Immunology, Rheumatology, Allergy and Rare Diseases Department, San Raffaele Scientific Institute, Milan and Santa Chiara Hospital, Trento, Italy; Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Respir Med. 2018 Sep;142:66-72. doi: 10.1016/j.rmed.2018.07.017. Epub 2018 Jul 24.
Although asthma, rhinitis/rhinosinusitis and peripheral eosinophilia are present in virtually all patients with eosinophilic granulomatosis with polyangiitis (EGPA), the role of atopy in these patients is not well defined.
To clarify the role of atopy in patients affected with EGPA.
Clinical, laboratory and standard spirometry data have been abstracted from medical records. Only patients who underwent skin and/or specific IgE testing for common aeroallergens before the vasculitic phase were included.
Overall, 33.5% (63) of our patients underwent skin and/or specific IgE testing to aeroallergens. Atopy related to aeroallergens was confirmed in 22.3% (two-third of those tested), and was associated with more severe/uncontrolled asthma (p < 0.001), including a greater use of oral glucocorticoids for respiratory manifestations the year before the diagnosis of EGPA (p = 0.013). Atopic patients with EGPA had higher total serum IgE levels and less renal disease at EGPA diagnosis compared to non-atopic patients (p < 0.05). Among atopic patients, the majority had multiple sensitizations (76%); dust mite and grass pollen were the most common respiratory allergens identified. The number of allergens did not correlate with peripheral eosinophilia, total serum IgE, ESR, or measures of airway obstruction (p > 0.05 in all cases). The presence of atopy increased the risk of severe/uncontrolled asthma, but not the risk of severe vasculitis (Five Factor Score≥1). Atopic patients had a better overall survival (p = 0.027).
In EGPA, atopy is associated with better prognosis and more severe/uncontrolled asthma manifestations in the year before the development of vasculitis, but not with more severe vasculitis at presentation.
虽然变应性肉芽肿性多血管炎（EGPA）患者几乎都存在哮喘、鼻炎/鼻鼻窦炎和外周血嗜酸性粒细胞增多，但特应性在这些患者中的作用尚未明确。
阐明特应性在 EGPA 患者中的作用。
从病历中提取了临床、实验室和标准肺功能检查数据。仅纳入在血管炎期前接受过常见变应原皮肤和/或特异性 IgE 检测的患者。
总体而言，33.5%（63 例）的患者接受了皮肤和/或特异性 IgE 检测。有 22.3%（三分之二接受检测者）证实存在与变应原相关的特应性，且与更严重/未得到控制的哮喘相关（p<0.001），包括在 EGPA 诊断前一年，因呼吸道表现而更多使用口服糖皮质激素（p=0.013）。与非特应性患者相比，特应性 EGPA 患者的总血清 IgE 水平更高，且 EGPA 诊断时的肾脏疾病更少（p<0.05）。在特应性患者中，大多数存在多重致敏（76%）；尘螨和草花粉是最常见的呼吸道变应原。过敏原数量与外周血嗜酸性粒细胞增多、总血清 IgE、ESR 或气道阻塞测量值均无相关性（p>0.05）。特应性的存在增加了严重/未得到控制哮喘的风险，但不增加严重血管炎的风险（五因素评分≥1）。特应性患者的总体生存率更好（p=0.027）。
在 EGPA 中，特应性与血管炎前一年更严重/未得到控制的哮喘表现相关，但与发病时更严重的血管炎无关。
