鼻过敏原激发(NAC)可能是评估过敏原特异性疗法的适应症和/或结果的一种手段。特别是常年性过敏原。NAC通常不在哮喘儿童中进行,蟑螂NAC还没有很好的建立。本研究的目的是确定一系列能引起鼻部症状的德国蟑螂提取物剂量,并评估蟑螂NAC在哮喘患儿中的安全性。
10名成人(18-37岁),25名儿童(8-14岁),控制良好,对持续性哮喘和蟑螂致敏进行NAC稀释,然后添加8次递增剂量的蟑螂提取物(0.00381-11.9µg/mLBlag1).通过总鼻症状评分(TNSS)和/或打喷嚏评分确定NAC结果。在外周血单核细胞中测量蟑螂过敏原诱导的T细胞活化和IL-5产生。
67%(6/9)的成人和68%(17/25)的儿童在Blag1的中位反应剂量为0.120µg/mL[IQR0.0380-0.379µg/mL]时NAC呈阳性。此外,三名儿童仅对稀释剂有反应,没有接受任何蟑螂提取物。总的来说,32%(11/34)单独打喷嚏呈阳性,15%(5/34)单独使用TNSS,和21%(7/34),这两个标准。在基线,NAC反应者有较高的蟑螂特异性IgE(P=0.03),较低的蟑螂特异性IgG/IgE比率(儿童,P=.002),和增加产生蟑螂特异性IL-5的T淋巴细胞(P=0.045)。NAC耐受性良好。
我们报道了持续性哮喘和蟑螂致敏儿童NAC发育的方法学。该NAC可以被认为是确认临床相关致敏和评估治疗研究中的反应的工具。
Nasal allergen challenge (NAC) could be a means to assess indication and/or an outcome of allergen-specific therapies, particularly for perennial allergens. NACs are not commonly conducted in children with asthma, and cockroach NACs are not well established. This study\'s objective was to identify a range of German cockroach extract doses that induce nasal symptoms and to assess the safety of cockroach NAC in children with asthma.
Ten adults (18-37 years) followed by 25 children (8-14 years) with well-controlled, persistent asthma and cockroach sensitization underwent NAC with diluent followed by up to 8 escalating doses of cockroach extract (0.00381-11.9 µg/mL Bla g 1). NAC outcome was determined by Total Nasal Symptom Score (TNSS) and/or sneeze score. Cockroach allergen-induced T-cell activation and IL-5 production were measured in peripheral blood mononuclear cells.
67% (6/9) of adults and 68% (17/25) of children had a positive NAC at a median response dose of 0.120 µg/mL [IQR 0.0380-0.379 µg/mL] of Bla g 1. Additionally, three children responded to diluent alone and did not receive any cockroach extract. Overall, 32% (11/34) were positive with sneezes alone, 15% (5/34) with TNSS alone, and 21% (7/34) with both criteria. At baseline, NAC responders had higher cockroach-specific IgE (P = .03), lower cockroach-specific IgG/IgE ratios (children, P = .002), and increased cockroach-specific IL-5-producing T lymphocytes (P = .045). The NAC was well tolerated.
We report the methodology of NAC development for children with persistent asthma and cockroach sensitization. This NAC could be considered a tool to confirm clinically relevant sensitization and to assess responses in therapeutic studies.