Obihara C C, Beyers N, Gie R P, Hoekstra M O, Fincham J E, Marais B J, Lombard C J, Dini L A, Kimpen J L L
Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands.
Clin Exp Allergy. 2006 May;36(5):640-8. doi: 10.1111/j.1365-2222.2006.02479.x.
Epidemiological relation of intestinal helminth infection and atopic disease, both associated with a T-helper (Th) 2 immune response, is controversial, as it has been reported that helminth infection may either suppress or pre-dispose to atopic disease. This relation has not been tested in an area with a high burden of Mycobacterium tuberculosis (MTB) infection, a known Th1-stimulating infection.
To study the association of intestinal helminth infection and atopic disease in a community where helminth infection is endemic and MTB infection is high.
Three-hundred and fifty-nine randomly selected children aged 6-14 years from a poor urban suburb were tested with allergy questionnaire, skin prick test (SPT) to common aeroallergens, Ascaris-specific IgE (Ascaris-sIgE), fecal examination for pathogenic intestinal helminths and tuberculin skin testing (TST). Histamine bronchoprovocation was tested in the group of children aged 10 years and older.
were corrected for demographic variables, socioeconomic status, parental allergy, environmental tobacco smoke (ETS) exposure in the household, recent anthelminthic treatment and for clustering in the sampling unit. Results Ascaris-sIgE was elevated in 48% of children, Ascaris eggs were found in 15% and TST was positive in 53%. Children with elevated Ascaris-sIgE had significantly increased risk of positive SPT to aeroallergens, particularly house dust mite, atopic asthma (ever and recent), atopic rhinitis (ever and recent) and increased atopy-related bronchial hyper-responsiveness. In children with negative TST (<10 mm), elevated Ascaris-sIgE was associated with significantly increased risk of atopic symptoms (adjusted odds ratio (OR(adj)) 6.5; 95% confidence interval (CI) 1.9-22.4), whereas in those with positive TST (>/=10 mm) this association disappeared (OR(adj) 0.96; 95% CI 0.4-2.8).
These results suggest that immune response to Ascaris (Ascaris-sIgE) may be a risk factor of atopic disease in populations exposed to mild Ascaris infection and that MTB infection may be protective against this risk, probably by stimulation of anti-inflammatory networks.
肠道蠕虫感染与特应性疾病均与辅助性T细胞（Th）2免疫反应相关，二者之间的流行病学关系存在争议，因为有报道称蠕虫感染可能抑制或易患特应性疾病。在结核分枝杆菌（MTB）感染负担较高（一种已知的Th1刺激感染）的地区，尚未对这种关系进行测试。
研究蠕虫感染流行且MTB感染率高的社区中肠道蠕虫感染与特应性疾病的关联。
从城市贫困郊区随机选取359名6至14岁儿童，进行过敏问卷调查、针对常见气传变应原的皮肤点刺试验（SPT）、蛔虫特异性IgE（Ascaris-sIgE）检测、肠道致病性蠕虫粪便检查以及结核菌素皮肤试验（TST）。对10岁及以上儿童组进行组胺支气管激发试验。
对人口统计学变量、社会经济地位、父母过敏情况、家庭环境烟草烟雾（ETS）暴露、近期驱虫治疗以及抽样单位中的聚集情况进行校正。结果显示，48%的儿童Ascaris-sIgE升高，15%的儿童发现蛔虫卵，53%的儿童TST呈阳性。Ascaris-sIgE升高的儿童对气传变应原（尤其是屋尘螨）进行SPT呈阳性、患特应性哮喘（既往和近期）、特应性鼻炎（既往和近期）以及与特应性相关的支气管高反应性增加的风险显著增加。在TST阴性（<10 mm）的儿童中，Ascaris-sIgE升高与特应性症状风险显著增加相关（调整优势比（OR(adj)）6.5；95%置信区间（CI）1.9 - 22.4），而在TST阳性（>/=）10 mm）的儿童中，这种关联消失（OR(adj) 0.96；95% CI 0.4 - 2.8）。
这些结果表明，对蛔虫的免疫反应（Ascaris-sIgE）可能是轻度蛔虫感染人群中特应性疾病的一个危险因素，而MTB感染可能通过刺激抗炎网络对这种风险起到保护作用。
