Nowacki Zygmunt, Neuberg Jolanta, Strzałka Krystyna, Szczepanik Magdalena, Szczepanik Renata, Mazurek Henryk
Gabinet Alergologiczno-Pediatryczny, ul. Masarska 7/II, 31-534 Kraków.
Pneumonol Alergol Pol. 2010;78(4):263-70.
The term allergic march has been used to describe natural evolution of the atopic disease in children, accompanied by the change in organ manifestation with time. The aim of the study was to analyze the role of the cellular components of the nasal cytology as a tool for prediction of atopic diseases and clinical symptoms preceding allergic march.
In a retrospective manner out of a group of 1620 children, 146 symptomatic children (60 girls and 86 boys) meeting inclusion criteria (age below 4 years at first visit, symptoms suggesting allergy, nasal cytology performed at the beginning of observation, observation of at least 4 years) were included in analysis.
Mean age of children at time of enrollment was 27 months (SD 10 months). After 4 years allergic rhinitis (AR) was diagnosed in 85 children (58.2%), atopic eczema/dermatitis syndrome (AEDS) in 51 (34.9%) and asthma in 48 (32.9%). Nonallergic etiology was identified in 36 patients (22.5%). All patients with asthma suffered from AR. Significant differences between groups were found in number of eosinophils (p < 0.001), neutrophils (p < 0.001), and lymphocytes (p = 0.028) in cytological examination of nasal mucosa. In children with AR (alone or combined with other comorbidities) nasal eosinophilia was higher than in children with AEDS (18% v. 3%; p = 0.004) or non-allergic disease (18% v. 4%; p < 0.001). Nasal eosinophilia of at least 8% was predictive for development of AR (sensitivity 80%, specificity 95%).
In children below 4 years nasal eosinophilia >or= 8% was predictive for AR development. Allergic march was observed in children with AEDS or/and gastrointestinal allergy symptoms present at the beginning of observation. Nasal eosinophilia in small children might be predictive for the risk of allergic march.
“过敏进程”一词用于描述儿童特应性疾病的自然演变，其伴随着器官表现随时间的变化。本研究的目的是分析鼻细胞学的细胞成分作为预测特应性疾病及过敏进程之前临床症状的工具的作用。
以回顾性方式，从1620名儿童中选取了146名有症状的儿童（60名女孩和86名男孩）纳入分析，这些儿童符合纳入标准（首次就诊年龄低于4岁、有提示过敏的症状、在观察开始时进行了鼻细胞学检查、观察至少4年）。
入组时儿童的平均年龄为27个月（标准差10个月）。4年后，85名儿童（58.2%）被诊断为变应性鼻炎（AR），51名（34.9%）为特应性湿疹/皮炎综合征（AEDS），48名（32.9%）为哮喘。36名患者（22.5%）被确定为非变应性病因。所有哮喘患者均患有AR。鼻粘膜细胞学检查中，各组在嗜酸性粒细胞数量（p<0.001）、中性粒细胞数量（p<0.001）和淋巴细胞数量（p = 0.028）方面存在显著差异。患有AR（单独或合并其他合并症）的儿童鼻嗜酸性粒细胞增多高于患有AEDS的儿童（18%对3%；p = 0.004）或非变应性疾病的儿童（18%对4%；p<0.001）。鼻嗜酸性粒细胞增多至少8%可预测AR的发生（敏感性80%，特异性95%）。
4岁以下儿童鼻嗜酸性粒细胞增多≥8%可预测AR的发生。在观察开始时出现AEDS或/和胃肠道过敏症状的儿童中观察到了过敏进程。幼儿鼻嗜酸性粒细胞增多可能预测过敏进程的风险。
