Schering-Plough Ltd, Welwyn Garden City, UK.
Clin Exp Allergy. 2009 Dec;39(12):1889-95. doi: 10.1111/j.1365-2222.2009.03366.x. Epub 2009 Oct 7.
There is considerable international interest in understanding the sequential progression of multiple allergic conditions (also sometimes known as 'the allergic march').
To study the sequential progression of multiple allergic conditions in a national birth cohort throughout childhood.
We constructed a birth cohort of 43,477 children born in 1990 and registered in UK general practices within a year of birth, using the national General Practice Research Database. Of these, 24,112 with complete follow-up until the age of 18 years were studied in order to understand disease progression and to estimate the absolute and relative risks of developing second and third allergic diagnoses following an index allergic condition.
52.1% of children were diagnosed with at least one condition at some point in childhood. We were able to describe 15 different disease trajectories. Eczema was the most likely index condition with 60.7% [95% confidence interval (CI): 59.8-61.6] of allergy sufferers being diagnosed with this condition first. For those with a diagnosis of eczema, the relative risks of being diagnosed with asthma followed by rhinitis and rhinitis followed by asthma were 1.59 (95% CI: 1.32-1.91; P<0.0001) and 0.54 (95% CI: 0.43-0.68; P<0.0001), respectively. For those diagnosed with asthma first, the relative risks of being diagnosed with eczema followed by rhinitis and rhinitis followed by eczema were 1.27 (95% CI: 0.96-1.68; P=0.095) and 0.27 (95% CI: 0.20-0.36; P<0.0001), respectively. For those diagnosed with rhinitis first, the relative risks of being diagnosed with eczema followed by asthma and asthma followed by eczema were 0.64 (95% CI: 0.42-0.95; P=0.025) and 0.47 (95% CI: 0.32-0.67; P<0.0001), respectively.
Among children diagnosed with multiple allergic diseases there is likely to be a number of variants of 'the allergic march'. Of these, the diagnosis of eczema followed by asthma, which is in turn followed by rhinitis, is the most common trajectory. Surprisingly, some diagnoses indicate a possible strong protective effect of manifesting further likely allergic diagnoses.
国际上对于了解多种过敏疾病（有时也称为“过敏进行曲”）的连续进展非常感兴趣。
研究全国出生队列中儿童时期多种过敏疾病的连续进展。
我们构建了一个由 1990 年出生并在出生后一年内注册于英国全科医生诊所的 43477 名儿童组成的出生队列，使用国家全科医生研究数据库。其中，对 24112 名完成了 18 岁之前随访的儿童进行了研究，以了解疾病的进展情况，并估计在出现索引过敏疾病后，发展为第二和第三过敏诊断的绝对和相对风险。
52.1%的儿童在某个时候被诊断出患有至少一种疾病。我们能够描述 15 种不同的疾病轨迹。湿疹是最有可能的索引疾病，60.7%（95%置信区间：59.8-61.6）的过敏患者首先被诊断出这种疾病。对于那些被诊断为湿疹的患者，随后被诊断为哮喘和随后被诊断为鼻炎的相对风险分别为 1.59（95%置信区间：1.32-1.91；P<0.0001）和 0.54（95%置信区间：0.43-0.68；P<0.0001）。对于首先被诊断为哮喘的患者，随后被诊断为湿疹和随后被诊断为鼻炎的相对风险分别为 1.27（95%置信区间：0.96-1.68；P=0.095）和 0.27（95%置信区间：0.20-0.36；P<0.0001）。对于首先被诊断为鼻炎的患者，随后被诊断为湿疹和随后被诊断为哮喘的相对风险分别为 0.64（95%置信区间：0.42-0.95；P=0.025）和 0.47（95%置信区间：0.32-0.67；P<0.0001）。
在被诊断出患有多种过敏疾病的儿童中，可能存在多种“过敏进行曲”的变体。其中，以湿疹为先导的哮喘，再以鼻炎为先导的模式最为常见。令人惊讶的是，一些诊断表明，进一步出现可能的过敏诊断可能具有较强的保护作用。
