重视儿童“侧呼吸道”过敏性炎症
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摘要
过敏性疾病是全身多器官的系统性疾病,随年龄增长存在"过敏进程",具有外在的多种表型,也存在内在的紧密联系,又因年龄和人群的差异而变化多端。由于儿童存在身体结构和免疫系统的动态变化而比较特殊,因此聚焦"儿童""呼吸道""过敏性疾病"显得尤为重要。过敏性鼻炎、过敏性哮喘和分泌性中耳炎是三种来自同一气道、不同解剖部位的儿童呼吸道疾病,其关联性越来越受到关注,涉及上、下和侧呼吸道过敏性炎症是否存在一致性值得深入探讨,通过临床研究和循证医学证据提出我们的思考。
Allergic diseases are autoimmune diseases that involve multi-organ systems producing a variety of clinical manifestations;concurrently,there is an intrinsic and inseparable link between multiple systems and clinical manifestations,producing a variety of manifestations among different age-groups and populations. Focusing on allergic diseases that are associated with the respiratory airway in children is relatively complicated due to the dynamic changes observed with respect to their body structures and immune systems.Allergic rhinitis,allergic asthma,and otitis media with effusion are three examples of allergic respiratory diseases in children that affect the same airway at different anatomical regions,and the correlation between them is receiving greater attention. Whether the upper,lower,and lateral airways could ever truly be in concurrence with each other is worth an in-depth discussion,and thus,we put forward some minor thoughts and suggestions based on the available clinical research and literature.
Allergic diseases are autoimmune diseases that involve multi-organ systems producing a variety of clinical manifestations;concurrently,there is an intrinsic and inseparable link between multiple systems and clinical manifestations,producing a variety of manifestations among different age-groups and populations. Focusing on allergic diseases that are associated with the respiratory airway in children is relatively complicated due to the dynamic changes observed with respect to their body structures and immune systems.Allergic rhinitis,allergic asthma,and otitis media with effusion are three examples of allergic respiratory diseases in children that affect the same airway at different anatomical regions,and the correlation between them is receiving greater attention. Whether the upper,lower,and lateral airways could ever truly be in concurrence with each other is worth an in-depth discussion,and thus,we put forward some minor thoughts and suggestions based on the available clinical research and literature.
引文
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[16]Takeuchi K,Fujita Y,Tomemori T,et al. Analysis of T cell receptor beta chain repertoire in middle ear effusions[J]. Ann Otol Rhinol Laryngol,1996,105(3):213-217. doi:10.1177/000348949610500307.
[17]Boisvert P,Wasserman SI,Schiff M,et al. Histamineinduced middle ear effusion and mucosal histopathology in the guinea pig[J]. Ann Otol Rhinol Laryngol,1985,94(2 Pt 1):212-216. doi:10.1177/000348948509400224.
[18]Nguyen LH,Manoukian JJ,Tewfik TL,et al. Evidence of allergic inflammation in the middle ear and nasopharynx in atopic children w ith otitis media w ith effusion[J].J Otolaryngol,2004,33(6):345-351.
[19]Nguyen LH,Manoukian JJ,Sobol SE,et al. Similar allergic inflammation in the middle ear and the upper airway:evidence linking otitis media with effusion to the united airways concept[J]. J Allergy Clin Immunol,2004,114(5):1110-1115. doi:10.1016/j.jaci.2004.07.061.
[20]Downs BW,Butehorn HFrd,Prazma J,et al. Action of histamine on eustachian tube function[J]. Otolaryngol Head Neck Surg,2001,124(4):414-420. doi:10.1067/mhn.2001.113943.
[21]Ebert CS Jr,Rose AS,Blanks DA,et al. Immune modulatory oligonucleotides in prevention of nasal allergeninduced Eustachian tube dysfunction in rats[J]. Otolaryngol Head Neck Surg,2007,137(2):250-255. doi:10.1016/j.otohns.2007.03.004.
