变应性真菌性鼻窦炎中对重组烟曲霉变应原的致敏作用

McCann William A, Cromie Marc, Chandler Francis, Ford Jan, Dolen William K

Department of Pediatrics, Medical College of Georgia, Augusta 30912, USA.

Ann Allergy Asthma Immunol. 2002 Aug;89(2):203-8. doi: 10.1016/S1081-1206(10)61939-4.

BACKGROUND

Allergic bronchopulmonary mycosis is primarily caused by Aspergillus fumigatus. Despite similarities, allergic fungal sinusitis (AFS) is thought to be caused by various fungi.

OBJECTIVE

Identify fungal elements in AFS allergic mucin and determine the prevalence of specific immunoglobulin (Ig)E to recombinant A. fumigatus allergens (rAsp) in AFS patients.

METHODS

Allergic mucin from 17 definitive and 10 probable AFS patients were histologically examined for fungal elements. Sera from 18 definitive AFS patients, 10 probable AFS patients, 6 chronic sinusitis patients, and 5 A. fumigatus-allergic patients were tested for specific IgE to A. fumigatus and five rAsps.

RESULTS

Ten of the 17 definitive cases had hyphae morphologically resembling Aspergillus or Fusarium spp. One probable AFS patient had similar findings. Of definitive patients, 94% (17 of 18) showed A. fumigatus-specific IgE (> or = 0.35 kUa/L), and 67% were positive to one or more rAsp. Four of 10 probable patients demonstrated A. fumigatus-specific IgE, and 2 had IgE to one or more rAsp. The definitive group had greater mean A. fumigatus IgE (P < 0.05) versus the probable and chronic sinusitis groups. The definitive group's rate of IgE to the rAsps was statistically greater. All definitive patients with Aspergillus or Fusarium spp. in situ had A. fumigatus-specific IgE, and 7 of 10 had IgE to at least one rAsp.

CONCLUSIONS

Most definitive AFS patients have A. fumigatus-specific IgE and many have specific IgE to rAsps. Many also demonstrate Aspergillus spp. or Fusarium spp. in situ. Findings suggests that A. fumigatus is an important causative agent in AFS in the southeast United States.

背景

变应性支气管肺真菌病主要由烟曲霉引起。尽管存在相似之处，但变应性真菌性鼻窦炎（AFS）被认为是由多种真菌引起的。

目的

鉴定AFS变应性黏蛋白中的真菌成分，并确定AFS患者中针对重组烟曲霉变应原（rAsp）的特异性免疫球蛋白（Ig）E的患病率。

方法

对17例确诊和10例疑似AFS患者的变应性黏蛋白进行组织学检查以寻找真菌成分。对18例确诊AFS患者、10例疑似AFS患者、6例慢性鼻窦炎患者和5例烟曲霉变应性患者的血清检测针对烟曲霉和5种rAsp的特异性IgE。

结果

17例确诊病例中有10例具有形态上类似于曲霉属或镰刀菌属的菌丝。1例疑似AFS患者有类似发现。在确诊患者中，94%（18例中的17例）显示有烟曲霉特异性IgE（≥0.35 kUa/L），67%对一种或多种rAsp呈阳性。10例疑似患者中有4例显示有烟曲霉特异性IgE，2例对一种或多种rAsp有IgE。确诊组的平均烟曲霉IgE水平高于疑似组和慢性鼻窦炎组（P<0.05）。确诊组对rAsp的IgE率在统计学上更高。所有原位存在曲霉属或镰刀菌属的确诊患者都有烟曲霉特异性IgE，10例中有7例对至少一种rAsp有IgE。