Ćosićkić Almira, Skokić Fahrija, Selimović Amela, Mulić Maida, Suljendić Sanimir, Dedić Nermina, Sabitović Damir, Džafić Fejzo
Clinical Department for Children's Diseases, Tuzla University Clinical Center.
Public Health Institute of Tuzla Canton.
Acta Clin Croat. 2017 Jun;56(2):308-317. doi: 10.20471/acc.2017.56.02.15.
Children with atopic dermatitis (AD) usually develop symptoms when they reach the age of 6-7 years, but the risk of developing respiratory allergies, asthma and allergic rhinitis (AR) remains high. In most children with AD, the development of asthma and AR is associated with sensitization to food allergens and/or aeroallergens, while only a small percentage missed atopic diathesis. In about 35% of children with AD, food allergy is the provoking cause, and 60% of infants who had AD in the first 3 months of life were sensitized against aeroallergens by the age of 5. The aim of the study was to follow development of asthma and AR and to assess the most significant risk factors for developing respiratory allergy. A total of 114 children with AD were followed up for five years. At annual visits, the severity of disease, total immunoglobulin E (IgE) antibody values, skin prick tests, specific IgE antibodies to food allergens and aeroallergens, and absolute eosinophil count were assessed. Information on the family history of atopy and AD, feeding patterns during infancy, data on sensitivity to food allergens and/or aeroallergens, and on the occurrence of bronchial obstruction and nose symptoms were obtained. Asthma developed in 36 children, median age 7.7 years; 33 children had symptoms of AR, and 13 children with AD had both diseases associated; 38 children had sensitivity to food, of which 24 developed asthma and 13 AR; asthma developed in 18/23 children with sensitivity to aeroallergens, and almost an equal number of children developed AR. The increased absolute eosinophil count and specific IgE to aeroallergens and food allergens were the best asthma predictors, while AR predictors were family history and early onset of AD. In conclusion, children with AD are at a significant risk of developing respiratory allergies, and those with the increased absolute eosinophil count, positive specific IgE to aeroallergens and food allergens, heredity of AD, and early onset of AD are at the highest risk. Identification of risk factors will enable us to improve the treatments of AD in order to reduce the severity of disease and prevent manifestation of respiratory allergy.
特应性皮炎（AD）患儿通常在6至7岁时出现症状，但发生呼吸道过敏、哮喘和过敏性鼻炎（AR）的风险仍然很高。在大多数AD患儿中，哮喘和AR的发生与对食物过敏原和/或气传过敏原的致敏有关，而只有一小部分患儿没有特应性素质。在约35%的AD患儿中，食物过敏是诱发因素，5岁时，60%在出生后前3个月患有AD的婴儿对气传过敏原致敏。该研究的目的是跟踪哮喘和AR的发展情况，并评估发生呼吸道过敏的最重要风险因素。总共114名AD患儿被随访了5年。在每年的随访中，评估疾病的严重程度、总免疫球蛋白E（IgE）抗体值、皮肤点刺试验、针对食物过敏原和气传过敏原的特异性IgE抗体以及嗜酸性粒细胞绝对计数。获取有关特应性和AD家族史、婴儿期喂养模式、对食物过敏原和/或气传过敏原的敏感数据以及支气管阻塞和鼻部症状发生情况的信息。36名儿童患哮喘，中位年龄7.7岁；33名儿童有AR症状，13名AD患儿同时患有这两种疾病；38名儿童对食物过敏，其中24名患哮喘，13名患AR；18/23名对气传过敏原过敏的儿童患哮喘，患AR的儿童数量几乎相同。嗜酸性粒细胞绝对计数增加以及对气传过敏原和食物过敏原的特异性IgE升高是哮喘的最佳预测指标，而AR的预测指标是家族史和AD的早发。总之，AD患儿发生呼吸道过敏的风险很高，而那些嗜酸性粒细胞绝对计数增加、对气传过敏原和食物过敏原的特异性IgE呈阳性、有AD遗传以及AD早发的患儿风险最高。识别风险因素将使我们能够改进AD的治疗方法，以降低疾病的严重程度并预防呼吸道过敏的表现。
