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变态反应在特应性皮炎(湿疹)中的作用

Author
Jonathan M Spergel, MD, PhD, FAAAAI
Section Editor
Scott H Sicherer, MD, FAAAAI
Deputy Editor
Elizabeth TePas, MD, MS
Translators
耿松梅, 主任医师

引言

变态反应在特应性皮炎[(atopic dermatitis, AD)，即湿疹]中的作用目前尚有争议。一些临床医生认为气源性致敏原引发的变态反应极少是AD发作的原因，且食物变态反应通常不会引发AD。其他临床医生则认为变态反应在一些患者的AD发作中起到重要作用[1]，他们认为，食物变态反应主要引发幼儿患者的症状，而环境过敏原在年长儿童和成人患者中起的作用更大。

尽管命名为“特应性皮炎”，但AD本身不属于Ⅰ型变态反应，也不一定与变应性敏化有关。但总的来说，研究资料显示变态反应在特定AD患者的发病中起到一定作用。

AD的流行病学、临床表现、诊断、治疗及机体对外用药物和护肤品中的化学物质发生的迟发型超敏反应在AD发作中的作用将单独讨论。 (参见“特应性皮炎(湿疹)的发病机制、临床表现和诊断”和“特应性皮炎(湿疹)的治疗”)

特应性相关性

AD患者变态反应性疾病的患病率高于一般人群。可高达80%的AD患儿会在儿童期较晚阶段发生哮喘和/或变态反应性鼻炎[2]，反之亦然，患有哮喘的青少年的AD患病率明显高于未患哮喘的青少年(RR 4.5，95%CI 3.1-6.5)[3]。10%-20%的AD患者存在食物诱发的荨麻疹/全身性过敏反应[4,5]，而一般人群的患病率仅为1%-3%[6,7]。排除既往有全身性过敏反应史和特异性免疫球蛋白E(immunoglobulin E ,IgE)阳性的患者后进行的双盲安慰剂对照食物激发试验(double-blind, placebo-controlled food challenge, DBPCFC)证实：患有湿疹的婴儿中由IgE介导的食物变态反应的阳性率为33%-63%[4,8-12]。发病较早(<3个月)且症状较重的AD患者存在蛋、牛奶和/或花生特异性IgE食物敏化的风险较高[13]。同时存在蛋、花生或尘螨变态反应的AD患者，其AD更有可能持续到5岁以后[14]。

AD也与血清IgE偏高有关，研究显示，出生到6岁间的儿童，血清总IgE水平居高为AD的强危险因素[15]。白细胞介素-13(interleukin-13, IL-13)变异型与年幼AD患儿总IgE水平的轻度升高及对食物过敏原(鸡蛋最常见)的敏化相关[16]。在成人中，经过10年随访发现，总IgE水平居高与持久性、泛发性湿疹相关[17]。

       

