在诊断职业性哮喘的特定吸入挑战中持续使用吸入式皮质类固醇治疗的影响。

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2024-11-01 DOI:10.1016/j.jaip.2024.07.021

Gabriel Lavoie MD , Catherine Lemière MD, MSc

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引用次数: 0

摘要

背景：特异性吸入挑战试验（SIC）仍然是诊断致敏剂诱发的职业性哮喘（SIOA）的参考试验。欧洲呼吸学会建议在 SIC 前 72 小时停止吸入皮质类固醇（ICS）：目的：评估 SIC 期间持续使用 ICS 对 FEV1 最大降幅、甲基胆碱 PC20 变化以及痰中嗜酸性粒细胞计数的影响：我们利用 1999 年至 2022 年期间因疑似 SIOA 转诊至本中心的病例数据库进行了回顾性分析。比较了在SIC期间接受ICS治疗的受试者和未接受类固醇治疗的受试者的SIC结果：结果：六百七十一人在实验室接受了SIC治疗。其中 318 人接受了 ICS 治疗，353 人未接受类固醇治疗。在接受过 ICS 治疗的受试者中，SIC 阳性的比例（39.6%）高于类固醇未接受过治疗的受试者（27.5%，P20 或类固醇治疗受试者和类固醇未接受治疗受试者 SIC 后痰中嗜酸性粒细胞的百分比）：结论：对于长期接受 ICS 治疗的受试者来说，在 SIC 期间持续接受 ICS 治疗不会影响哮喘反应的发生、气道反应性的变化或接触可疑病原体后的嗜酸性粒细胞炎症。

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Impact of Ongoing Treatment With Inhaled Corticosteroids During Specific Inhalation Challenges for Diagnosing Occupational Asthma

Background

Specific inhalation challenge (SIC) tests are still the reference test for diagnosing sensitizer-induced occupational asthma (SIOA). The European Respiratory Society recommends the cessation of inhaled corticosteroids (ICS) 72 hours before SIC.

Objective

To assess the effect of an ongoing ICS treatment during SIC on the maximum fall in forced expiratory volume in 1 second (FEV₁), the change in methacholine provocative concentration of methacholine inducing a 20% fall in FEV₁ (PC₂₀), and sputum eosinophil counts after exposure to the suspected agent.

Methods

We performed a retrospective analysis using a database of cases referred to our center for suspected SIOA from 1999 to 2022. The results of the SIC were compared between subjects treated with ICS during SIC and steroid-naïve subjects.

Results

Six hundred and seventy-one individuals underwent SIC in the laboratory. Three hundred and eighteen were treated with ICS, whereas 353 were steroid naïve. The proportion of subjects with a positive SIC was greater among ICS-treated subjects (39. 6%) compared with steroid-naïve subjects (27.5%, P < .001). A treatment with ICS did not influence the outcome of the SIC. There was no difference in the change in PC₂₀ or the percentage of sputum eosinophils after SIC between steroid-treated and steroid-naïve subjects.

Conclusions

An ongoing ICS treatment during an SIC did not affect the occurrence of an asthmatic reaction, the change in airway responsiveness, or eosinophilic inflammation after exposure to the suspected agent in subjects who have been treated with ICS for a long period of time.

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来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.