severity grade on follow-up reactions. Editor's comment: Education is the primary means to control PTNR. By doing so, accidental reactions are uncommon and when they do occur, they are usually mild requiring little or no treatment. Clark AT, et al., J Allergy Clin Immunol 2008;122:286.

过敏专科治疗下,对花生及坚果过敏有反应的儿童临床表现改善,预后良好

随诊785名儿童共3640个患者年,观察是否有花生及坚果反应。有PTNR的儿童预后良好,再发反应较轻,发生率低,肾上腺素(E)的使用更少。学龄儿童复发反应的危险最高,且主要在家里。很少有在学校发生反应的,原因是食物过敏专业人士在学校进行了培训。接触引起的PTNR一般很轻微。与诊断前的反应相比,诊断后发生的反应其对肾上腺素的使用降低了3倍。诊断前的反应在66%的儿童是轻微的(516),29%(224)反应中等强度,5%(45)反应很重。90%随诊中的反应严重性具和以前相同或降低。编者点评:教育是控制PTNR的主要方式。通过教育,意外反应不再普遍,即使发生,通常症状轻,不需要或只需要很少的治疗。Clark AT, et al., J Allergy Clin Immunol 2008;122:286.

11. REVIEW ARTICLES ON EXERCISE-INDUCED ASTHMA (EIA)
The August J Allergy Clin Immunol contains five articles on EIA, "Airway injury as a mechanism for exercise-induced bronchoconstriction in elite athletes" (Anderson SD, et al., p225); "Exercise and other indirect challenges to demonstrate asthma or exercise-induced bronchoconstriction in athletes" (Rundell KW, et al., p238); "The elite athlete: Yes, with allergy we can" (Bonini S, et al., p249); "Long-acting β-agonists and exercise" (Weinberger M, p251); "Asthma and the elite athlete: Summary of the International Olympic Committee's Consensus Conference, Lausanne, Switzerland, January 22-24, 2008" (Fitch KD, et al., p254). EIA is caused by evaporative water loss resulting in cooling and dehydration of the airway surface. The release of mediators is also implicated. These reviews outline the pathophysiology of EIB and how to diagnose and treat it even in elite athletes compelled to follow international guidelines required by the World Anti-Doping Agency. Editor's comment: Great review articles on EIA. J Allergy Clin Immunol 2008;122. Anderson; Rundell; Bonini; Weinberger; Fitch

运动诱发的哮喘(EIA)

八月份的JACI杂志上有五篇关于EIA的文章,"Airway injury as a mechanism for exercise-induced bronchoconstriction in elite athletes" (Anderson SD, et al., p225); "Exercise and other indirect challenges to demonstrate asthma or exercise-induced bronchoconstriction in athletes" (Rundell KW, et al., p238); "The elite athlete: Yes, with allergy we can" (Bonini S, et al., p249); "Long-acting β-agonists and exercise" (Weinberger M, p251); "Asthma and the elite athlete: Summary of the International Olympic Committee's Consensus Conference, Lausanne, Switzerland, January 22-24, 2008" (Fitch KD, et al., p254).EIA是由于水分蒸发丢失后气道表面变凉并脱水而引起的。介质的释放也参予其中。本综述概述了EIB的病理生理,以及如何在遵循世界反兴奋剂机构规定的前提诊断治疗运动员。编者点评:本文是对EIA的优秀综述。

12. NEURO-MEDIATORS AS PREDICTORS OF PAEDIATRIC ATOPIC DERMATITIS (AD)
40 AD cases were matched with 80 unaffected controls from the prospective Taiwan birth panel cohort study. Concentrations of IgE, nerve growth factor (NGF), and vaso-active intestinal peptide (VIP) in cord and maternal plasma were performed by ELISA. The NGF levels were significantly higher in AD patients vs controls (mean ± SD: 65.47 ± 44.45 vs 49.21 ± 12.18 pg/mL for cord plasma and 89.68 ± 41.04 vs 66.96 ± 23.05 pg/mL for maternal plasma) (P < 0.05). Comparative VIP levels were not significantly different from controls. NGF was a better biomarker than IgE to detect both intrinsic and extrinsic pediatric AD. The authors conclude that NGF is a good alternative biomarker to predict childhood AD. Editor's comment: NGF should be investigated as a biomarker for other atopic diseases. Wang IJ, et al., Clin Exp Allergy 2008;38:1302.

神经递质对儿童特应性皮炎(AD)的预测作用

从台湾出生队列研究中找到40例AD患者与80例对照者匹配。用Elisa法测定脐带及母血的IgE浓度,神经生长因子(NGF)以及血管活性肠肽(VIP)水平。AD患者的NGF水平显著高于对照组(平均值 ± SD:脐带血 65.47 ± 44.45 vs 49.21 ± 12.18 pg/mL 母血89.68 ± 41.04 vs 66.96 ± 23.05 pg/mL) (P < 0.05)。两组VIP水平没有显著差异。NGF比IgE更易于发现内源性及外源性AD患儿。作者的结论是NGF是预测儿童AD的一个很好的生物指标。编者点评:应该研究NGF在其它特应性疾病中的生物指标作用。Wang IJ, et al., Clin Exp Allergy 2008;38:1302.

13. WHEEZING (W) IN CHILDHOOD: INCIDENCE, LONGITUDINAL PATTERNS AND FACTORS PREDICTING PERSISTENCE
This study investigates the incidence and natural course of W over the first 13 yrs of life and risk factors which predict W at 11-13 yrs. The Multicentre Allergy Study, a German birth cohort, recruited 1,314 children in 1990. History and physical examinations, immunoglobulin(Ig) E, and lung function tests were performed up to 13 yrs of age. Complete data on 441 children indicate that W declined with age. The first W episode was reported by 29%, 9% and 9% of participants at <3 yrs (early W), 3-6 yrs (late W), and >6 yrs (very late W) of age, respectively. W at age 13 was associated with parental atopy, with positive in vitro IgE tests, elevated IgE, and exposure to high levels of indoor allergens in early life. All associations were stronger among early W vs nonwheezers. The authors conclude that the early expression of atopy as a predictor of W at age 13 declines with increasing age of W onset. Editor's comment: Parental atopy, positive in vitro IgE tests, elevated IgE, and high levels of indoor allergens in early life are associated with higher incidence of W at age 13 in children. Matricardi PM, et al., Eur Respir J 2008;32:585.

 儿童喘息:发病率,病程形式以及预示持续性的因素

本研究观察了13岁以下儿童喘息的发病率及自然进程,探讨哪些因素对11-13岁的喘息有预测作用。德国出生队列研究,是一个多中心过敏性疾病研究,在1990年纳入了1314名儿童。从出生到13岁,定期进行病史采集,体格检查,免疫球蛋白E及肺功能的测定。441名儿童的完整资料显示喘息随着年龄的增加而降低。29%的儿童第一次喘息发生于3岁以下(早期喘息),9%发生于3-6岁间(迟发喘息),9%发生于6岁以后。13岁发作喘息与父母具有特应性,体外IgE检验阳性,TIgE升高,以及早期暴露于高水平的室内变应原相关。与无喘息者相比,早期喘息者上诉因素的相关性都更强。作者得出结论,特应性对13岁发生喘息的预测性随着喘息起病年龄增大而降低。编者点评:父母有特应性,体外IgE检测阳性,IgE增高,以及室内高水平的变应原暴露与13岁时喘息的发病率增高相关。Matricardi PM, et al., Eur Respir J 2008;32:585.

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