Hosoki Koa, Suga Shigeru, Takahashi Junya, Tanida Hisashi, Nagao Mizuho, Fujisawa Takao
Institute for Clinical Research, Mie National Hospital.
Arerugi. 2011 Jul;60(7):823-33.
Recent advances in medical care have drastically improved life prognosis of severe life-threatening diseases in newborns and young children. However, 'intact' survival without sequelae for all the children is still to be achieved and prevalence of severe motor and intellectual disabilities (SMID) secondary to central nervous system damages of any cause in childhood, especially in neonatal period, is increasing. Patients with SMID have complex problems involving multiple organs and multidisciplinary approach is mandatory. However, prevalence of allergic diseases in SMID patients is not known.
Forty one patients who were institutionalized and 26 outpatients at Mie National Hospital with SMID were enrolled. Diagnosis of allergic diseases was determined based on guidelines for the institutionalized patients and on a questionnaire asking if he/she had ever been diagnosed as the allergic diseases by any physician for outpatients. Serum total IgE, specific IgE to common allergens, eosinophil number, and exhaled nitric oxide by on-line tidal breathing method were measured.
Lifetime prevalence of bronchial asthma, atopic dermatitis, food allergy, allergic rhinitis, allergic conjunctivitis, and drug allergy were 13.4%, 3.0%, 3.0%, 23.9%, 10.4%, and 6.0%, respectively. The sensitizations to Japanese cedar pollen, cypress, orchard grass, and ragweed were significantly more prevalent in outpatients compared with institutionalized patients. The prevalence of allergic rhinitis and allergic conjunctivitis are higher in outpatients compared with institutionalized patients (61.5% vs 0%, 23.1% vs 2.4%, respectively, p< 0.05). Exhaled nitric oxide levels in subjects who were diagnosed as asthma were significantly higher than in non-asthma.
Allergic diseases are as common in SMID patients as general population. Further study is necessary to establish proper management for the patients.
医疗护理方面的最新进展已极大地改善了新生儿和幼儿严重危及生命疾病的生命预后。然而，仍未实现所有儿童都能“完好无损”地存活且无后遗症，并且儿童期（尤其是新生儿期）因任何原因导致中枢神经系统损伤继发的严重运动和智力残疾（SMID）的患病率正在上升。患有SMID的患者存在涉及多个器官的复杂问题，多学科方法必不可少。然而，SMID患者中过敏性疾病的患病率尚不清楚。
招募了41名在三重国立医院住院的SMID患者和26名门诊患者。根据住院患者指南以及一份询问门诊患者是否曾被任何医生诊断为过敏性疾病的问卷来确定过敏性疾病的诊断。测量血清总IgE、对常见过敏原的特异性IgE、嗜酸性粒细胞数量以及通过在线潮气呼吸法测量呼出一氧化氮。
支气管哮喘、特应性皮炎、食物过敏、过敏性鼻炎、过敏性结膜炎和药物过敏的终生患病率分别为13.4%、3.0%、3.0%、23.9%、10.4%和6.0%。与住院患者相比，门诊患者对日本柳杉花粉、柏树、果园草和豚草的致敏率明显更高。门诊患者中过敏性鼻炎和过敏性结膜炎的患病率高于住院患者（分别为61.5%对0%，23.1%对2.4%，p<0.05）。被诊断为哮喘的受试者呼出一氧化氮水平明显高于非哮喘患者。
过敏性疾病在SMID患者中与普通人群一样常见。有必要进一步研究以建立针对这些患者的适当管理方法。
