2세 이하 영유아 중증 아토피피부염에서의 항원 감작
Allergen Sensitization of Severe Atopic Dermatitis in Children under 2 Years
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목 적 : 아토피피부염이 지속될 가능성이 높은 2세 이하의 중증 아토피피부염 환자에서 비아토피성 아토피피부염이 차지하는 정도와 IgE, 호산구, 식품, 흡입 항원에 대한 감작과 아토피피부염의 중증도와의 연관성을 보고자 하였다. 방 법 : 한강성심병원과 서울아산병원을 방문한 2세 미만의 중증 아토피피부염 환자 215명 (남아 123명, 여아 92명)을 대상으로 SCORAD를 측정하고 혈액검사로 총 호산구 수, 호산구 분율, 혈청 eosinophil cationic protein (ECP), 혈청 총 IgE, 항원 특이 IgE 12종(난백, 우유, 콩, 땅콩, 밀가루, 생선, D. pteronyssinus (D.p), D. farinae (D.f), 개, 고양이, 바퀴벌레, alternaria)을 검사하였다. 아토피성 아토피피부염은 혈청 총 IgE가 200 IU/mL 이상이거나 항원 특이 IgE에 양성인 경우로 정의하였다. 결 과 : 전체 환자의 평균 SCORAD 값은 69.0이었다. 아토피성 아토피피부염은 161명(75%)으로 비아토피성 아토피피부염 환자보다 많았으며 이 두 환자군간의 SCORAD 점수, 총 호산구 수, 혈청 총 IgE, 호산구 분율, 혈청 ECP는 아토피성 아토피피부염에서 높았다. 아토피성 아토피피부염 환자군에서 식품에 대한 혈청 특이 IgE 감작은 난백이 76.4%로 가장 많았고 우유, 밀가루, D.f, D.p 의 감작률은 각각 58.4%, 40.4%, 49.1%, 46.6%이었다. 감작된 식품 항원의 개수가 많을수록 SCORAD 점수도 높은 것으로 나타났으나(r= 0.241, P=0.037), 감작된 흡입 항원의 개수와는 연관성을 보이지 않았다. 결 론 : 2세 미만의 중증 아토피피부염 환자에서 아토피성 아토피피부염 환자가 비아토피성 아토피피부염 환자보다 차지하는 비율과 중증도가 높고, 흡입 항원에 대한 감작보다는 식품 항원에 대한 감작 개수와 정도가 중증도에 영향을 준다. 따라서 2세 이하의 아토피피부염에서 식품 항원에 대한 감작 정도를 파악하는 것은 환자의 중증도를 예측하는데 도움이 될 수 있을 것이며 흡입 항원에 대한 감작이 있는 경우는 향후 추적 관찰을 통해 호흡기 알레르기 질환 발생 여부를 보는 것이 필요할 것으로 생각된다.
Abstract
Purpose : Atopic dermatitis (AD) is the allergic disease which appears during infancy. This study aimed to find associations between clinical parameters, allergen sensitization and severity of AD in chidren under 2 years. Methods : Two hundred fifteen patients (123 boys, 92 girls) under 2 years with severe AD who visited the department of pediatrics of Hangang Sacred Heart Hospital and Asan Medical Center were enrolled. We checked the severity scoring of atopic dermatitis (SCORAD), total eosinophil count, eosinophil ratio, eosionphil cationic protein (ECP), total IgE and specific IgE to 12 allergens [egg white, milk, soybean, peanut, wheat, fish, Dermatophagoides pteronyssinus (D.p), Dermatophagoides farinae (D.f), dog, cat, cockroach, alternaria]. Atopic AD was defined as serum total IgE 200 IU/mL or specific IgE positive. Results : The mean of SCORAD was 69.0. Atopic AD was 161 (75%). There were no differences in age between atopic and non-atopic AD. However, SCORAD, IgE, eosinophil, and ECP were the higher in atopic AD. Sensitization to food allergen was the highest in egg white (76.4%), followed by milk (58.4%) and aeroallergens such as D.f (49.1%) and D.p (46.6%). The more the number of sensitized food allergens, the higher the SCORAD appeared. However, it did not show any relationships with the number of sensitized aeroallergens. Conclusion : The percentage and severity were higher in atopic AD than non-atopic AD. The number of sensitized to food allergen affect the severity. Therefore, understanding the sensitization to food allergens may be more helpful in predicting severity than sensitization to aeroallergen. In cases of positive reaction to aeroallergens, it is necessary to observe the development of respiratory allergic disease.
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