Ravensberg A J, van Rensen E L J, Grootendorst D C, de Kluijver J, Diamant Z, Ricciardolo F L M, Sterk P J
Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands.
Clin Exp Allergy. 2007 Jan;37(1):100-7. doi: 10.1111/j.1365-2222.2006.02617.x.
House dust mite (HDM) is the most common aeroallergen causing sensitization in many Western countries and is often used in allergen inhalation challenges. The concentration of inhaled allergen causing an early asthmatic reaction [provocative concentration of inhaled allergen causing a 20% fall of forced expiratory volume in 1 s (FEV(1))(PC(20) allergen)] needs to be predicted for safety reasons to estimate accurately the severity of allergen-induced airway responsiveness. This can be accomplished by using the degree of non-specific airway responsiveness and skin sensitivity to allergen.
We derived prediction equations for HDM challenges using PC(20) histamine or PC(20) methacholine and skin sensitivity data obtained from patients with mild to moderate persistent asthma and validated these equations in an independent asthma population.
PC(20) histamine or PC(20) methacholine, skin sensitivity, and PC(20) allergen were collected retrospectively from 159 asthmatic patients participating in allergen challenge trials. Both the histamine and methacholine groups (n=75 and n=84, respectively), were divided randomly into a reference group to derive new equations to predict PC(20) allergen, and a validation group to test the new equations.
Multiple linear regression analysis revealed that PC(20) allergen could be predicted either from PC(20) methacholine only ((10)log PC(20) allergen=-0.902+0.741.(10)log PC(20) methacholine) or from PC(20) histamine and skin sensitivity (SS) ((10)log PC(20) allergen=-0.494+0.231.(10)log SS+0.546.(10)log PC(20) histamine). In the validation study, these new equations accurately predicted PC(20) allergen following inhalation of HDM allergen allowing a safe starting concentration of allergen of three doubling concentrations below predicted PC(20) allergen in all cases.
The early asthmatic response to inhaled HDM extract is predominantly determined by non-specific airway responsiveness to methacholine or histamine, whereas the influence of the cutaneous sensitivity to HDM appears to be rather limited. Our new equations accurately predict PC(20) allergen and hence are suitable for implementation in HDM inhalation studies.
屋尘螨（HDM）是许多西方国家引起致敏的最常见空气变应原，常用于变应原吸入激发试验。出于安全考虑，需要预测引起早期哮喘反应的吸入变应原浓度[引起第1秒用力呼气量（FEV₁）下降20%的吸入变应原激发浓度（PC₂₀变应原）]，以便准确估计变应原诱导的气道反应性的严重程度。这可以通过使用非特异性气道反应性程度和对变应原的皮肤敏感性来实现。
我们利用PC₂₀组胺或PC₂₀乙酰甲胆碱以及从轻度至中度持续性哮喘患者获得的皮肤敏感性数据，推导了HDM激发试验的预测方程，并在一个独立的哮喘人群中对这些方程进行了验证。
回顾性收集了159名参与变应原激发试验的哮喘患者的PC₂₀组胺或PC₂₀乙酰甲胆碱、皮肤敏感性和PC₂₀变应原数据。组胺组和乙酰甲胆碱组（分别为n = 75和n = 84）均随机分为一个参考组以推导预测PC₂₀变应原的新方程，以及一个验证组以测试新方程。
多元线性回归分析显示，PC₂₀变应原可以仅从PC₂₀乙酰甲胆碱预测（（10）log PC₂₀变应原 = -0.902 + 0.741·（10）log PC₂₀乙酰甲胆碱），或者从PC₂₀组胺和皮肤敏感性（SS）预测（（10）log PC₂₀变应原 = -0.494 + 0.231·（10）log SS + 0.546·（10）log PC₂₀组胺）。在验证研究中，这些新方程准确地预测了吸入HDM变应原后的PC₂₀变应原，在所有情况下都允许变应原的安全起始浓度比预测的PC₂₀变应原低三个倍增浓度。
对吸入HDM提取物的早期哮喘反应主要由对乙酰甲胆碱或组胺的非特异性气道反应性决定，而皮肤对HDM的敏感性影响似乎相当有限。我们的新方程准确地预测了PC₂₀变应原，因此适用于HDM吸入研究。
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