哮喘变应原免疫治疗现状与思考苏州九龙医院倪殿涛材料.ppt

哮喘变应原免疫治疗现状与思考 WAO White Book on Allergy 2011-2012 A steady increase in the prevalence of allergic diseases globally has occurred with about 30-40% of the world population now being affected by one or more allergic conditions Types of allergies Common cold or allergy Asthma Derived from the Greek root ασθμαινω Originally did not define a disease, but was employed to describe respiratory symptoms of a variety of pulmonary conditions By the beginning of the 20th century,?asthma?was seen to be a unique illness characterized by spasmodic afflictions of the bronchial tubes. Today,?asthma?is seen as a chronic inflammatory disease which is not yet fully understood in its pathophysiology Therapy is still on the path to becoming optimal. 盲人摸象 Terminology of allergic phenomena idiosyncrasy - antipathy - Hypersensitivity -Anaphylaxis -allergy A.F. Coca and R.A. Cooke introduced the term atopy：hypersensitiveness occurred spontaneously atopy gained a new sense, since IgE is a characteristic - Clinically similar diseases such as asthma, rhinoconjunctivitis or eczema can be found in the absence of IgE, and are then called intrinsic variants of the same disease Does intrinsic asthma exist? Ten to forty percent of asthmatics are intrinsic Analysis of bronchial mucosal expression of pro-eosinophilic and pro-atopic markers [IL-3, -4, -5, -13, GM-CSF, RANTES, MCP-3, IgE and high affinity IgE receptor (Fc epsilon RI)] There were more similarities than differences in immunopathology between atopic and nonatopic Allergic vs nonallergic asthma: what makes the difference? Nonallergic：Greater age, female sex, sinusal polyposis, and FEV1 below 80% of the predicted value Allergic：history of hay fever, seasonal exacerbation of asthma, and asthma duration Asthma phenotypes: nonallergic (intrinsic) asthma. The definition ：subjects with asthma and with whom allergic sensitization cannot be demonstrated negative skin prick test or in vitro specific-IgE test to a panel of seasonal and perenni