背景:尘螨是世界范围内呼吸道过敏性疾病的主要原因。对储存螨(SM)的过敏主要与职业暴露有关。然而,最近的研究表明,对SM的敏感性,如鳞形文字析构函数(Lepd),在城市人口中也相当重要,在家庭环境的粉尘样本中患病率很高。现在,在某些地区,房屋尘螨(HDMs)和SM之间的共同敏感性非常频繁,它们之间的交叉反应似乎很狭窄。因此,SM致敏能力日益成为研究的主题。鼻激发试验(NPT),作为一种体内技术,可以被认为是过敏原临床相关性评估的黄金标准,多敏感性鼻炎患者。
目的:本研究的目的是分析SMLepd的临床相关性,通过评估城市环境中体内致敏与过敏性呼吸道疾病表达之间的关系。
方法:在我们的研究中,我们共纳入了32例过敏性鼻炎患者(伴或不伴哮喘),通过皮肤点刺试验(SPT)和特异性IgE(sIgE)证实对HDMs和/或SM致敏.使用主观(Lebel症状评分量表)和客观测量(峰值鼻吸气流量[PNIF])对患者进行Lepd,以评估鼻反应。
结果:大多数SPT和sIgE阳性至Lepd的患者NPT阳性(24/27;89%)。真正的Lepd过敏,由积极的《不扩散核武器条约》评估,可以通过SPT风团尺寸和9.7毫米和sIgE预测。0.42kUA/L,具有100%/95.7%的灵敏度和75.0%/83.3%的特异性,分别。Lepd和Derp之间的协同敏感性很高,75.0%。哮喘在LepdNPT阳性组中更为频繁(54vs.12%,p<0.05)。该组中有更多的患者报告了体育锻炼,非特异性刺激物,和呼吸道感染是呼吸道症状的相关诱因(p&lt;0.01-p&lt;0.05)。
结论:据我们所知,这是第一项研究表明,在非职业环境中,对Lepd的致敏可能具有临床意义.在这个群体中,对Lepd的过敏似乎与呼吸系统疾病的严重程度有关,更多的支气管炎症,与仅对HDM敏感的螨过敏患者相比。因此,作者认为,在城市环境中评估和治疗过敏性呼吸道疾病时,应考虑对Lepd的致敏作用.
BACKGROUND: Dust mites are the leading cause of respiratory allergic diseases worldwide. Allergy to storage mites (SMs) has mostly been related to occupational exposures. However, recent studies have shown that sensitisation to SM, such as Lepidoglyphus destructor (Lep d), is of considerable importance also in urban populations, with high prevalence in dust samples of domestic environments. Co-sensitisation between house dust mites (HDMs) and SM is now regarded as very frequent in some regions, and cross-reactivity between them seems to be narrow. Therefore, SM allergenic capacity is increasingly a subject of study. The nasal provocation test (NPT), as an in vivo technique, could be considered the gold standard for the clinical relevance assessment of an allergen, in polysensitised rhinitis patients.
OBJECTIVE: The objective of this study was to analyse the clinical relevance of the SM Lep d, by assessing the relationship between in vivo sensitisation and expression of allergic respiratory disease in an urban setting.
METHODS: In our study, we enrolled a total of 32 allergic patients with rhinitis (with or without asthma) with proven sensitisation by skin prick test (SPT) and specific IgE (sIgE) to HDMs and/or SM. Patients underwent NPT with Lep d using subjective (Lebel Symptom Score Scale) and objective measurements (peak nasal inspiratory flow [PNIF]) for assessment of nasal response.
RESULTS: Most of the patients with positive SPT and sIgE to Lep d had a positive NPT (24/27; 89%). True Lep d allergy, assessed by a positive NPT, could be predicted by a SPT wheal size >9.7 mm and a sIgE >0.42 kUA/L, with 100%/95.7% sensitivity and 75.0%/83.3% specificity, respectively. Co-sensitisation between Lep d and Der p was high, 75.0%. Asthma was more frequent in the positive Lep d NPT group (54 vs. 12%, p < 0.05). Significantly more patients from this group reported physical exercise, nonspecific irritants, and respiratory infections as relevant triggers of respiratory symptoms (p < 0.01-p < 0.05).
CONCLUSIONS: To our knowledge, this is the first study to show that sensitisation to Lep d may have clinical relevance in a non-occupational setting. In this group, there seems to be a relationship between allergy to Lep d and severity of respiratory disease, with more bronchial inflammation, when comparing with mite-allergic patients sensitised only to HDM. Therefore, the authors consider that sensitisation to Lep d should be considered when assessing and treating allergic respiratory disease in urban environments.