Rullo Vera E V, Arruda L Karla, Cardoso M Regina, Valente Vivien, Zampolo Alessandra S, Nóbrega Fernando, Naspitz Charles K, Solé Dirceu
Division of Pediatric Allergy, Immunology and Rheumatology, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
Int Arch Allergy Immunol. 2009;150(2):172-8. doi: 10.1159/000218120. Epub 2009 May 12.
Environmental factors may influence the development of allergen sensitization and asthma. The aim of this study was to evaluate the role of endotoxin and allergen exposure in early life as a risk factor for recurrent wheezing.
One hundred and four infants from low-income families, at high risk of asthma, were enrolled at birth. Dust samples were collected from the bedding and bedroom floor within 6 months after birth. Recurrent wheezing was defined as 3 or more wheezing episodes in the past year. Endotoxin was determined by Limulus amebocyte lysate assay, and major indoor allergens were quantitated by ELISA in dust extracts. IgE antibodies were measured by ImmunoCAP at 30 months of age.
At 30 months, 51 of the 99 infants who completed the study (51.5%) had recurrent wheezing. Respiratory infection was strongly associated with recurrent wheezing (OR 6.67, 95% CI 1.96-22.72), whereas exclusive breastfeeding for at least 1 month was a protective factor (OR 0.09, 95% CI 0.01-0.51). Exposure to high levels of mouse allergen was more frequent among non-recurrent wheezers, approaching significance (OR 0.12, 95% CI 0.01-1.13; p = 0.064). None of the children were sensitized to mouse. Sensitization to mite was found in 26/90 (28.8%) children, with no association with recurrent wheezing.
Respiratory infection was strongly associated with recurrent wheezing in the first 30 months of life, in children at high risk of asthma, living in a socially deprived community in Brazil.
环境因素可能影响过敏原致敏和哮喘的发展。本研究的目的是评估生命早期内毒素和过敏原暴露作为复发性喘息危险因素的作用。
104名来自低收入家庭、哮喘高危的婴儿在出生时被纳入研究。在出生后6个月内从床上用品和卧室地板上采集灰尘样本。复发性喘息定义为过去一年中出现3次或更多次喘息发作。通过鲎试剂法测定内毒素，并用酶联免疫吸附测定法（ELISA）对灰尘提取物中的主要室内过敏原进行定量。在30月龄时通过免疫化学发光法（ImmunoCAP）测量IgE抗体。
在30月龄时，完成研究的99名婴儿中有51名（51.5%）出现复发性喘息。呼吸道感染与复发性喘息密切相关（比值比[OR]6.67，95%置信区间[CI]1.96 - 22.72），而至少纯母乳喂养1个月是一个保护因素（OR 0.09，95% CI 0.01 - 0.51）。在非复发性喘息患儿中，接触高水平小鼠过敏原的情况更常见，接近显著水平（OR 0.12，95% CI 0.01 - 1.13；p = 0.064）。没有儿童对小鼠致敏。在90名儿童中有26名（28.8%）对螨虫致敏，与复发性喘息无关。
在巴西社会贫困社区中，处于哮喘高危的儿童在生命的前30个月里，呼吸道感染与复发性喘息密切相关。
