Wahn U, Lau S, Bergmann R, Kulig M, Forster J, Bergmann K, Bauer C P, Guggenmoos-Holzmann I
Universitätskinderklinik, Virchow-Klinikum Humboldt-Universität, Berlin, Germany.
J Allergy Clin Immunol. 1997 Jun;99(6 Pt 1):763-9. doi: 10.1016/s0091-6749(97)80009-7.
The purpose of the study was to investigate the influence of environmental allergen exposure on allergic sensitization in infancy and early childhood.
A cohort of 1314 newborns was recruited and followed up prospectively at the ages 12, 24, and 36 months. The levels of major mite (Der p 1 and Der f 1) and cat (Fel d 1) allergens were determined from domestic carpet dust samples by sandwich ELISA. Specific serum IgE antibodies to mite and cat allergens were determined by CAP fluoroimmunoassay (Pharmacia). Logistic regression was used to assess the effects of allergen exposure, age, family history, and cord blood IgE simultaneously on the risk of sensitization.
Children, who had been found to be sensitized at least once during the first 3 years of life, were found to be exposed to significantly higher house dust mite (median, 868 ng/gm vs 210 ng/mg; p = 0.001) and cat (median, 150 ng/gm vs 64 ng/gm; p = 0.011) allergen concentrations in domestic carpet dust compared with the group without sensitization. In homes with low (< or = 25th percentile) dust concentrations, the risk of sensitization to mite (1.6%), and cat (2.0%) is low, compared with 6.5% for mite and 6.3% for cat if the domestic exposure is above the 75th percentile. The dose-response relationships between allergen levels and sensitization indicate that the increase in sensitization risk at low allergen levels is more pronounced in cat allergy (p = 0.002) than in mite allergy (p = 0.026). In the group with a positive family history, lower mite and cat allergen concentrations are needed to achieve specific sensitization compared with the group with a negative family history.
Our data indicate that avoidance measures in the domestic environment aimed at the primary prevention of allergen-driven sensitization should be introduced at the earliest possible stage, if possible during infancy.
本研究的目的是调查环境过敏原暴露对婴幼儿过敏致敏的影响。
招募了1314名新生儿，并在12、24和36个月龄时进行前瞻性随访。通过夹心ELISA法测定家庭地毯灰尘样本中主要螨虫（Der p 1和Der f 1）和猫（Fel d 1）过敏原的水平。通过CAP荧光免疫测定法（Pharmacia）测定针对螨虫和猫过敏原的特异性血清IgE抗体。采用逻辑回归分析同时评估过敏原暴露、年龄、家族史和脐血IgE对致敏风险的影响。
在生命的前3年中至少有一次致敏的儿童，其家庭地毯灰尘中的屋尘螨（中位数，868 ng/gm对210 ng/mg；p = 0.001）和猫（中位数，150 ng/gm对64 ng/gm；p = 0.011）过敏原浓度显著高于未致敏组。在灰尘浓度低（≤第25百分位数）的家庭中，对螨虫（1.6%）和猫（2.0%）致敏的风险较低，而如果家庭暴露高于第75百分位数，则螨虫致敏风险为6.5%，猫致敏风险为6.3%。过敏原水平与致敏之间的剂量反应关系表明，低过敏原水平下致敏风险的增加在猫过敏（p = 0.002）中比在螨虫过敏（p = 0.026）中更明显。与家族史阴性的组相比，家族史阳性的组实现特异性致敏所需的螨虫和猫过敏原浓度更低。
我们的数据表明，旨在一级预防过敏原驱动的致敏的家庭环境回避措施应尽早引入，如有可能在婴儿期引入。
