特应性皮炎过敏原的确定

据估计大约50％婴幼儿特应性皮炎和35％成人特应性皮炎患者对常见过敏原过敏。气源性过敏原、食物过敏原和小分子接触性过敏原是特应性皮炎发病的主要环境诱发因素。临床可通过皮肤点刺试验、斑贴试验、特应性斑贴试验等体内试验并结合外周血过敏原特异性IgE检测进行过敏原诊断。当明确与发病相关的过敏原后,回避治疗是首要的原则,对于尘螨等难以完全回避的过敏原,特异性免疫治疗是有可能改善病情并达到长期缓解的治疗手段。     

湿疹？还是特应性皮炎？

特应性皮炎（AD）是一种慢性复发性、瘙痒性、炎症性皮肤疾病,常自幼时发病,可持续终生,严重影响患者的生活质量。目前尚无单一特异性的,洛床表现或实验室检查指标可以鉴别诊断AD与湿疹。然而,与湿疹相比较,AD患者常伴有血清免疫球蛋白IgE增高,个人及家族遗传性AD、过敏性哮喘和／或过敏性鼻炎的病史,且皮疹及瘙痒更为严重,还可合并皮肤感染及皮肤屏障功能的损害。因此,区分湿疹还是AD,对于正确诊断及采取合适的治疗方案具有重要意义。     

导言：从皮肤开始，全面关注过敏性疾病

自100多年前奥地利儿科医师Clemens Von Pirquet首创变态反应（allergy）一词以后,有关变态反应的研究有了长足的发展。由变态反应,也称过敏反应,所致的疾病均可泛称为变态反应性疾病或过敏性疾病,它是一种过敏性的全身疾病,可以发生在全身的任何部位,以鼻部、皮肤、眼部、气管支气管、神经系统、胃肠道多见。过敏性疾病虽然有着不同的临床表现,但它们都是因为变态反应引起,同根共源,相互影响。近年来,     

过敏性鼻炎和支气管哮喘治疗的统一性与整体观

过敏性鼻炎和支气管哮喘是常见的上下气道联合炎性疾病。尽管其治疗手段多样,效果良好,但由于目前对过敏性鼻炎的认识及重视程度不够,治疗现状并不乐观。从哲学上辩证统一的认识过敏性鼻炎和支气管哮喘的治疗,并以现代整体医学的观点分析两者的同一性,为临床实践中针对两者进行整体治疗提供理论依据。     

过敏性鼻炎和支气管哮喘治疗的统一性与整体观

过敏性鼻炎和支气管哮喘是常见的上下气道联合炎性疾病.尽管其治疗手段多样,效果良好,但由于目前对过敏性鼻炎的认识及重视程度不够,治疗现状并不乐观.从哲学上辩证统一的认识过敏性鼻炎和支气管哮喘的治疗,并以现代整体医学的观点分析两者的同一性,为临床实践中针对两者进行整体治疗提供理论依据.     

婴幼儿喘息的分类和小儿哮喘的鉴别诊断

喘息是小儿时期常见的症状,尤其是婴幼儿。婴幼儿喘息分为三种类型：一过性的早期喘息,只发生在3岁以前的喘息。无家族的哮喘病史,与过敏原的致敏无关,与父母吸烟有关。持续性的早发的喘息,即非过敏的喘息,与病毒感染诱发有关。晚发的喘息/哮喘,即过敏性的喘息, 有湿疹和哮喘的气道病理特点。在诊断支气管哮喘前,还必须排除以下疾病：先天性气道和肺的发育异常,先天性心、血管异常,异物吸入,胃食管返流,支气管结核,纤毛不动综合征,免疫缺陷病等。     

婴幼儿喘息的分类和小儿哮喘的鉴别诊断

喘息是小儿时期常见的症状,尤其是婴幼儿.婴幼儿喘息分为三种类型:一过性的早期喘息,只发生在3岁以前的喘息.无家族的哮喘病史,与过敏原的致敏无关,与父母吸烟有关.持续性的早发的喘息,即非过敏的喘息,与病毒感染诱发有关.晚发的喘息/哮喘,即过敏性的喘息.有湿疹和哮喘的气道病理特点.在诊断支气管哮喘前,还必须排除以下疾病:先天性气道和肺的发育异常,先天性心、血管异常,异物吸入,胃食管返流,支气管结核,纤毛不动综合征,免疫缺陷病等.     