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Literature review current through: 2017-07 . | This topic last updated: 2017-02-09.
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References
Top
  1. Caubet JC, Eigenmann PA. Allergic triggers in atopic dermatitis. Immunol Allergy Clin North Am 2010; 30:289.
  2. Eichenfield LF, Hanifin JM, Beck LA, et al. Atopic dermatitis and asthma: parallels in the evolution of treatment. Pediatrics 2003; 111:608.
  3. Naldi L, Parazzini F, Gallus S, GISED Study Centres. Prevalence of atopic dermatitis in Italian schoolchildren: factors affecting its variation. Acta Derm Venereol 2009; 89:122.
  4. Eigenmann PA, Calza AM. Diagnosis of IgE-mediated food allergy among Swiss children with atopic dermatitis. Pediatr Allergy Immunol 2000; 11:95.
  5. García C, El-Qutob D, Martorell A, et al. Sensitization in early age to food allergens in children with atopic dermatitis. Allergol Immunopathol (Madr) 2007; 35:15.
  6. Kanny G, Moneret-Vautrin DA, Flabbee J, et al. Population study of food allergy in France. J Allergy Clin Immunol 2001; 108:133.
  7. Woods RK, Thien F, Raven J, et al. Prevalence of food allergies in young adults and their relationship to asthma, nasal allergies, and eczema. Ann Allergy Asthma Immunol 2002; 88:183.
  8. Eigenmann PA, Sicherer SH, Borkowski TA, et al. Prevalence of IgE-mediated food allergy among children with atopic dermatitis. Pediatrics 1998; 101:E8.
  9. Sampson HA. The immunopathogenic role of food hypersensitivity in atopic dermatitis. Acta Derm Venereol Suppl (Stockh) 1992; 176:34.
  10. Burks AW, James JM, Hiegel A, et al. Atopic dermatitis and food hypersensitivity reactions. J Pediatr 1998; 132:132.
  11. Niggemann B, Sielaff B, Beyer K, et al. Outcome of double-blind, placebo-controlled food challenge tests in 107 children with atopic dermatitis. Clin Exp Allergy 1999; 29:91.
  12. Breuer K, Heratizadeh A, Wulf A, et al. Late eczematous reactions to food in children with atopic dermatitis. Clin Exp Allergy 2004; 34:817.
  13. Hill DJ, Hosking CS, de Benedictis FM, et al. Confirmation of the association between high levels of immunoglobulin E food sensitization and eczema in infancy: an international study. Clin Exp Allergy 2008; 38:161.
  14. Horwitz AA, Hossain J, Yousef E. Correlates of outcome for atopic dermatitis. Ann Allergy Asthma Immunol 2009; 103:146.
  15. Fukiwake N, Furusyo N, Takeoka H, et al. Association factors for atopic dermatitis in nursery school children in Ishigaki islands - Kyushu University Ishigaki Atopic Dermatitis Study (KIDS). Eur J Dermatol 2008; 18:571.
  16. Zitnik SE, Rüschendorf F, Müller S, et al. IL13 variants are associated with total serum IgE and early sensitization to food allergens in children with atopic dermatitis. Pediatr Allergy Immunol 2009; 20:551.
  17. Katoh N, Hirano S, Kishimoto S. Prognostic factor of adult patients with atopic dermatitis. J Dermatol 2008; 35:477.
  18. Schäfer T. The impact of allergy on atopic eczema from data from epidemiological studies. Curr Opin Allergy Clin Immunol 2008; 8:418.
  19. Flohr C, Johansson SG, Wahlgren CF, Williams H. How atopic is atopic dermatitis? J Allergy Clin Immunol 2004; 114:150.
  20. Eller E, Kjaer HF, Høst A, et al. Food allergy and food sensitization in early childhood: results from the DARC cohort. Allergy 2009; 64:1023.
  21. Hon KL, Leung TF, Ching G, et al. Patterns of food and aeroallergen sensitization in childhood eczema. Acta Paediatr 2008; 97:1734.
  22. Pónyai G, Hidvégi B, Németh I, et al. Contact and aeroallergens in adulthood atopic dermatitis. J Eur Acad Dermatol Venereol 2008; 22:1346.
  23. Fuiano N, Fusilli S, Incorvaia C. House dust mite-related allergic diseases: role of skin prick test, atopy patch test, and RAST in the diagnosis of different manifestations of allergy. Eur J Pediatr 2010; 169:819.
  24. Flohr C, Weiland SK, Weinmayr G, et al. The role of atopic sensitization in flexural eczema: findings from the International Study of Asthma and Allergies in Childhood Phase Two. J Allergy Clin Immunol 2008; 121:141.
  25. Schäfer T, Krämer U, Vieluf D, et al. The excess of atopic eczema in East Germany is related to the intrinsic type. Br J Dermatol 2000; 143:992.
  26. de Benedictis FM, Franceschini F, Hill D, et al. The allergic sensitization in infants with atopic eczema from different countries. Allergy 2009; 64:295.
  27. Werfel T, Breuer K. Role of food allergy in atopic dermatitis. Curr Opin Allergy Clin Immunol 2004; 4:379.
  28. Akdis CA, Akdis M, Bieber T, et al. Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. Allergy 2006; 61:969.
  29. Rancé F. Food allergy in children suffering from atopic eczema. Pediatr Allergy Immunol 2008; 19:279.
  30. Noh G, Jin H, Lee J, et al. Eosinophilia as a predictor of food allergy in atopic dermatitis. Allergy Asthma Proc 2010; 31:e18.
