IgE介导食物过敏和婴幼儿特应性皮炎的相关性研究

Correlation between IgE mediated food allergy and atopic dermatitis in infants

目的探讨婴幼儿IgE介导的食物过敏和特应性皮炎(AD)的相关性。方法选取2014年1月至2016年12月在济宁市第一人民医院皮肤科和儿科变态反应门诊确诊为AD的婴幼儿80例,年龄3个月至3岁。详细询问病史并填写食物过敏调查问卷,再行血清食物特异性IgE(sIgE)检测。除极高水平sIgE外,sIgE阳性患儿需要口服食物激发试验(OFCs),采用二元Logistic回归分析食物sIgE阳性分级对诊断食物过敏的影响。结果 26(32.50%)例AD患儿有食物过敏史或可疑食物过敏史。食物sIgE阳性38例,占总数的47.50%。不同程度的AD患儿在一种食物sIgE阳性和两种及以上食物sIgE阳性比较差异有统计学意义(χ~2=12.88,P<0.05)。其中极高水平sIgE(6级)5例。结合过敏史、sIgE阳性和OFCs,确诊食物过敏18例(鸡蛋12例、牛奶5例、鱼1例),总阳性率为22.50%。食物sIgE阳性分级越高,IgE介导的食物过敏发生率越高(Waldχ~2=13.24,P<0.05,OR=2.81)。结论婴幼儿AD与IgE介导的食物过敏存在密切关联性。个人史和家族过敏史为诊断提供线索,sIgE分级为诊断提供有价值的参考,确诊需要OFCs。牛奶和鸡蛋是婴幼儿最常见的过敏原。

Objective To explore the correlation between IgE mediated food allergy and atopic dermatitis（AD）in infants.Methods Eighty infants aged from 3 months to 3 years and diagnosed of AD in dermatology and pediatric allergy outpatient departments in Jining First People＇s Hospital from January 2014 to December 2016 were enrolled in this study.Medical history was investigated,food allergy questionnaire was filled and then serum-specific IgE antibody（sIgE）to food was tested.Except cases with very high levels of sIgE,sIgE-positive infants were subjected to oral food challenges（OFCs）.The influence of food sIgE grades on IgE mediated food allergy was analyzed by binary Logistic regression.Results Twenty-six（32.50%）infants with AD had a history of food allergy or suspicious food allergy.Thirty-eight infants were positive of food sIgE,accounting for 47.5% of the total.There was significant difference in case number with sIgE positive for one kind of food and that with more than two kinds of food among infants with different degrees of AD（χ~2=12.88,P〈0.05）.Among them,5 infants had very high levels of sIgE（6 grade）.Combining allergic history,positive sIgE and OFCs,18 infants were diagnosed with IgE mediated food allergy（12 cases of egg allergy,5 cases of milk allergy,1 case of fish allergy）,and total positive rate was 22.50%.The higher the sIgE positive grade of food,the higher the incidence of IgE mediated food allergy（Walsχ~2=13.24,P〈0.05,OR=2.81）.ConclusionInfants with AD are closely related to IgE mediated food allergy.Personal history and family allergic history provide clues for diagnosis,and sIgE grade provides valuable reference for diagnosis.OFCs is needed for confirmation.Milk and eggs are the most common allergens in infants with AD.