特异性免疫疗法在儿童哮喘治疗中的应用

支气管哮喘是儿童最常见的慢性呼吸道疾病,近年来发病呈逐年上升趋势。在儿童哮喘的治疗方案中,脱敏治疗是唯一从变态反应疾病的病因治疗可改变疾病进程的疗法。注射脱敏是传统的脱敏方法,儿童疗效优于成人,但由于采用注射的方式,使该方法一直应用于5岁以上的儿童。舌下脱敏治疗是90年代开始在国外进行应用的一种脱敏治疗方法,其安全性和有效性在国外已得到多项临床研究的证实,且其安全性在儿童要优于成人,因此舌下脱敏治疗为5岁以下年幼哮喘儿童的特异性免疫治疗提供了新的思路和治疗策略。     

鼻部因素在阻塞性睡眠呼吸暂停低通气综合征中的作用

比较临床鼻中隔偏曲、解剖鼻中隔偏曲及无鼻中隔偏曲组间睡眠呼吸紊乱指数(AHI)、最低血氧饱和度的差异.比较过敏性鼻炎与无过敏性鼻炎病史组间AHI、最低血氧饱和度的差异.分析性别、年龄、病程、过敏性鼻炎、鼻中隔偏曲等多种因素对AHI和最低血氧饱和度的影响作用.比较临床鼻中隔偏曲组、解剖鼻中隔偏曲组、无鼻中隔偏曲组的AHI和最低血氧饱和度,均无统计学差异.比较过敏性鼻炎组与无过敏性鼻炎组AHI和最低血氧饱和度,过敏性鼻炎组的AHI大于无过敏性鼻炎组,差异有统计学意义,两组间最低血氧饱和度无统计学差异.多种因素对AHI和最低血氧饱和度的影响作用无统计学意义.合并过敏性鼻炎的OSAHS患者可能睡眠中的呼吸暂停和低通气次数更多,但不能通过性别、年龄、病程、过敏性鼻炎及鼻中隔偏曲的因素来预测OSAHS的疾病严重程度.     

特异性免疫疗法在儿童哮喘治疗中的应用

支气管哮喘是儿童最常见的慢性呼吸道疾病,近年来发病呈逐年上升趋势.在儿童哮喘的治疗方案中,脱敏治疗是唯一从变态反应疾病的病因治疗可改变疾病进程的疗法.注射脱敏是传统的脱敏方法,儿童疗效优于成人,但由于采用注射的方式,使该方法一直应用于5岁以上的儿童.舌下脱敏治疗是90年代开始在国外进行应用的一种脱敏治疗方法,其安全性和有效性在国外已得到多项临床研究的证实,且其安全性在儿童要优于成人,因此舌下脱敏治疗为5岁以下年幼哮喘儿童的特异性免疫治疗提供了新的思路和治疗策略.     

Comorbidity in allergic asthma and allergic rhinitis: functional somatic syndromes

Based on the concept of central sensitisation, the present study tested the hypothesis of comorbidity in allergic asthma and allergic rhinitis with diagnoses of functional somatic syndromes (FSSs), including fibromyalgia, irritable bowel syndrome and migraine. Data were used from the population-based Västerbotten Environmental Health Study (n = 3406). The participants consisted of 164 individuals with allergic asthma and 298 individuals with allergic rhinitis as well as 2876 individuals without allergic or non-allergic asthma, allergic rhinitis or atopic dermatitis. Diagnoses were based on self-reports of having been diagnosed by a physician. Odds ratios (ORs) were calculated from binary logistic regression analysis, both crude and adjusted for age and education. The adjusted ORs (1.87–4.00) for all FSSs differed significantly from unity for both allergic asthma and rhinitis. The results provide support for the hypothesis of comorbidity in allergic asthma and rhinitis with FSSs. Since central sensitisation is likely to underlie FSSs, the present findings raises the question as to whether central sensitisation may also be involved in allergic asthma and rhinitis.     