[22]Cengel S,Akyol MU. The role of topical nasal steroids in the treatment of children w ith otitis media w ith effusion and/or adenoid hypertrophy[J]. Int J Pediatr Otorhinolaryngol,2006,70(4):639-645. doi:10.1016/j.ijporl.2005.08.013.
[23]崔艳红,韩富根.儿童分泌性中耳炎治疗中应用糖皮质激素疗效分析[J].中华耳科学杂志,2013,11(3):448-450. doi:10.3969/j.issn.1672-2922.2013.03.025.CUI Yanhong,HAN Fugen. Nasal steroids for the treatment of secretory otitis media in children[J]. Chinese Journal of Otology,2013,11(3):448-450. doi:10.3969/j.issn.1672-2922.2013.03.025.
[24] Rosenfeld RM,Shin JJ,Schwartz SR,et al. Clinical practice guideline:otitis media w ith effusion(update)[J]. Otolaryngol Head Neck Surg,2016,154(1 Suppl):S1-S41. doi:10.1177/0194599815623467.
[25]Williamson I. Otitis media with effusion[J]. Clin Evid,2006(15):814-821.
[2]Bousquet J,Van Cauwenberge P,Khaltaev N,et al. Allergic rhinitis and its impact on asthma[J]. J Allergy Clin Immunol,2001,108(5 Suppl):S147-S334.
[3]Bousquet J,Khaltaev N,Cruz AA,et al. Allergic Rhinitis and its Impact on Asthma(ARIA)2008 update(in collaboration w ith the World Health Organization,GA(2)LEN and AllerGen)[J]. Allergy,2008,63(Suppl 86):8-160. doi:10.1111/j.1398-9995.2007.01620.x.
[4]韩德民.过敏性鼻炎[M]. 2版.北京:人民卫生出版社,2014.
[5]李颖,赵守琴.儿童分泌性中耳炎与变应性鼻炎相关研究进展[J].中华耳科学杂志,2016,14(2):295-298.doi:10.3969/j.issn.1672-2922.2016.02.034.LI Ying,ZHAO Shouqin. Advances in clinical research on otitis media w ith effusion and allergic rhinitis in children[J]. Chinese Journal of Otology,2016,14(2):295-298. doi:10.3969/j.issn.1672-2922.2016.02.034.
[6] Zernotti ME,Pawankar R,Ansotegui I,et al. Otitis media w ith effusion and atopy:is there a causal relationship?[J]. World Allergy Organ J,2017,10(1):37.doi:10.1186/s40413-017-0168-x.
[7] Tai A,Volkmer R,Burton A. Prevalence of asthma symptoms and atopic disorders in preschool children and the trend over a decade[J]. J Asthma,2009,46(4):343-346. doi:10.1080/02770900802660998.
[8] Mandel EM,Casselbrant ML,Rockette HE,et al. Systemic steroid for chronic otitis media w ith effusion in children[J]. Pediatrics,2002,110(6):1071-1080.
[9]Kwon C,Lee HY,Kim MG,et al. Allergic diseases in children w ith otitis media w ith effusion[J]. Int J Pediatr Otorhinolaryngol,2013,77(2):158-161. doi:10.1016/j.ijporl.2012.09.039.
[10]Tomonaga K,Kurono Y,Mogi G. The role of nasal allergy in otitis media w ith effusion. A clinical study[J].Acta Otolaryngol Suppl,1988,458:41-47.
[11]Pau BC,Ng DK. Prevalence of otitis media with effusion in children w ith allergic rhinitis,a cross sectional study[J]. Int J Pediatr Otorhinolaryngol,2016,84:156-160.doi:10.1016/j.ijporl.2016.03.008.
[12]Chantzi FM,Kafetzis DA,Bairamis T,et al. IgE sensitization,respiratory allergy symptoms,and heritability independently increase the risk of otitis media w ith effusion[J]. Allergy,2006,61(3):332-336. doi:10.1111/j.1398-9995.2006.00971.x.
