van den Biggelaar Anita H J, Rodrigues Laura C, van Ree Ronald, van der Zee Jaring S, Hoeksma-Kruize Yvonne C M, Souverijn John H M, Missinou Michel A, Borrmann Steffen, Kremsner Peter G, Yazdanbakhsh Maria
Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands.
J Infect Dis. 2004 Mar 1;189(5):892-900. doi: 10.1086/381767. Epub 2004 Feb 18.
Several studies have shown an inverse association between helminth infections and atopy, but none have clearly established that the pathogens themselves, rather than other associated factors, cause the suppression of atopy. To show a direct link, prospective intervention studies are required.
A randomized, controlled trial was performed to study whether repeated anthelminthic treatment results in increased allergic sensitivity to house dust mites (HDMs) in chronically infected children. The trial population consisted of 317 Gabonese schoolchildren with a high prevalence of intestinal helminths. Intervention consisted of treatment every 3 months with praziquantel and mebendazole and with placebo in the control group. Follow-up lasted 30 months: at 6-month intervals, skin-test sensitivity to mites, helminth infection status, and levels of total IgE were determined.
Treatment resulted in a significant increase in the rate of developing skin sensitivity to HDMs (hazard ratio, 2.51; 95% confidence interval, 1.85-3.41), which was mediated, in part, by reductions in Ascaris and/or Trichuris infections. Levels of total IgE were reduced, but this did not mediate the effect of treatment on skin-test reactivity.
Anthelminthic treatment of chronically infected children results in increased atopic reactivity, which indicates that helminths directly suppress allergic reactions.
多项研究表明蠕虫感染与特应性之间存在负相关，但尚无研究明确证实是病原体本身而非其他相关因素导致特应性受到抑制。为了证明直接联系，需要进行前瞻性干预研究。
开展了一项随机对照试验，以研究反复进行驱虫治疗是否会导致慢性感染儿童对屋尘螨（HDM）的过敏敏感性增加。试验人群包括317名肠道蠕虫感染率高的加蓬学童。干预措施为每3个月用吡喹酮和甲苯达唑治疗一次，对照组使用安慰剂。随访持续30个月：每隔6个月测定对螨虫的皮肤试验敏感性、蠕虫感染状况和总IgE水平。
治疗导致对HDM皮肤敏感性的发生率显著增加（风险比，2.51；95%置信区间，1.85 - 3.41），部分原因是蛔虫和/或鞭虫感染减少。总IgE水平降低，但这并未介导治疗对皮肤试验反应性的影响。
对慢性感染儿童进行驱虫治疗会导致特应性反应性增加，这表明蠕虫直接抑制过敏反应。
