Lynch N R, Palenque M, Hagel I, DiPrisco M C
Instituto de Biomedicina, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela.
Am J Respir Crit Care Med. 1997 Jul;156(1):50-4. doi: 10.1164/ajrccm.156.1.9606081.
Intestinal helminths are among the most common infectious organisms of humans, particularly in tropical regions, and can induce the production of large quantities of IgE antibody. Part of this response is directed against the helminths own antigens, but a polyclonal stimulation also occurs that may increase the allergic reactivity toward environmental allergens. The importance of this in the symptomatology of asthma in these regions is, however, uncertain. In the present study we evaluated the effect of regular anthelminthic treatment with albendazol for 1 yr on a group of asthmatic patients in a zone in which these parasites are endemic. The number of asthmatic crises, need for maintenance therapy with inhaled steroids, and use of inhaled beta 2-agonists were compared both with those in the year prior to the study for the treated patients, and with those in a group of asthmatic subjects evaluated in parallel, but in whom the parasitic infections were not controlled. Significant improvement in all of these indicators of clinical status occurred in the treated group, not only for the period of anthelminth administration, but also for the year following. However, after 2 yr without treatment, the severity of asthma reverted to the initial state. No significant changes were observed in the control group over the entire period of evaluation. At the beginning of the study, the patients' pulmonary function was below the levels predicted for normal individuals, but this was not changed by the anthelminthic treatment. The patients' total serum IgE levels, which were elevated at the beginning of the study, were significantly diminished by the anthelminth administration, as were the specific IgE antibody levels and positivity in skin tests for immediate hypersensitivity to the common environmental allergen Dermatophagoides sp. However, the specific response to Ascaris lumbricoides, a common helminth in the area, was maintained despite treatment. These results indicate that intestinal helminthic infections can contribute to the clinical symptoms of asthma in an endemic situation. This may occur via a direct response to the parasite and/or a nonspecific potentiation of allergic reactivity to environmental allergens.
肠道蠕虫是人类最常见的感染性生物之一，尤其是在热带地区，并且可诱导产生大量的IgE抗体。这种反应部分针对蠕虫自身抗原，但也会发生多克隆刺激，这可能会增加对环境过敏原的过敏反应性。然而，这在这些地区哮喘症状学中的重要性尚不确定。在本研究中，我们评估了在这些寄生虫为地方病的地区，对一组哮喘患者进行为期1年的阿苯达唑常规驱虫治疗的效果。将哮喘发作次数、吸入性类固醇维持治疗的需求以及吸入性β2受体激动剂的使用情况，与治疗患者研究前一年的情况进行比较，同时也与一组平行评估的哮喘受试者（但其寄生虫感染未得到控制）的情况进行比较。治疗组所有这些临床状态指标均有显著改善，不仅在驱虫治疗期间，而且在之后的一年也是如此。然而，在未经治疗的2年后，哮喘严重程度恢复到初始状态。在整个评估期间，对照组未观察到显著变化。研究开始时，患者的肺功能低于正常个体预测水平，但驱虫治疗并未改变这一情况。研究开始时升高的患者血清总IgE水平，在给予驱虫药后显著降低，对常见环境过敏原食螨属的速发型超敏反应的特异性IgE抗体水平及皮肤试验阳性率也是如此。然而，尽管进行了治疗，对该地区常见蠕虫蛔虫的特异性反应仍得以维持。这些结果表明，在地方病情况下，肠道蠕虫感染可导致哮喘的临床症状。这可能通过对寄生虫的直接反应和/或对环境过敏原过敏反应性的非特异性增强而发生。
