Instituto de Saude Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
Clin Exp Allergy. 2013 Jan;43(1):60-72. doi: 10.1111/cea.12040.
Most childhood asthma in poor populations in Latin America is not associated with aeroallergen sensitization, an observation that could be explained by the attenuation of atopy by chronic helminth infections or effects of age.
To explore the effects of geohelminth infections and age on atopy, wheeze, and the association between atopy and wheeze.
A case-control study was done in 376 subjects (149 cases and 227 controls) aged 7-19 years living in rural communities in Ecuador. Wheeze cases, identified from a large cross-sectional survey, had recent wheeze and controls were a random sample of those without wheeze. Atopy was measured by the presence of allergen-specific IgE (asIgE) and skin prick test (SPT) responses to house dust mite and cockroach. Geohelminth infections were measured in stools and anti-Ascaris IgE in plasma.
The fraction of recent wheeze attributable to anti-Ascaris IgE was 45.9%, while those for SPT and asIgE were 10.0% and 10.5% respectively. The association between atopy and wheeze was greater in adolescents than children. Although Anti-Ascaris IgE was strongly associated with wheeze (adj. OR 2.24 (95% CI 1.33-3.78, P = 0.003) and with asIgE (adj. OR 5.34, 95% CI 2.49-11.45, P < 0.001), the association with wheeze was independent of asIgE. There was some evidence that the association between atopy and wheeze was greater in uninfected subjects compared with those with active geohelminth infections.
Atopy to house dust mite and cockroach explained few wheeze cases in our study population, while the presence of anti-Ascaris IgE was an important risk factor. Our data provided only limited evidence that active geohelminth infections attenuated the association between atopy and wheeze in endemic areas or that age modified this association. The role of allergic sensitization to Ascaris in the development of wheeze, independent of atopy, requires further investigation.
在拉丁美洲的贫困人群中，大多数儿童哮喘与过敏原致敏无关，这种观察结果可以用慢性寄生虫感染对特应性的衰减或年龄的影响来解释。
探讨地理性蠕虫感染和年龄对特应性、喘息的影响，以及特应性与喘息之间的关系。
在厄瓜多尔农村社区的 376 名 7-19 岁的受试者（149 例病例和 227 例对照）中进行了病例对照研究。从一项大型横断面研究中确定的喘息病例为近期有喘息，而对照是无喘息的随机抽样。特应性通过过敏原特异性 IgE（asIgE）和屋尘螨和蟑螂皮肤点刺试验（SPT）反应来测量。寄生虫感染通过粪便检测和血浆抗蛔虫 IgE 来测量。
近期喘息归因于抗蛔虫 IgE 的比例为 45.9%，而 SPT 和 asIgE 的比例分别为 10.0%和 10.5%。特应性与喘息之间的关联在青少年中比在儿童中更大。尽管抗蛔虫 IgE 与喘息（adj.OR 2.24（95%CI 1.33-3.78，P = 0.003）和 asIgE（adj.OR 5.34，95%CI 2.49-11.45，P < 0.001）强烈相关，但与喘息的关联独立于 asIgE。有一些证据表明，在未感染的受试者中，特应性与喘息之间的关联大于有活动性地理性蠕虫感染的受试者。
在我们的研究人群中，屋尘螨和蟑螂的特应性解释了很少的喘息病例，而抗蛔虫 IgE 的存在是一个重要的危险因素。我们的数据仅提供了有限的证据表明，活动性地理性蠕虫感染在流行地区减弱了特应性与喘息之间的关联，或者年龄改变了这种关联。需要进一步研究过敏性致敏对蛔虫引起的喘息的作用，而不依赖于特应性。
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