[13]邓慧仪,杨钦泰,王玮豪,等.儿童腺样体肥大合并变应性鼻炎对分泌性中耳炎发生率的影响[J].中山大学学报(医学科学版),2017,38(1):101-105. doi:10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2017.0016.DENG Huiyi,YANG Qintai,WANG Weihao,et al. Incidence of otitis media w ith effusion in adenoid hypertrophy w ith allergic rhinitis in children[J]. Journal of Sun Yat-Sen University(M edical Sciences),2017,38(1):101-105. doi:10. 13471/j. cnki. j. sun. yat-sen. univ(med.sci).2017.0016.
[14]Hurst DS. Efficacy of allergy immunotherapy as a treatment for patients w ith chronic otitis media w ith effusion[J]. Int J Pediatr Otorhinolaryngol,2008,72(8):1215-1223. doi:10.1016/j.ijporl.2008.04.013.
[15]吴佳欐,陈淑梅,田欣,等.腺样体肥大儿童伴变应性鼻炎与分泌性中耳炎的相关性分析[J].山东大学耳鼻喉眼学报,2013,27(6):53-56.WU Jiali,CHEN Shumei,TIAN Xin,et al. Relationship betw een allergic rhinitis and secretory otitis media in children w ith adenoid hypertrophy[J]. Journal of Otolaryngology and Ophthalmology of Shandong University,2013,27(6):53-56.
[16]Takeuchi K,Fujita Y,Tomemori T,et al. Analysis of T cell receptor beta chain repertoire in middle ear effusions[J]. Ann Otol Rhinol Laryngol,1996,105(3):213-217. doi:10.1177/000348949610500307.
[17]Boisvert P,Wasserman SI,Schiff M,et al. Histamineinduced middle ear effusion and mucosal histopathology in the guinea pig[J]. Ann Otol Rhinol Laryngol,1985,94(2 Pt 1):212-216. doi:10.1177/000348948509400224.
[18]Nguyen LH,Manoukian JJ,Tewfik TL,et al. Evidence of allergic inflammation in the middle ear and nasopharynx in atopic children w ith otitis media w ith effusion[J].J Otolaryngol,2004,33(6):345-351.
[19]Nguyen LH,Manoukian JJ,Sobol SE,et al. Similar allergic inflammation in the middle ear and the upper airway:evidence linking otitis media with effusion to the united airways concept[J]. J Allergy Clin Immunol,2004,114(5):1110-1115. doi:10.1016/j.jaci.2004.07.061.
[20]Downs BW,Butehorn HFrd,Prazma J,et al. Action of histamine on eustachian tube function[J]. Otolaryngol Head Neck Surg,2001,124(4):414-420. doi:10.1067/mhn.2001.113943.
[21]Ebert CS Jr,Rose AS,Blanks DA,et al. Immune modulatory oligonucleotides in prevention of nasal allergeninduced Eustachian tube dysfunction in rats[J]. Otolaryngol Head Neck Surg,2007,137(2):250-255. doi:10.1016/j.otohns.2007.03.004.
[22]Cengel S,Akyol MU. The role of topical nasal steroids in the treatment of children w ith otitis media w ith effusion and/or adenoid hypertrophy[J]. Int J Pediatr Otorhinolaryngol,2006,70(4):639-645. doi:10.1016/j.ijporl.2005.08.013.
[23]崔艳红,韩富根.儿童分泌性中耳炎治疗中应用糖皮质激素疗效分析[J].中华耳科学杂志,2013,11(3):448-450. doi:10.3969/j.issn.1672-2922.2013.03.025.CUI Yanhong,HAN Fugen. Nasal steroids for the treatment of secretory otitis media in children[J]. Chinese Journal of Otology,2013,11(3):448-450. doi:10.3969/j.issn.1672-2922.2013.03.025.
[24] Rosenfeld RM,Shin JJ,Schwartz SR,et al. Clinical practice guideline:otitis media w ith effusion(update)[J]. Otolaryngol Head Neck Surg,2016,154(1 Suppl):S1-S41. doi:10.1177/0194599815623467.
[25]Williamson I. Otitis media with effusion[J]. Clin Evid,2006(15):814-821.