아토피성피부염환아에서의피부반응검사, MAST 검사및비유발반응검사성적

Transcription

1 KISEP Rhinology Korean J Otolaryngol 2001;44: 아토피성피부염환아에서의피부반응검사, MAST 검사및비유발반응검사성적 신승엽 조중생 진영완 이건희 문지호 차창일 Result of Allergic Skin Test, MAST and Nasal Provocation Test in Children with Atopic Dermatitis Seung Youp Shin, MD, Joong Saeng Cho, MD, Young Wan Jin, MD, Kun Hee Lee, MD, Ji Ho Moon, MD and Chang Il Cha, MD Department of Otolaryngology, College of Medicine, Kyung Hee University, Seoul, Korea ABSTRACT Background and ObjectivesAllergic diseases are considered to be systemic diseases. Atopic diseases are the first manifestation among allergic diseases, with the suggested relation to allergic rhinitis and asthma, as reported in several studies. The objective of this study was to evaluate the responses to allergic tests in children who have atopic dermatitis or have allergic rhinitis and atopic dermatitis. Materials and MethodsEighty subjects without atopic dermatitis control group and 80 patients with atopic dermatitis atopy group were subjected to study from Nov to Nov The atopic group included pediatric patients who were diagnosed as having atopic dermatitis, but excluded patients who received medical treatment of steroid or antihistamine before the test for 1 month. In all the control and atopic groups, the nasal cavity volume was first estimated by acoustic rhinometry, followed by the allergic skin test AST and MAST. A nasal provocation test was taken with a positive allergen for patients who showed positive response to AST and MASTfor patients who showed negative response to AST and MAST, the test was taken with the House dust mites. ResultsIn the atopic dermatitis group, the rate of positive responses to AST and MAST were 65% and 72.5%, respectivelyin the control group, the rates were 25% and 35%, respectively. The most common positive allergen was the House dust mite in AST and MAST. In the nasal provocation test, the more positive rate was observed in the atopic group. ConclusionThe atopic group showed more positive response than the control group to AST, MAST and the nasal provocation test. Also, the nasal mucosa of 37.5% of the atopic dermatitis patients were sensitized to a certain allergen. Korean J Otolaryngol 2001;44: KEY WORDSAtopic dermatitis Allergic skin test MAST Nasal provocation test. 499

2 500 Table 1. Diagnostic characteristics of atopic dermatitis Hanifin and Rajka, 1980 Major criteria must have four Pruritus Age-appropriate distribution and morphology Infants, chidrenextensor and facial involvement Adolescents, adultsflexural involvement with lichenification Chronic or recurrent dermatitis Early age onset Personal or family history of atopy Table 2. Offending allergens used for AST TORII, Tokyo, Japan 1. House dust 11. Crab 21. House dust mix 2. Pine, red 12. Spinach 22. Mold mix 3. Goldenred 13. Dog hair 23. Shellfish mix 4. Hop, Jap 14. Cat hair 24. Tree mix 5. Orchard grass 15. Alternaria 25. Silk 6. Pine, brack 16. Aspergillus 26. Cotton 7. Cedar, Jap 17. Candida 27. Yeast 8. Flag 18. Cladosporium 28. D. farinae 9. Ragweed 19. Penicillium 29. Cockroach 10. Chrysanthenum 20. Epidermal mix 30. Histamine Table 3. Offending allergens used for MAST MAST IMMUN- OSYS-TEMS, California, USA 1. Total IgE 13. Russian thistle 25. Mite farinae 2. Ash mix 14. Dandelion 26. Mite pterony 3. Box elder 15. Sheep sorrel 27. Cow s milk 4. Elm mix 16. Birch/Alder 28. Crab 5. Hazelnut 17. White oak 29. Egg white 6. Mt. Cedar 18. Rue 30. Peach 7. Poplar mix 19. Mugwort 31. Shrimp 8. Sycamore 20. Short ragweed 32. Soybean 9. Bermuda grass 21. Cat 33. Alternaria 10. Cocks foot 22. Cockroach mix 34. Aspergillus 11. Timothy grass 23. Dog 35. Cladosporium 12. Pigweed mix 24. House dust 36. Penicillium Korean J Otolaryngol 2001;44:

3 Fig. 1. Difference of rate of allergic skin test and MAST between control and atopy group *p0.01. Fig. 2. Change of nasal volume on acoustic rhinometry in positive nasal provocation test *p

4 Fig. 3. Percentage change of nasal volume on acoustic rhinometry in positive nasal provocation test *p0.01. Fig. 5. Change of nasal volume on acoustic rhinometry in negative nasal provocation test *p0.05. Fig. 4. Percentage of number of positive nasal provocation test *p0.01. Fig. 6. Percentage change of nasal volume on acoustic rhinometry in negative nasal provocation test *p Korean J Otolaryngol 2001;44:

5 503

6 REFERENCES 1) Jones CA, Holloway JA, Warner JO. Does atopic disease start in foetal life? Allergy 2000;55: ) Marin A, Eseverri JL, Botey J. From atopic dermatitis to asthma. Allergol Immunopathol (Madr) 1998;26: ) Ratner B, Crawford LV, Flynn JG. Allergy in the infant and preschool child. Am J Dis Child 1966;91: ) Johnstone DE, Dutton AM. Dietary prophylaxis of allergic disease in children. N Eng J Med 1966;274: ) Halpern SR, Sellars WA, Johnson RB, Anderson DM, Saperstein S, Reich JS. Development of childhood allergy in infants fed breast, soy or cow milk. J Allergy Clin Immunol 1973;51: ) Gustafsson D, Sjoberg O, Foucard T. Development of allergies and asthma in infants and young children with atopic dermatitis-a prospective follow-up to 7 years of age. Allergy 2000;55: ) Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol Suppl 1980;92: ) Coca RF, Cooke RA. On the classification of the phenomenon of hypersensitiveness. J Immunol 1922;8:163. 9) Johnson ML. Prevalence of dermatologic disease among persons 1-74 years of age. United states. Advance data from vital and health statistics of the National Center for Health Statistics; ) Oakes RC, Cox AD, Burgdorf WHC. Atopic dermatitis: a review of diagnosis, pathogenesis, and management. Clin Pediatr 1983; 22: ) Niels M. Atopic dermatitis Ⅱ: clinical presentation. In: Niels M, Ronald D, Soren P, Kristian TP, editors. Essential immunology. 504 Korean J Otolaryngol 2001;44:

7 2nd ed. London;1996. p ) Jung DH, Jang TY. The clinic of allergic rhinitis. In: Min YG, editor. Clinical Rhinology. 1st ed. Seoul: Ilchokak Publishing Co.; p ) Besnier E. Premiere note et observations preliminairies pour servir d'introduction a l etude diathesique. Ann Dermatol Syphiligr (Paris) 1892;4: ) Hansel FK. Observation on the cytology of the secretions in allergy of the nose and paranasal sinuses. J Allergy 1934;5: ) Van Asperen PP, Kemp AS. The natural history of IgE sensitis- ation and atopic disease in early childhood. Acta Paediatr Scand 1989;78: ) Umeki S. Allergic cycle: relationships between asthma, allergic rhinitis, and atopic dermatitis. J Asthma 1994;31: ) Van Asperen PP, Kemp AS, Mellis CM. A prospective study of the clinical manifestation of atopic disease in infancy. Acta Paediatr Scand 1984;73: ) Berman BA, Kniker WT, Cohen GA. An allergist s view of atopic dermatitis. Dermatol Clin 1986;4: