Sears M R, Burrows B, Flannery E M, Herbison G P, Hewitt C J, Holdaway M D
Department of Medicine, University of Otago Medical School, Dunedin, New Zealand.
N Engl J Med. 1991 Oct 10;325(15):1067-71. doi: 10.1056/NEJM199110103251504.
Although asthma diagnosed by a physician is known to be related to serum IgE levels, it is not known whether there is a relation between the level of IgE and airway hyperresponsiveness to a methacholine challenge. The characteristics of asymptomatic persons that predispose them to airway hyperresponsiveness are also unknown.
We studied the relation between the serum total IgE level and airway hyperresponsiveness in the presence or absence of asthma and other atopic diseases in a birth cohort of children. Data from a questionnaire regarding respiratory symptoms, plus measurements of the serum total IgE level and airway responsiveness to inhaled methacholine, were obtained for 562 11-year-olds in New Zealand.
The boys had a higher prevalence than the girls of current diagnosed asthma (13 percent vs. 6 percent), current symptoms of wheezing (22 percent vs. 15 percent), and airflow obstruction at base line (6 percent vs. 1 percent) and had a wider distribution of IgE levels, although mean IgE levels (120.8 IU per milliliter in the boys and 98.1 IU per milliliter in the girls) did not differ significantly between the sexes. The prevalence of diagnosed asthma was strongly related to the serum IgE level (P for trend less than 0.0001). No asthma was reported in children with IgE levels less than 32 IU per milliliter, whereas 36 percent of those with IgE levels greater than or equal to 1000 IU per milliliter were reported to have asthma. This relation with the serum IgE level was not explained by a concomitant diagnosis of allergic rhinitis or eczema. Airway hyperresponsiveness to a methacholine challenge also correlated very highly (P less than 0.0001) with the serum IgE level. This relation remained significant even after the exclusion of children with diagnosed asthma (P less than 0.0001) and of all children with a history of wheezing, allergic rhinitis, or eczema (P less than 0.0001).
Even in children who have been asymptomatic throughout their lives and have no history of atopic disease, airway hyperresponsiveness appears to be closely linked to an allergic diathesis, as reflected by the serum total IgE level.
虽然医生诊断的哮喘已知与血清IgE水平有关，但IgE水平与对乙酰甲胆碱激发试验的气道高反应性之间是否存在关联尚不清楚。使无症状个体易患气道高反应性的特征也不明确。
我们在一个儿童出生队列中研究了哮喘及其他特应性疾病存在与否的情况下血清总IgE水平与气道高反应性之间的关系。获取了来自新西兰562名11岁儿童关于呼吸道症状的问卷调查数据，以及血清总IgE水平和对吸入乙酰甲胆碱的气道反应性测量值。
目前诊断为哮喘的男孩患病率高于女孩（13%对6%），目前有喘息症状的患病率（22%对15%）以及基线时气流受限的患病率（6%对1%）均如此，并且男孩的IgE水平分布更广泛，尽管两性的平均IgE水平（男孩为每毫升120.8国际单位，女孩为每毫升98.1国际单位）差异无统计学意义。诊断为哮喘的患病率与血清IgE水平密切相关（趋势P值小于0.0001）。IgE水平低于每毫升32国际单位的儿童中未报告有哮喘，而IgE水平大于或等于每毫升1000国际单位的儿童中有36%报告患有哮喘。这种与血清IgE水平的关系不能用同时诊断的过敏性鼻炎或湿疹来解释。对乙酰甲胆碱激发试验的气道高反应性也与血清IgE水平高度相关（P值小于0.0001）。即使排除诊断为哮喘的儿童（P值小于0.0001）以及所有有喘息、过敏性鼻炎或湿疹病史的儿童后，这种关系仍然显著（P值小于0.0001）。
即使在一生都无症状且无特应性疾病病史的儿童中，气道高反应性似乎也与血清总IgE水平所反映的过敏性素质密切相关。
