Yin Z X, Zhu Y, Zhai X, Zhang J L, Liu G
Department of Otorhinolaryngology, Huanhu Hospital, Tianjin, 300350, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 Aug 5;31(15):1146-1151. doi: 10.13201/j.issn.1001-1781.2017.15.002.
To investigate the clinical symptoms and immunology inspection characteristics of nasal cavity local allergy. Selected 60 patients as observation group, who had only nasal local allergy symptoms, allergen skin prick test and serum allergen specific IgE (SIgE) test were negative, 40 allergic rhinitis (AR) patients and 40 healthy volunteers as control groups. To detect Symptom scores and VAS scores, and eosinophilia counts in venous blood, allergen skin prick test (SPT), serum allergen SIgE test, nasal secretions allergen SIgE test, nasal mucous membrane excitation test in both observation group and AR group, eosinophilia counts in nasal secretion, taked the data for statistical analysis.There was no difference (> 0.05) in the symptom scores and VAS scores of observation group and the AR group. The eosinophilia counts in venous blood in the AR group were higher than in the observation group (< 0.05). The eosinophilia counts in venous blood in the observation group were higher than in the healthy volunteers group (< 0.05). The positive rate of nasal secretions dust mites and pollen allergen was 90% (54/60) in observation group. There was no significant difference (> 0.05) in the eosinophilia percentages in nasal secretion in the observation group and the AR group. There was significant difference (< 0.05) in the eosinophilia percentages in nasal secretion in the observation group and the healthy volunteers group. There were 6 patients in observation group whose nasal secretions allergen SIgE test and nasal mucous membrane excitation test were both negative, could be diagnosised as non-allergic rhinitis (NAR). According to eosinophilia counts in venous blood and nasal secretions, 4 patients were diagnosised as vasomotor rhinitis and 2 patients were diagnosised as NAR with eosinophilia syndrome. There were 54 patients in observation group whose nasal secretions allergen SIgE test and (or) nasal mucous membrane excitation test were positive, could be diagnosised as local allergic rhinitis. After three years, all of the observation group patients were detected with SPT and serum allergen SIgE test. Five patients diagnosed as local allergic rhinitis before three years were positive. Six patients diagnosed as NAR before three years were negative.For patients with the typical medical history and symptoms of AR, but allergen SPT and serum allergen SIgE test were negative, there was local specific hypersensitivity in nasal mucosa, but the reaction was not accompanied by systemic sensitization. Combined with nasal secretions allergen SIgE test or allergen nasal mucosa proocation tests positive, could be diagnosed as local allergic rhinitis.
探讨鼻腔局部过敏的临床症状及免疫学检查特点。选取仅具有鼻腔局部过敏症状、变应原皮肤点刺试验及血清变应原特异性IgE（SIgE）检测均为阴性的60例患者作为观察组，40例变应性鼻炎（AR）患者及40例健康志愿者作为对照组。检测观察组和AR组的症状评分、视觉模拟评分（VAS），静脉血嗜酸性粒细胞计数，变应原皮肤点刺试验（SPT）、血清变应原SIgE检测、鼻分泌物变应原SIgE检测、鼻黏膜激发试验，鼻分泌物嗜酸性粒细胞计数，并对数据进行统计学分析。观察组与AR组的症状评分及VAS评分差异无统计学意义（>0.05）。AR组静脉血嗜酸性粒细胞计数高于观察组（<0.05）。观察组静脉血嗜酸性粒细胞计数高于健康志愿者组（<0.05）。观察组鼻分泌物尘螨及花粉变应原阳性率为90%（54/60）。观察组与AR组鼻分泌物嗜酸性粒细胞百分比差异无统计学意义（>0.05）。观察组与健康志愿者组鼻分泌物嗜酸性粒细胞百分比差异有统计学意义（<0.05）。观察组有6例患者鼻分泌物变应原SIgE检测及鼻黏膜激发试验均为阴性，可诊断为非变应性鼻炎（NAR）。根据静脉血及鼻分泌物嗜酸性粒细胞计数，4例诊断为血管运动性鼻炎，2例诊断为嗜酸性粒细胞增多综合征型NAR。观察组有54例患者鼻分泌物变应原SIgE检测及（或）鼻黏膜激发试验阳性，可诊断为局部变应性鼻炎。3年后对观察组所有患者进行SPT及血清变应原SIgE检测。3年前诊断为局部变应性鼻炎的5例患者结果为阳性。3年前诊断为NAR的6例患者结果为阴性。对于具有典型AR病史及症状，但变应原SPT及血清变应原SIgE检测为阴性的患者，鼻黏膜存在局部特异性超敏反应，但该反应不伴有全身致敏。结合鼻分泌物变应原SIgE检测或变应原鼻黏膜激发试验阳性，可诊断为局部变应性鼻炎。
