Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Allergol Int. 2012 Mar;61(1):171-4. doi: 10.2332/allergolint.11-CR-0352. Epub 2011 Dec 25.
Autoimmune pancreatitis is characterized by diffuse swelling of the pancreas and a high serum immunoglobulin (Ig) G4 concentration. Histopathologically, dense infiltration of lymphocytes and IgG4-positive plasma cells with fibrosis are seen in the pancreas. Although allergic diseases complicating autoimmune pancreatitis have been reported, the clinical features of bronchial asthma complicated by autoimmune pancreatitis remain unclear.
We report three cases of bronchial asthma preceding the onset of type 1 autoimmune pancreatitis by 3 months to 30 years. All three cases were males with high serum IgG, IgG4, and IgE concentrations. The radioallergosorbent tests were positive for common allergens such as mites and house dust. One case had a pulmonary manifestation that proved to be an inflammatory pseudotumor of the lung with an accumulation of IgG4-positive plasma cells. The asthma symptom was ameliorated by oral prednisolone therapy for autoimmune pancreatitis, and when the corticosteroid doses were reduced, asthma became worse in all three cases.
It is possible that atopy and increased Th2 cell activity are related to a higher coincidence of IgG4-related diseases such as type 1 autoimmune pancreatitis. Because the present cases are few in number, further studies are necessary.
自身免疫性胰腺炎的特征为胰腺弥漫性肿大和血清免疫球蛋白（Ig）G4 浓度升高。组织病理学上，胰腺可见淋巴细胞和 IgG4 阳性浆细胞密集浸润伴纤维化。尽管有报道称自身免疫性胰腺炎合并过敏性疾病，但自身免疫性胰腺炎合并支气管哮喘的临床特征仍不清楚。
我们报告了 3 例支气管哮喘在 1 型自身免疫性胰腺炎发病前 3 个月至 30 年的病例。这 3 例均为男性，血清 IgG、IgG4 和 IgE 浓度升高。放射过敏原吸附试验对螨和屋尘等常见过敏原呈阳性。1 例肺部表现为 IgG4 阳性浆细胞积聚的炎性假瘤。自身免疫性胰腺炎口服泼尼松龙治疗后哮喘症状得到改善，当减少皮质类固醇剂量时，3 例患者的哮喘均加重。
特应性和 Th2 细胞活性增加可能与 IgG4 相关疾病（如 1 型自身免疫性胰腺炎）的更高合并率有关。由于目前的病例数量较少，需要进一步研究。
