JACI：食物过敏可加剧儿童哮喘
2012-03-31 MedSci MedSci原创
302例美国患儿的分析结果显示，合并食物过敏的哮喘患儿需要使用控制药物和住院治疗的几率，显著高于无食物过敏但哮喘病情相似的患儿。波士顿儿童医院的James L. Friedlander博士在美国过敏、哮喘与免疫学会(AAAAI)年会上报告，食物过敏在城市中心社区的哮喘患儿中“相当普遍”，城市中心学校儿童哮喘研究的受试者中约1/4存在食物过敏。多重食物过敏带来的不良效应更加明显，“可使更严重哮喘的发
302例美国患儿的分析结果显示，合并食物过敏的哮喘患儿需要使用控制药物和住院治疗的几率，显著高于无食物过敏但哮喘病情相似的患儿。波士顿儿童医院的James L. Friedlander博士在美国过敏、哮喘与免疫学会(AAAAI)年会上报告，食物过敏在城市中心社区的哮喘患儿中“相当普遍”，城市中心学校儿童哮喘研究的受试者中约1/4存在食物过敏。多重食物过敏带来的不良效应更加明显，“可使更严重哮喘的发病风险更高，需要消耗更多医疗资源”。
本项研究从美国东北部地区20所学校招募了302例年龄5~13岁的儿童。所有入组儿童均被医生诊断为哮喘，并且具有症状性疾病的3种标志中的至少1种：在此前12个月至少有1次喘息发作，需要每日服药预防发作，或在此前12个月内至少有1次因哮喘而非定期就诊。入组患儿的平均入学年龄为8岁，男、女各半，近3/4来自年收入少于45,000美元的家庭，80%有哮喘家族史。(J. Allergy Clin. Immunol. 2012;129[suppl.]:AB132)。
基线时，75例患儿(25%)被检出食物过敏，其中36例对1种以上食物过敏。最常见的过敏食物为花生(43%)，之后依次为坚果(29%)、水果(25%)、贝类(21%)、鸡蛋(17%)、牛奶(15%)、大豆(10%)和鱼类(10%)。大约一半患儿还被诊断为湿疹。在有食物过敏的患儿中，过敏症状一般在摄入过敏食物后1 h内出现。过敏症状包括荨麻疹(60%)，口或喉咙发痒(44%)，以及水肿(40%)。但是，许多患儿还表现出呼吸道症状，包括33%的患儿曾出现呼吸困难，31%喉咙发紧，29%喘息，28%咳嗽。
根据入组患儿父母填写的调查问卷，研究者确定了食物过敏加重哮喘的若干特点。在合并食物过敏的患儿中，73%使用控制药物，而这一比例在无食物过敏的患儿中仅为58%，有统计学显著性差异。食物过敏患儿中63%曾住院至少1次，而无食物过敏患儿仅为40%，差异显著。在36例对≥2种食物过敏的患儿中，78%有住院治疗史，78%使用控制药物，17%在此前1年内曾住院治疗(无食物过敏患儿仅为7%)。
多重食物过敏患儿病情加重的其他特点还包括： 42%在既往2周内至少有3 d出现哮喘症状(无食物过敏患儿仅为22%)，既往12个月内平均就诊(门诊或急诊)5.8次(无食物过敏患儿仅为4.1次)。
doi:10.1016/j.jaci.2011.12.441
Food Allergy and Increased Asthma Morbidity in a School Inner-city Asthma Study
J. Friedlander, W. Sheehan, E. Hoffman, C. Fu, D. Gold, W. Phipatanakul
Rationale
Children with asthma have increased prevalence of coexisting food allergies. While food allergy has been shown to be an independent risk factor for increased asthma morbidity, this has not been examined within an urban inner-city asthma school-aged cohort. The School Inner-City Asthma (SICAS) is an NIH-funded prospective study evaluating specific risk factors and asthma morbidity among urban children. We aimed to determine the relationship between food allergy and asthma morbidity.
Methods
We prospectively surveyed children from 20 urban, inner-city schools with a diagnosis of asthma, followed by full clinical evaluation and pulmonary function testing. Food allergy symptoms were reported including symptoms experienced within one hour of food ingestion. Asthma morbidity, pulmonary function, and resource utilization were compared between children with food allergies and without. Significance was tested using Wilcoxon rank-sum tests.
Results
Fifty-five (24%) of the 228 asthmatic children surveyed had food allergies. Asthmatic children with food allergies had significantly more hospitalizations than those without food allergies (OR: 2.15, 95% CI: 1.16-4.00, p=0.01). Percent-predicted FEV1 scores were significantly lower in the food allergy group (median: 93.8, IQR 82.9-111.5) compared to the non-allergic group (median 101.5, IQR: 91.4-112.9, p=0.04). Children with food allergies were more likely to have been prescribed an asthma controller medication (OR: 1.73, 95% CI 0.90-3.34, p=0.10) and have escalated asthma therapy in the last 12 months (p=0.07).
Conclusions
School-aged children with asthma and coexisting food allergies have increased asthma morbidity, decreased lung function, and increased healthcare utilization.
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#儿童哮喘#
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