van Asperen P P, Kemp A S
Department of Respiratory Medicine, Children's Hospital, Camperdown, Sydney, Australia.
Acta Paediatr Scand. 1989 Mar;78(2):239-45. doi: 10.1111/j.1651-2227.1989.tb11063.x.
We have prospectively followed 57 children of atopic parents up to 5 years of age, documenting clinical atopic disease and allergen skin test reactions. The cumulative prevalences of the clinical features of atopic disease over the 5 years were: atopic dermatitis (58%), wheeze (49%), recurrent wheeze (33%), rhinitis (68%) and immediate food reactions (18%). Atopic dermatitis and immediate food reactions predominated in infancy (birth to 20 months) while wheezing was more prominent in later childhood (20 months to 5 years). Rhinitis was common in both infancy and childhood. IgE sensitisation to ingested allergens was prominent in early infancy and was usually transient. Inhaled allergen sensitisation occurred later in infancy and was generally permanent with wheal sizes tending to increase with age. There was a significant association between IgE sensitisation to ingested but not inhaled allergens and all atopic manifestations in infancy, with the exception of rhinitis. In contrast IgE sensitisation to inhaled allergens was associated with rhinitis and wheeze in later childhood. We found two clinical groups. One group, with only ingested allergen sensitisation had a high incidence of atopic dermatitis but low incidence of respiratory symptoms at 5 years of age. The other group, who developed evidence of IgE sensitisation to inhaled allergens, had a high incidence of rhinitis and wheeze but low incidence of atopic dermatitis at 5 years of age.
我们前瞻性地追踪了57名有特应性父母的儿童直至5岁，记录临床特应性疾病和过敏原皮肤试验反应。5年期间特应性疾病临床特征的累积患病率分别为：特应性皮炎（58%）、喘息（49%）、复发性喘息（33%）、鼻炎（68%）和速发型食物反应（18%）。特应性皮炎和速发型食物反应在婴儿期（出生至20个月）最为常见，而喘息在儿童后期（20个月至5岁）更为突出。鼻炎在婴儿期和儿童期均很常见。对摄入性过敏原的IgE致敏在婴儿早期很突出，且通常是短暂的。吸入性过敏原致敏在婴儿期后期出现，且一般是永久性的，风团大小往往随年龄增加。除鼻炎外，婴儿期对摄入性而非吸入性过敏原的IgE致敏与所有特应性表现之间存在显著关联。相比之下，对吸入性过敏原的IgE致敏与儿童后期的鼻炎和喘息相关。我们发现了两个临床组。一组仅对摄入性过敏原致敏，5岁时特应性皮炎发病率高但呼吸道症状发病率低。另一组出现了对吸入性过敏原IgE致敏的证据，5岁时鼻炎和喘息发病率高但特应性皮炎发病率低。
