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KMID : 0369319930130030286
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Allergy
1993 Volume.13 No. 3 p.286 ~ p.295
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Factors Determining Airway Responses to Allergen Provocation Tests in Asthmatic Children
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임형석
권경배/윤경애/고영율/김동현
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Abstract
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Skin prick testing with allergen and determination of specific IgE are widely used in the investigation of respiratory disease, yet their relationships to the results of provocation testing of the bronchus remain obscure. It has been recently
hypothesized that knowledge of airway responsiveness to methacholine or histamine and skin sensitivity to allergen might allow prediction airway responsiveness to allergen
In order to investigate the relationships between allergen inhalation challenge and other diagnostic procedure, inhalation challenge with house bust mite(Dermatophagoides pteronyssinus, D.p) allergen, skin prick test with D.p. allergen,
inhalation
challenge with methacholine, and circulating total and D.p. allergen specific IgE levels were examined in 50 children with bronchial asthma. Forty-four patients demonstrated an early asthmatic response, and forty-three patients demonstrated an
early
asthmatic response, and forty-three patients also demonstrated a late asthmatic response, as demonstrated by a 20% decrease of FEV1 within 1 hour or between 3 and 10 hours after allergen challenge, respectively. With serially diluted D.p.
allergen,
skin-test sensitivity was expressed as the highest dilution required to produce a wheal of the same size as the positive control (histamine). Bronchial responsiveness to methacholine was evaluated as the concentration of methacholine(PC20) that
decresed
FEV1 by 20% from its baseline value. The levels of circulating total and allergen-specific IgE were measured with Phadebas PRIST and RAST system respectively.
For the relative importance of the above three variables in predicting both early and late responses, methacholine sensitivity was the most important and skin-test sensitivity the least important. Multiple regression analysis of data demonstrated
that
early asthmatic response, expressed as the allergen PD20 (the dose causing a fall of FEV1 of 20%) and late asthmatic reaction, expressed as the FEV1 maximum fall from control values, can be predicted with explained variance of 50% and 29%
respectively
methacholine PC20, skin-test sensitivity, and RAST score.
Therefore, we conclude that inhalation challenge with allergen is an essential test for determining the role of a specific allergen in the airways and for measuring the late phase responses at present.
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