2021—2023年天津市某儿童医院特应性皮炎患儿过敏原特异性IgE检测结果分析

Analysis of allergen-specific IgE in children with atopic dermatitis from 2021 to 2023 in a hospital of pediatric in Tianjin City

目的探讨天津地区特应性皮炎患儿过敏原特异性免疫球蛋白E(specific immunoglobulin E,sIgE)分布及规律,为临床诊疗提供参考依据。方法采用回顾性横断面研究方法,应用酶联免疫捕获法,对2021年3月至2023年2月在天津市儿童医院就诊的1841例特应性皮炎患儿进行20项过敏原sIgE的血清学检测,收集首次检测结果,采用χ^(2)检验分析其在不同性别、年龄和季节的过敏原分布特征。结果1841例患儿中,有1247例(67.73%)至少1种过敏原sIgE阳性;食物过敏原sIgE阳性率49.86%(918/1841),检出前3位依次为鸡蛋32.10%(591/1841)、牛奶25.91%(477/1841)、小麦面粉14.61%(269/1841);吸入过敏原sIgE阳性率47.96%(883/1841),检出前3位依次为屋尘24.33%(448/1841)、交链孢霉20.59%(379/1841)、粉尘螨14.83%(273/1841)。食物过敏原sIgE阳性率最高的年龄组为1~3岁组64.11%(434/677)(χ^(2)=122.854,P<0.001),吸入过敏原sIgE阳性率最高的年龄组为11~14岁组71.26%(62/87)(χ^(2)=134.968,P<0.001)。食物及吸入过敏原sIgE总的阳性率在不同季节没有明显差异(χ^(2)=4.047,P=0.256;χ^(2)=7.549,P=0.056),单项分析显示,大豆、牛奶sIgE阳性率在夏季最高(4.86%,30.54%)(χ^(2)=11.329,P=0.010;χ^(2)=28.720,P<0.001),而交链孢霉、艾蒿sIgE阳性率分别在夏季和秋季最高(24.86%,11.54%)(χ^(2)=8.462,P=0.037;χ^(2)=10.641,P=0.014)。1841例患儿中,有32.21%的患儿3种及以上过敏原sIgE阳性;鸡蛋、牛奶及屋尘的sIgE浓度等级以1~2级为主,3级及以上等级的比例均<15%;蟹、虾、花生尽管阳性率低,3级及以上等级的比例均>30%;交链孢霉、粉尘螨、艾蒿、猫毛皮屑阳性患儿的sIgE高浓度等级占比较大,分别为68.07%、49.45%、56.57%和47.83%。结论本研究可在一定程度上反映天津地区的特应性皮炎患儿的过敏原sIgE分布特征,不同年龄组中过敏原sIgE阳性率有明显差异,部分过敏原sIgE阳性率存在季节性差异和等级分布差异,有必要根据分布特征和临床症状,合理规避高风险的过敏原,做好特应性皮炎的预防和诊疗。

Objective To explore the distribution of allergen-specific IgE(sIgE)for children with atopic dermatitis in Tianjin City and provide the evidences of clinical diagnosis and treatment.Methods A retrospective cross-sectional study was conducted to analyze the children who were suspected of atopic dermatitis and tested for serum sIgE in the Tianjin Children′s Hospital from March 2021 to February 2023.Using first detection results only,a total of 1841 serum samples were tested for twenty common allergens.The method was the enzyme-linked immune capture assay.The allergen epidemiological characteristics were statistically analyzed by Chi square test based on the children′s characteristics and factors such as different sexes,ages and seasons by the mass data.Results Among the 1841 cases,the results showed that 1247(67.73%)were sensitized to at least 1 allergen-sIgE,comprising to 49.86%(918/1841)to food allergen-sIgE and 47.96%(883/1841)to aeroallergen-sIgE.The top three food allergens-sIgE were egg 32.10%(591/1841),milk 25.91%(477/1841)and wheat flour 14.61%(269/1841);the top three positive rates of aeroallergens-sIgE were house dust 24.33%(448/1841),alternaria 20.59%(379/1841)and dermatophagoides farinae 14.83%(273/1841).The positive rates of food allergens-sIgE were the highest in the 1-3 years old group(64.11%,434/677)(χ^(2)=122.854,P<0.001),while the positive rates of aeroallergens-sIgE were higher in the 11-14 years old group(71.26%,62/87)(χ^(2)=134.968,P<0.001).No seasonal difference was revealed in the overall positive rate of food allergen-sIgE and aeroallergen-sIgE(χ^(2)=4.047,P=0.256;χ^(2)=7.549,P=0.056).The positive rates of soybean-sIgE and milk-sIgE were the highest in summer(χ^(2)=11.329,P=0.010;χ^(2)=28.720,P<0.001),whereas alternaria-sIgE and mugwort-sIgE were the highest in summer and autumn,respectively(χ^(2)=8.462,P=0.037;χ^(2)=10.641,P=0.014).Among the 1841 cases,32.21%were sensitized to three or more allergens-sIgE.The sIgE concentration levels of egg,milk and house dust were mainly level 1 to 2,and the proportions of level 3 and above were all under 15%;although the positive rates of crab,shrimp,and peanut were low,the proportions of grade 3 and above were all beyond 30%.Children sensitized to alternaria,dermatophagoides farinae,mugwort,and cat dander had higher sIgE concentration levels,which were 68.07%,49.45%,56.57%and 47.83%respectively.Conclusions This study can reflect the epidemic characteristics of allergen-sIgE in children with atopic dermatitis in Tianjin region to a certain extent.Allergen-sIgE positivity in patients differed by age,and there were seasonal differences and grade distribution differences in the positive rates of some allergens-sIgE.It is necessary to reasonably avoid the high-risk allergens according to the epidemiological characteristics and clinical symptoms,which provide valuable information for the prevention,diagnosis and treatment of atopic dermatitis.