Pilot study of personality traits assessed by the Karolinska Scales of Personality (KSP) in asthma, atopy, and rhinitis

Asthma and atopy are common diseases. To study associations between personality and asthma, atopy, rhinitis, and personality traits were measured on the Karolinska Scales of Personality for 193 persons working in 19 buildings with suspected indoor air problems. In addition, information on history of atopy, asthma, and rhinitis was collected by postal questionnaire. In analyses, asthma was associated with higher impulsiveness scores, and atopy in non-asthmatics was associated with higher social desirability scores and lower irritability, guilt, and impulsiveness scores. Non-atopic rhinitis was associated with scores on several anxiety-related scales, while atopic rhinitis was not associated with scores on the Karolinska Scales of Personality. This exploration implies that asthma, atopy, and rhinitis may be associated with various but different personality trait scores. The finding of such personality trait associations in persons with non-asthmatic atopy raises the question of a potential role of an emotional conflict in atopy and the role of personality in asthma, atopy, and rhinitis.     

Allergic disorders and attention deficit disorder in children

It has been suggested that children with attention deficit disorder-hyperactivity (ADDH) are likely to show allergic disorders, and that both ADDH and allergic disorders may share a common biological background. In a large sample of children from the general population we found no association between parent, teacher, and self-reports of ADDH behaviors and a history of allergic disorders (asthma, eczema, rhinitis, and urticaria) at ages 9 or 13 years. Similarly, reports of ADDH behaviors at age 13 years were not related to level of atopic responsiveness by skin test or serum IgE levels. Our findings call into question the hypothesis that there is a relationship between ADDH and allergic disorder.The Dunedin Multidisciplinary Health and Development Research Unit is supported by the Health Research Council of New Zealand, and involves several departments of the University of Otago. The authors are indebted to the many people whose contributions made this study possible, and in particular the members of the sample and their parents.     

Coping among children and adolescents with chronic illness

The present study was aimed to investigate age and gender effects on coping with everyday stressors among children and adolescents with chronic illness and healthy controls. Patients (8–13 years of age) with asthma (n=47), atopic dermatitis (n=52), and cancer (n=57) were compared to healthy controls (n=158) matched by age, gender, and grade. Self-report data on coping with academic and interpersonal stressors were collected. The primary results indicated that coping with everyday stressors was improved in children and adolescents with chronic illness compared to healthy controls. Thus, patients reported less passive avoidance on cross-situational coping and tended to show more situation-specific coping with social and school-related stressors than healthy controls. Additionally, among the clinical groups, patients with atopic dermatitis and cancer scored higher on positive self-instructions than patients with asthma. Conclusively, the results suggest that coping with a chronic illness may lead to more effective coping with everyday stressors. Implications for evaluating coping styles in patients with chronic illness are discussed.     

Nasal diseases and psychological distress

A high rate of ENT doctors were murdered by nasal disordered patients in China recently. It is obviously important and urgent to find out whether there is any potential relationship between nasal diseases (ND) and psychological distress that might contribute to violent behavior. For this purpose, we carried out this literature review. There is a complex relationship between ND and psychiatric distress, which is mainly considered as a bidirectional causal relationship with other controversy opinions. However, most of the previous studies were found to be focused on allergic rhinitis and chronic rhinosinusitis, while reports about other ND were rare. Further study is still needed to uncover the secret aspects in this field, and more attentions need to be paid to other ND.     

Prevalence of suicidal ideation in patients with atopic dermatitis

The prevalence of suicidal ideation in patients with mild, moderate, and severe atopic dermatitis between the age of 15 to 49 years were 0.21%, 6%, and 19.6%, respectively. In addition, the prevalence of homicide-suicidal ideation in mothers or fathers of patients (aged 0-14 years) with mild, moderate, and severe atopic dermatitis were 0.11%, 0.35%, and 3.28%, respectively. These results indicate that patients with atopic dermatitis or even parents of patients with atopic dermatitis have high prevalence of suicidal ideation.     

Impact of Allergic Rhinitis on Simulated Real‐World Performance1

A few studies have shown that untreated seasonal allergic rhinitis (hay fever) may have unfavorable effects on performance. However, prior research has employed tasks of limited or moderate difficulty (e.g., verbal learning) or has focused on visual‐motor efforts (e.g., driving a vehicle). The present research compared performance in the absence (asymptomatic) versus presence (symptomatic) of rhinitis, using the validated strategic management simulation (SMS). Obtained data indicated that whenever task‐demands were contextual (e.g., cued by the environment), no differences between symptomatic and asymptomatic conditions were obtained. Whenever task‐demands were more difficult, untreated seasonal allergic rhinitis decreased effectiveness. To avoid loss of productivity and limit decrements in quality of life, treatment of seasonal allergic rhinitis with medications without sedating effects appears of value.