Department of Medicine, Division of Allergy and Immunology, Johns Hopkins University, Baltimore, Maryland, USA.
Allergy Asthma Proc. 2010 Nov-Dec;31(6):472-6. doi: 10.2500/aap.2010.31.3372.
Epidemiologic studies have shown an association between mouse allergen exposure and asthma morbidity among urban populations, but confirmatory challenge studies in community populations have not been performed. This study was designed to examine the clinical relevance of mouse sensitization using a nasal challenge model. Forty-nine urban adults with asthma underwent skin-prick testing (SPT) and intradermal testing (IDT) with mouse epithelia extract. A positive SPT was defined as a net wheal size ≥3 mm and a positive IDT was defined as a net wheal size ≥6 mm using a 1:100 dilution of extract (1:10 w/v was obtained from Greer Laboratories (Lenoir, NC) as a single lot [Mus m 1 concentration = 2130 ng/mL]). Mouse-specific IgE (m-IgE) was measured by ImmunoCAP (Phadia, Uppsala, Sweden). Nasal challenge was performed with increasing concentrations of mouse epithelia extract and symptoms were assessed by visual analog scale. A positive challenge was defined as a 20-mm increase in the scale. The age range of the 49 participants was 18-50 years; 41% were men and 86% were black. Fourteen participants were SPT(+) to mouse, 15 participants were SPT(-) but (IDT(+)), and 20 participants were negative on both SPT(-) and IDT(-) (SPT(-)/IDT(-)). Sixty-four percent of the SPT(+) group, 40% of the IDT(+) group, and 20% of the SPT(-)/IDT(-) group had a positive nasal challenge. Sixty-seven percent (10/15) of those who were either SPT(+) or m-IgE(+) had a positive nasal challenge. SPT or the combination of SPT plus m-IgE performed best in diagnosing mouse allergy. The great majority of mouse-sensitized urban adults with asthma appear to have clinically relevant sensitization. Urban adults with asthma should be evaluated for mouse sensitization using SPT or SPT plus m-IgE testing.
流行病学研究表明，城市人群中，鼠过敏原暴露与哮喘发病率之间存在关联，但尚未在社区人群中进行过确认性的激发挑战研究。本研究旨在使用鼻激发模型来检验鼠致敏的临床相关性。49 名患有哮喘的城市成年人接受了皮肤点刺试验（SPT）和鼠上皮提取物的皮内试验（IDT）。SPT 阳性定义为净风团大小≥3mm，IDT 阳性定义为使用 1:100 稀释的提取物（Greer Laboratories（北卡罗来纳州莱诺）获得的 1:10 w/v[Mus m 1 浓度=2130ng/mL]）净风团大小≥6mm。鼠特异性 IgE（m-IgE）通过 ImmunoCAP（瑞典 Uppsala 的 Phadia）进行测量。用增加浓度的鼠上皮提取物进行鼻激发，并通过视觉模拟量表评估症状。激发阳性定义为量表增加 20mm。49 名参与者的年龄范围为 18-50 岁；41%为男性，86%为黑人。14 名参与者对鼠 SPT（+），15 名参与者 SPT（-）但 IDT（+），20 名参与者 SPT（-）和 IDT（-）均为阴性（SPT（-）/IDT（-））。SPT（+）组的 64%、IDT（+）组的 40%和 SPT（-）/IDT（-）组的 20%的鼻激发阳性。在 SPT（+）或 m-IgE（+）的 10 名参与者中，有 67%（10/15）的人鼻激发阳性。SPT 或 SPT 加 m-IgE 联合检测对诊断鼠过敏的效果最佳。大多数患有哮喘的城市鼠致敏成年人似乎存在具有临床相关性的致敏。应使用 SPT 或 SPT 加 m-IgE 测试评估患有哮喘的城市成年人的鼠致敏情况。
