链格孢菌合并其他吸入过敏原对儿童和青少年变应性鼻炎的影响

Effects of Alternaria alternata combined with other inhaled allergens on allergic rhinitis in children and adolescents

目的研究链格孢菌合并其他吸入过敏原对儿童和青少年变应性鼻炎(AR)的影响。方法本研究为队列研究,采用非随机抽样的方法选取2021年1月至2022年1月于乌鲁木齐市第一人民医院就诊的链格孢菌特异性免疫球蛋白E阳性的151例AR患者为研究对象。根据致敏原的种类不同,分为单纯链格孢菌阳性组(A组)28例和链格孢菌阳性合并其他吸入过敏原阳性组(B组)123例。分析B组患者过敏原分布情况,采用重复测量方差分析比较2组AR患者不同季节鼻部症状视觉模拟法(VAS)评分和鼻呼出气一氧化氮(nNO),比较2组患者链格孢菌过敏等级。结果在B组中,合并1种其他吸入过敏原者占比35.77%(44/123),其中链格孢菌+草花粉占比最高17.07%(21/123);合并2种其他吸入过敏原者占比33.33%(41/123),其中链格孢菌+草花粉+树花粉占比最高26.83%(33/123);合并3种其他吸入过敏原者占比19.51%(24/123);合并4种其他吸入过敏原者占比11.38%(14/123)。A组和B组AR患者鼻部症状VAS评分在组间比较差异无统计学意义(F=2.52,P=0.115),在不同时点间及组间和时点间的交互作用差异均有统计学意义(F值分别为39.84、3.35,均P<0.05)。A组和B组AR患者nNO水平在组间、时点间及组间和时点间的交互作用差异均无统计学意义(均P>0.05)。2组AR患者链格孢菌过敏等级均以3级、2级、4级多见,在A组达96.43%(27/28),在B组达88.62%(109/123),2组AR患者链格孢菌过敏等级比较差异无统计学意义(Z=1.69,P>0.05)。结论链格孢菌致敏的AR患者同时合并草花粉、树花粉过敏的比例较高;链格孢菌与草花粉、树花粉之间可能存在过敏原的叠加效应,导致AR患者的症状有明显的季节性加重。

ObjectiveTo investigate the effects of Alternaria alternata combined with other inhaled allergens on allergic rhinitis(AR)in children and adolescents.MethodsIn this cohort study,a total of 151 children and adolescents with AR who were positive for Alternaria alternata special immunoglobulin E and received treatment in Urumqi First People′s Hospital from January 2021 to January 2022 were enrolled by non-random sampling.According to the different types of allergens,the cases were divided into two groups,including single Alternaria alternata positive group(group A,n=28)and Alternaria alternata positive combined with other inhaled allergens positive group(group B,n=123).The distribution of allergens in group B was analyzed.The visual analog scale(VAS)scores of nasal symptoms and nasal nitric oxide(nNO)in different seasons were compared between the two groups of AR patients by repeated measurement analysis of variance,and the grade of Alternaria alternata allergy was compared between the two groups as well.ResultsIn group B,the proportion of AR patients combined with one other inhaled allergen was 35.77%(44/123),and the proportion of Alternaria alternata+grass pollen was the highest 17.07%(21/123).The proportion of AR patients combined with two other inhaled allergens was 33.33%(41/123),with the proportion of Alternaria alternata+grass pollen+tree pollen the highest 26.83%(33/123).The proportion of AR patients combined with three other inhaled allergens was 19.51%(24/123).Meanwhile,11.38%(14/123)of AR patients were combined with four other inhaled allergens.There was no significant difference in VAS scores of nasal symptoms between group A and group B(F=2.52,P=0.115),while there were statistically significant differences at different time points(F=39.84,P<0.001).There was also significant differences in interaction between groups and time points of VAS scores of nasal symptoms(F=3.35,P=0.021).No significant difference was observed in nNO levels between groups,time points,and interaction between groups and time points in group A and group B(all P>0.05).Grade 3,grade 2 and grade 4 of patients with AR in the two groups were dominant,with 96.43%(27/28)in group A and 88.62%(109/123)in group B,respectively.There was no significant difference in the grade of Alternaria alternata allergy between the two groups(Z=1.69,P>0.05).ConclusionsA high proportion of AR patients sensitized by Alternaria alternata were allergic to grass pollen and tree pollen at the same time.There may be a synergistic effect of allergens between Alternaria alternata,grass pollen and tree pollen,resulting in obvious seasonal aggravation of symptoms in AR patients.