人类对猫和狗的过敏：分子与环境决定因素、诊断及精准管理

文献信息

中文摘要

猫和狗来源的致敏蛋白是重要的室内暴露来源，但过敏原暴露、IgE致敏和临床显性过敏是不同的生物学和临床状态。主要分子包括猫分泌球蛋白Fel d 1和几种狗脂质运载蛋白，包括Can f 1，以及血清白蛋白、激肽释放酶和其他可导致物种特异性致敏或交叉反应性的成分。这些蛋白在环境中通过异质性载体如皮屑碎片、灰尘和气溶胶颗粒运输，允许直接和间接暴露。临床相关性取决于暴露、分子致敏、症状和宿主因素之间的一致性，而非仅取决于环境检测。本叙述性综述整合了分子过敏原生物学与环境传播、IgE介导的免疫机制、临床表型、诊断解释和管理。特别强调分子同源性、IgE交叉反应性与临床相关交叉过敏之间的区别；组分解析诊断的补充作用和局限性；以及支持环境控制和猫与狗过敏原免疫疗法的可变证据。标准药物治疗仍是症状控制的核心，而生物制剂和过敏原中和方法仅限于特定适应症或仍处于研究阶段。因此，精准管理框架需要在暴露-反应一致性、临床表型和炎症性疾病特征的背景下解释分子结果。

英文摘要

Cat- and dog-derived allergenic proteins are important indoor exposure sources, but allergen exposure, IgE sensitization, and clinically manifest allergy are distinct biological and clinical states. Major molecules include the cat secretoglobin Fel d 1 and several dog lipocalins, including Can f 1, together with serum albumins, kallikreins, and other components that can contribute to species-specific sensitization or cross-reactivity. These proteins are transported in the environment on heterogeneous carriers such as dander fragments, dust, and aerosol particles, allowing both direct and indirect exposure. Clinical relevance depends on the concordance among exposure, molecular sensitization, symptoms, and host factors rather than on environmental detection alone. This narrative review integrates molecular allergen biology with environmental dissemination, IgE-mediated immune mechanisms, clinical phenotypes, diagnostic interpretation, and management. Particular emphasis is placed on the distinction between molecular homology, IgE cross-reactivity, and clinically relevant cross-allergy; on the complementary role and limitations of component-resolved diagnosis; and on the variable evidence supporting environmental control and cat- versus dog-allergen immunotherapy. Standard pharmacotherapy remains central to symptom control, whereas biologics and allergen-neutralizing approaches are restricted to specific indications or remain investigational. A precision-management framework therefore requires molecular results to be interpreted in the context of exposure-response concordance, clinical phenotype, and inflammatory disease characteristics.