  31. Kvenshagen B, Jacobsen M, Halvorsen R. Atopic dermatitis in premature and term children. Arch Dis Child 2009; 94:202.
  32. Hill DJ, Heine RG, Hosking CS. The diagnostic value of skin prick testing in children with food allergy. Pediatr Allergy Immunol 2004; 15:435.
  33. Sampson HA. Food allergy. Part 2: diagnosis and management. J Allergy Clin Immunol 1999; 103:981.
  34. Spergel JM, Beausoleil JL, Fiedler JM, et al. Correlation of initial food reactions to observed reactions on challenges. Ann Allergy Asthma Immunol 2004; 92:217.
  35. Forbes LR, Saltzman RW, Spergel JM. Food allergies and atopic dermatitis: differentiating myth from reality. Pediatr Ann 2009; 38:84.
  36. Sampson HA, McCaskill CC. Food hypersensitivity and atopic dermatitis: evaluation of 113 patients. J Pediatr 1985; 107:669.
  37. Uenishi T, Sugiura H, Tanaka T, Uehara M. Role of foods in irregular aggravation of skin lesions in children with atopic dermatitis. J Dermatol 2008; 35:407.
  38. Bath-Hextall F, Delamere FM, Williams HC. Dietary exclusions for established atopic eczema. Cochrane Database Syst Rev 2008; :CD005203.
  39. Schäfer T, Heinrich J, Wjst M, et al. Association between severity of atopic eczema and degree of sensitization to aeroallergens in schoolchildren. J Allergy Clin Immunol 1999; 104:1280.
  40. Werfel T, Heratizadeh A, Niebuhr M, et al. Exacerbation of atopic dermatitis on grass pollen exposure in an environmental challenge chamber. J Allergy Clin Immunol 2015; 136:96.
  41. Ring J, Darsow U, Gfesser M, Vieluf D. The 'atopy patch test' in evaluating the role of aeroallergens in atopic eczema. Int Arch Allergy Immunol 1997; 113:379.
  42. Devillers AC, de Waard-van der Spek FB, Mulder PG, Oranje AP. Atopy patch tests with aeroallergens in children aged 0-3 years with atopic dermatitis. Allergy 2008; 63:1088.
  43. Boralevi F, Hubiche T, Léauté-Labrèze C, et al. Epicutaneous aeroallergen sensitization in atopic dermatitis infants - determining the role of epidermal barrier impairment. Allergy 2008; 63:205.
  44. Samochocki Z, Owczarek W, Rujna P, Raczka A. Hypersensitivity to aeroallergens in adult patients with atopic dermatitis develops due to the different immunological mechanisms. Eur J Dermatol 2007; 17:520.
  45. Czarnecka-Operacz M, Bator-Wegner M, Silny W. Atopy patch test reaction to airborne allergens in the diagnosis of atopic dermatitis. Acta Dermatovenerol Croat 2005; 13:3.
  46. Brinkman L, Aslander MM, Raaijmakers JA, et al. Bronchial and cutaneous responses in atopic dermatitis patients after allergen inhalation challenge. Clin Exp Allergy 1997; 27:1043.
  47. Tupker RA, De Monchy JG, Coenraads PJ, et al. Induction of atopic dermatitis by inhalation of house dust mite. J Allergy Clin Immunol 1996; 97:1064.
  48. Nankervis H, Pynn EV, Boyle RJ, et al. House dust mite reduction and avoidance measures for treating eczema. Cochrane Database Syst Rev 2015; 1:CD008426.
  49. Reekers R, Busche M, Wittmann M, et al. Birch pollen-related foods trigger atopic dermatitis in patients with specific cutaneous T-cell responses to birch pollen antigens. J Allergy Clin Immunol 1999; 104:466.
  50. Sager N, Feldmann A, Schilling G, et al. House dust mite-specific T cells in the skin of subjects with atopic dermatitis: frequency and lymphokine profile in the allergen patch test. J Allergy Clin Immunol 1992; 89:801.
  51. Wakugawa M, Hayashi K, Nakamura K, Tamaki K. Evaluation of mite allergen-induced Th1 and Th2 cytokine secretion of peripheral blood mononuclear cells from atopic dermatitis patients: association between IL-13 and mite-specific IgE levels. J Dermatol Sci 2001; 25:116.
  52. Werfel T, Breuer K, Ruéff F, et al. Usefulness of specific immunotherapy in patients with atopic dermatitis and allergic sensitization to house dust mites: a multi-centre, randomized, dose-response study. Allergy 2006; 61:202.
  53. Bussmann C, Maintz L, Hart J, et al. Clinical improvement and immunological changes in atopic dermatitis patients undergoing subcutaneous immunotherapy with a house dust mite allergoid: a pilot study. Clin Exp Allergy 2007; 37:1277.
  54. Belloni B, Andres C, Ollert M, et al. Novel immunological approaches in the treatment of atopic eczema. Curr Opin Allergy Clin Immunol 2008; 8:423.
  55. Sheinkopf LE, Rafi AW, Do LT, et al. Efficacy of omalizumab in the treatment of atopic dermatitis: a pilot study. Allergy Asthma Proc 2008; 29:530.
  56. Belloni B, Ziai M, Lim A, et al. Low-dose anti-IgE therapy in patients with atopic eczema with high serum IgE levels. J Allergy Clin Immunol 2007; 120:1223.
  57. Darabi K, Hostetler SG, Bechtel MA, Zirwas M. The role of Malassezia in atopic dermatitis affecting the head and neck of adults. J Am Acad Dermatol 2009; 60:125.
  58. Vilhelmsson M, Glaser AG, Martinez DB, et al. Mutational analysis of amino acid residues involved in IgE-binding to the Malassezia sympodialis allergen Mala s 11. Mol Immunol 2008; 46:294.