臺灣臺北盆地氣喘、蕁麻疹、及異位性皮膚炎兒童間血液中常見過敏原之特異性抗體的比較

Abstract

引言： 瞭解並識別常見兒童過敏疾病的致敏過敏原對於這些疾病的預測、診斷、預防和治療方法的開發至關重要。目的： 本研究比較了台灣台北盆地地區患有氣喘、蕁麻疹和異位性皮膚炎的兒童血液中對常見過敏原的特異性抗體。方法： 我們評估了台大醫院急診部（ED）及門診部（OPD）中接受多過敏原檢測(MAST)的氣喘、蕁麻疹、和異位性皮膚炎患者。我們首先使用因素分析，將過敏原分組，然後使用ANOVA和Tukey-Kramer事後檢定比較急診部中不同疾病類型的過敏原致敏情況，並在門診部使用多元回歸分析估算過敏原致敏與過敏性疾病類型的關係，以過敏性鼻炎患者作為參照。我們還比較了急診部和門診部中每個疾病組的特異性IgE差異。結果： 在急診部，共638名（60.2% 男性）因有上述疾病至急診看病，且有MAST檢查。其中471名（73.8%）為氣喘，155名（24.3%）為蕁麻疹，12名（1.9%）為異位性皮膚炎。我們發現急診部的異位性皮膚炎患者對食物、真菌、旋轉肌球蛋白、和寵物過敏原的致敏程度高於氣喘和蕁麻疹患者。在門診部，共納入了16,541名（58.9% 男性）有上述疾病，且有MAST檢查者。此部門的疾病組之間有一定重疊：氣喘組包含6,302名患者，蕁麻疹組包含1,936名患者，異位性皮膚炎組有3,531名患者。線性回歸模型發現，對食物、塵蟎和家庭灰塵的過敏與氣喘顯著相關；對塵蟎、家庭灰塵和寵物的過敏與蕁麻疹顯著相關；對食物、真菌、塵蟎和家庭灰塵、旋轉肌球蛋白和寵物的過敏與異位性皮膚炎顯著相關。此外，當比較急診部和門診部中每個疾病組的IgE致敏情況時，我們發現急診部中較重的氣喘、異位性皮膚炎和蕁麻疹病例與對常見過敏原的IgE致敏程度較高相關，但每種疾病中具有最大影響的具體過敏原有所不同。結論： 使用醫院所取得之慝名資料，其分析之結果有助於理解過敏性疾病中，特定過敏原IgE之相關影響。

Introduction: Understanding and identifying the causative allergens for common childhood allergic diseases is essential for the development of prediction, diagnostic, prevention, and treatment methods for these diseases. Aim: In this study, we compared the specific antibodies against common allergens in blood among Taiwanese children from the Taipei Basin area with asthma, urticaria and atopic dermatitis. Methods: We evaluated patients diagnosed as having asthma (AS), urticaria (UR) and atopic dermatitis (AD) that had undergone a multiple allergen simultaneous test in the emergency department (ED) and/or outpatient department (OPD) of the National Taiwan University Healthcare System – Taipei Branch. To achieve our objectives, we first used factor analysis to group the allergens, and then used a one-way ANOVA and Tukey-Kramer Post Hoc Test to compare the allergen sensitization with disease type in the ED and a multiple regression analysis to estimate the relationship between allergen sensitizations and allergic disease type, using allergic rhinitis (AR) as referents in the OPD. We also looked at the difference in the specific IgE of patients seen in the ED and those seen in the OPD for each disease group. Results: In the ED, a total of 638 patients (60.2% male) with IgE measurements were included and among them 471 (73.8%) had AS, 155 (24.3%) had UR, and 12 (1.9%) had AD. We found that patients seen in the ED with AD had greater sensitization to food, fungal, tropomyosin and pet allergens as compared to patients with AS and UR. In the OPD, a total of 16,541 (58.9% male) patients with IgE measurements were included. There was some overlap among the disease groups for this department: the AS group comprised of 6,302 patients, the UR group included 1,936 patients, and the AD group had 3,531 patients. Although the overall fits for our significant linear regression models were not ideal, they nevertheless provided valuable insight into the associations between disease groups and specific allergies. We found that allergies to food and mite and house dust were significantly associated with AS; allergies to mite and house dust and pets were significantly associated with UR; and allergies to food, fungi, mite and house dust, tropomyosin, and pets were significantly associated with AD. Additionally when comparing IgE sensitization of patients in each disease group between the ER and OPD, we found that more severe cases of AS, AD, and UR seen in the ER were associated with greater IgE sensitization to common allergens compared to patients seen in the OPD. However, the specific allergens that have the greatest influence varies disease to disease. Conclusion: Overall, our results help contribute to better understanding the relationship between allergen sensitization among certain allergic groups of childhood.