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首页> 外文期刊>Clinical and experimental allergy : >Reduced helminth burden increases allergen skin sensitization but not clinical allergy: a randomized, double-blind, placebo-controlled trial in Vietnam.
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Reduced helminth burden increases allergen skin sensitization but not clinical allergy: a randomized, double-blind, placebo-controlled trial in Vietnam.

机译：减少的蠕虫负担增加了过敏原的皮肤敏感性，但没有增加临床过敏性：越南的一项随机，双盲，安慰剂对照试验。

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BACKGROUND: Observational evidence suggests that infection with helminths protects against allergic disease and allergen skin sensitization. It is postulated that such effects are mediated by helminth-induced cytokine responses, in particular IL-10. OBJECTIVE: We tested this hypothesis in a rural area of central Vietnam where hookworm infection is endemic. METHODS: One thousand five hundred and sixty-six schoolchildren aged 6-17 were randomly allocated to receive either anti-helminthic therapy or a placebo at 0, 3, 6, and 9 months. We compared changes in the prevalence of exercise-induced bronchoconstriction, allergen skin sensitization, flexural eczema on skin examination, questionnaire-reported allergic disease (wheeze and rhinitis symptoms), and immunological parameters (hookworm-induced IFN-gamma, IL-5, IL-10) between 0 and 12 months. RESULTS: One thousand four hundred and eighty-seven children (95% of these randomized) completed the study. The most common helminth infections were hookworm (65%) and Ascaris lumbricoides (7%). There was no effect of the therapy on the primary outcome, exercise-induced bronchoconstriction (within-participant mean percent fall in peak flow from baseline after anti-helminthic treatment 2.25 (SD 7.3) vs. placebo 2.19 (SD 7.8, P=0.9), or on the prevalence of questionnaire-reported wheeze [adjusted odds ratio (OR)=1.16, 95% confidence interval (CI) 0.35-3.82, P=0.8] and rhinitis (adjusted OR=1.39, 0.89-2.15, P=0.1), or flexural dermatitis on skin examination (adjusted OR=1.15, 0.39-3.45, P=0.8). However, anti-helminthic therapy was associated with a significantly higher allergen skin sensitization risk (adjusted OR=1.31, 1.02-1.67, P=0.03). This effect was particularly strong for children infected with A. lumbricoides at baseline (adjusted OR=4.90, 1.48-16.19, P=0.009). Allergen skin sensitization was inversely related to hookworm-specific IL-10 at baseline (adjusted OR=0.76, 0.59-0.99, P=0.04). No cytokine tested, including IL-10, changed significantly after the anti-helminthic therapy compared with the placebo. CONCLUSION: A significant reduction in worm burden over a 12-month period in helminth-infected children increases the risk of allergen skin sensitization but not of clinical allergic disease. The effect on skin sensitization could not be fully explained by any of the immunological parameters tested.
机译：背景：观察证据表明，蠕虫感染可预防过敏性疾病和过敏原皮肤过敏。据推测，这种作用是由蠕虫诱导的细胞因子应答，特别是IL-10介导的。目的：我们在越南中部钩虫流行的农村地区检验了这一假设。方法：随机分配1566名6-17岁的小学生在0、3、6和9个月接受抗蠕虫药或安慰剂治疗。我们比较了运动诱发的支气管狭窄，过敏原皮肤致敏性，皮肤检查中的弯曲性湿疹，问卷调查报告的过敏性疾病（湿疹和鼻炎症状）和免疫学参数（钩虫诱导的IFN-γ，IL-5，IL）的患病率变化-10）在0到12个月之间。结果：1,487名儿童（其中95％为随机儿童）完成了研究。最常见的蠕虫感染是钩虫（65％）和A虫（7％）。该疗法对运动诱发的支气管狭窄的主要结局没有影响（抗蠕虫药治疗后参与者的平均血流量峰值从基线下降的百分比为2.25（SD 7.3）与安慰剂2.19（SD 7.8，P = 0.9） ，或根据问卷调查报告的喘息的发生率[调整后的优势比（OR）= 1.16，95％置信区间（CI）0.35-3.82，P = 0.8]和鼻炎（调整后的OR = 1.39，0.89-2.15，P = 0.1 ）或在皮肤检查时出现弯曲性皮炎（调整后OR = 1.15，0.39-3.45，P = 0.8）。然而，抗蠕虫病治疗与过敏原皮肤致敏风险显着相关（调整后OR = 1.31，1.02-1.67，P = 0.03）。对于基线时被褐飞虱感染的儿童，这种影响尤为明显（校正后的OR = 4.90，1.48-16.19，P = 0.009）。过敏原的皮肤致敏性与基线时钩虫特异性IL-10呈负相关（校正后） OR = 0.76，0.59-0.99，P = 0.04）。抗蠕虫药治疗后未检测到包括IL-10在内的任何细胞因子发生显着变化与安慰剂相比。结论：在蠕虫感染的儿童中，蠕虫负担在12个月内显着减少，增加了过敏原皮肤致敏的风险，但没有临床过敏性疾病的风险。对皮肤过敏的影响无法通过所测试的任何免疫学参数完全解释。

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