全国多中心支气管哮喘与过敏性鼻炎门诊患者对蟑螂变应原皮肤反应性的调查

Skin sensitization to cockroach allergens： a nationwide, multi-center survey on bronchial asthma and allergic rhinitis among outpatients

目的探讨支气管哮喘（简称哮喘）和过敏性鼻炎患者对常见蟑螂（美洲大蠊和德国小蠊）的过敏水平及一些流行病学的特点，同时比较对不同品种蟑螂间的研究，为深入研究昆虫过敏症奠定基础。方法在全国范围内挑选了25家主要从事变应性疾病防治研究的三级甲等医院，对就诊于呼吸科、儿科或变态反应科门诊的哮喘和（或）过敏性鼻炎患者6081例，采用统一的调查问卷和蟑螂抗原皮肤点刺试验。结果哮喘和过敏性鼻炎患者对两种蟑螂抗原的反应性是显著相关的，其阳性程度也显著相关（P〈0．001）；对美洲大蠊抗原的阳性率26．34％高于德国小蠊19．37％，南方地区阳性率高于北方与东部地区，对蟑螂过敏的患者大多在2级水平，强阳性患者极少；男性患者对美洲大蠊和德国小蠊的阳性率分别是28％与19％，均高于女性的25％与15％；成人对美洲大蠊和德国小蠊的阳性率30％与24％也显著高于儿童的23％与14％，对于蟑螂过敏的患者，约有90％同时对屋尘螨抗原阳性。结论蟑螂是哮喘和过敏性鼻炎患者的主要变应原之一、对美洲大蠊的阳性率高于德国小蠊，成人的阳性率高于儿童，男性高于女性，蟑螂和屋尘螨之间可能存在着抗原交叉的现象。

Objective To investigate the prevalence of allergy to two common species of cockroaches （Periplaneta americana and Blattella germanica） among outpatients with bronchial asthma（asthma） and allergic rhinitis from an epidemiological perspective,and to provide evidences for further research on insect hypersensitivity. Methods A total of 6081 outpatients with asthma and allergic rhinitis,registered to clinics of respiratory diseases, pediatrics or allergic diseases in 25 Three Grade-A hospitals, were included in the study. These patients were studied using a standardized questionnaire and skin prick tests for cockroach allergens. Results Among patients with asthma and allergic rhinitis, response to one of the cockroaches correlated well with that to another,as did the grades of response （ P 〈0. 001）. The overall rate of response to Periplaneta americana was 26. 34% vs 19.37% to Blattella germanica. Higher rate of response was found in the south as compared with northern and eastern regions of China. In those allergic to cockroach,grade 2 reactions appeared predominant, with strong-positive outcomes seen only in rare eases. Positive allergy to Periplaneta americana and Blattella germanica was identified in 28% and 19% of males vs 25% and 15% of females,30 % and 24 % of adults vs 23 % and 14% of children, respectively. About 90% cockroach-allergic patients concurrently tested positive to house dust mites. Conclusions Cockroach appears to be one of major allergens among patients with asthma and allergic rhinitis. The rate of response is higher with Periplaneta americana than with Blattella germanica. Higher prevalence of allergy to cockroach is found in males than in females,and in adults than in children. Cross-reactions may be implied between antigens of cockroach and house dust mite.