孩童過敏性鼻炎之血清專一性抗體IgE與IgG4之研究

The Serum IgE and IgG4 in Children with Allergic Rhinitis

王冠欽(Kuan-Ching Wang) ； 朱繡棟(Sau-Tung Chu) ； 劉博仁(Po-Jen Liu)

《台灣耳鼻喉頭頸外科雜誌》 50卷1期 (2015/03) Pp. 51-57

https://doi.org/10.6286/2015.50.1.51

摘要

背景：過敏性鼻炎（Allergic rhinitis）是一種盛行率高又惱人的慢性疾病。本研究目的是針對過敏性鼻炎的孩童，分析其吸入性以及食物過敏原專一性抗體IgE以及IgG4之分布，並採討食物過敏原專一性IgG4在過敏性鼻炎的角色。方法：自2013年1月至2013年6月之間，收集耳鼻喉科門診診斷為過敏性鼻炎之孩童納入研究。家長簽署同意書後，安排抽血檢驗血清專一性抗體IgE及IgG4。結果：共計32名孩童參與，男性19名，女性13名，平均年齡為8.1±2.9歲（範圍：4歲至14歲）。總量IgE濃度小於100 IU/ml有6名（18.8%），濃度介於100~199 IU/ml有7名（21.9%），濃度介於200~399 IU/ml有9名（28.1%），濃度介於400~799 IU/ml（15.6%），而濃度大於800 IU/ml以上的有5名（15.6%）。主要吸入性過敏原為塵蟎類90%。、牧草31.3%、狗牙根草21.9%、豬草12.5%；主要食物過敏原為蛋白62.5%、杏仁40.6%、牛奶34.4%、小麥31.3%、大豆25%。在食物專一性IgG4方面，93.8%的病人封於蛋白IgG4呈現高濃度反應，其他超過50%抗原呈現高濃度反應的食物有蛋黃、牛奶、花生、小麥、大豆、杏仁、鱈魚、乳酪。鱈魚、螃蟹、蝦子的專一性IgE檢測值對專一性IgG4檢測值為一顯著預測變數（p＜0.001）。結論：總量IgE只能做為過敏性鼻炎診斷的參考之一。而孩童之血清專一性抗體IgE分析顯示除了吸入性過敏原以外，食物過敏原也應納入過敏性鼻炎孩童之參考項目。血清專一性抗體IgG4在過敏性鼻炎孩童也呈現高比例陽性，其臨床意義仍須深入探討。

關鍵字

過敏性鼻炎 ； 孩童 ； 專一性免疫球蛋白E ； 專一性刷疫球蛋白G4

並列摘要

Background: Allergic rhinitis is a troublesome but usually-seen-in-daily-life disease. This study was aiming at children with allergic rhinitis, and we analyzed its distribution of inhalational antigens and the food specific IgE and IgG4. We also analyzed the association between specific IgE and IgG4. Methods: From January to June 2013, we've collected the cases of children with allergic rhinitis who were diagnosed in ENT outpatient department into the research. After their parents signed the informed consents, we arranged the blood sampling to check the specific IgE and IgG4. Results: Results: There were 32 children enrolled in this study, including 19 males and 13 females. The ages ranged from 4 to 14, and the average age was 8.1 ± 2.9. In total IgE level, there were 6 people (18.8%) less than 100 IU/ml, 7 (21.9%) cases were between 100-199 IU/ml, 9 (28.1%) cases were between 200-399 IU/ml, 5 cases (15.6%) were between 100-799 IU/ml, and 5 cases (15.6%) were greater than 800 IU/ ml. The major inhalational allergens were dust mite 90%, grass 31.3%, Timothy Grass 31.3%, Cynodon dactylon 21.9%, and ragweed 12.5%. The major food allergens were egg white 62.5%, apricot kernel 40.6%, milk 34.4%, wheat 31.3%, and soybean 25%. In the aspect of antigen specific IgG4, 93.8% cases were highly reactive to egg white, and the others were greater than 50% in the antigens of egg yolk, milk, peanut, wheat, soybean, apricot kernel, cod fish, and cheese. The specific IgE of cod fish, crab, and shrimp was correlated with specific igG4 significantly (p ＜ 0.001). Conclusions: Total IgE can only be one of the references for the diagnosis of allergic rhinitis. Furthermore, the analysis of serum specific IgE refers that besides the inhalant allergen, food allergen should also be taken into consideration of children's allergic rhinitis. Lastly, children with allergic rhinitis have high percentage of positive rates regarding the serum specific IgG4, and this observation should be concluded into further discussion of its clinical meaning.

並列關鍵字

allergic rhinitis ； children ； specific IgE ； specific IgG4