2019-2023年厦门过敏原特异性IgE致敏模式的时间变化：一项回顾性横断面分析

文献信息

中文摘要

背景： COVID-19大流行已引起环境、生活方式和健康行为的显著变化。我们观察到疫情期间与sIgE阳性率下降之间的时间关联；然而，由于回顾性观察设计，无法确定因果关系。区分无症状致敏（特异性IgE阳性但无临床症状）与真正的过敏性疾病仍然至关重要。本研究旨在描述2019年至2023年厦门人群过敏原特异性IgE（sIgE）阳性率——作为致敏标志物——的趋势，该标志物是致敏的替代指标，并不等同于临床过敏，从而为疫情期间人群水平的免疫学变化提供见解。
方法： 我们对2019年1月至2023年12月期间在我院接受过敏原筛查的患者的3,207份血清sIgE检测记录（3,210份初始记录减去3份排除）进行了回顾性横断面分析。这些记录包括部分个体的重复检测；其中来自2,750名独特患者的2,784份记录子集用于GEE建模，以考虑个体内相关性。分析了吸入性过敏原（如尘螨、猫皮屑、蟑螂）和食物过敏原（如蛋清、蟹、牛奶）的致敏数据。检查了年龄和性别分布，但无法获得临床症状（如湿疹、鼻炎）、合并症和个体患者纵向随访的详细信息。
结果： 在3,207份检测记录中，1,454份（45.34%）对一种或多种过敏原的sIgE呈阳性。年阳性率从2019年的76.07%（89/117）急剧下降至2023年的32.26%（519/1,609）（p < 0.001）。尘螨是最常见的吸入性过敏原，约三分之一的检测记录显示敏感（35.30%，1,035/3,207），其次是蟑螂和猫毛。对于食物过敏原，蛋清、蟹和牛奶排名最高。与女性相比，男性对吸入性和食物过敏原的阳性率均更高，差异具有统计学意义（p < 0.01）。除猫毛、狗上皮、crb和豚草外，大多数过敏原显示出年龄相关差异；蟑螂在不同年龄组间显示出统计学显著差异（χ2 = 32.89，p < 0.001）。我们观察到疫情期间与sIgE阳性率下降之间的时间关联；然而，由于观察性研究设计和潜在选择偏倚，这些发现应谨慎解读。
结论： 本研究记录了2019年至2023年厦门吸入性和食物过敏原sIgE阳性率的显著下降。据我们所知，这是厦门首个跨越整个COVID-19大流行期的报告，为未来假设驱动的研究提供了基础数据。观察到了致敏模式的性别和年龄特异性差异。然而，仅基于当前数据集，无法确定这些变化反映的是临床过敏性疾病的真实变化，还是检测实践、人群构成或其他混杂因素改变的结果。未来研究必须整合详细的临床表型（包括年龄分层症状数据、湿疹等合并症以及纵向随访）和生活方式/环境测量，以识别可改变的因素来预防过敏发生——而不仅仅是管理致敏。

英文摘要

BACKGROUND: The COVID-19 pandemic has induced substantial changes in environment, lifestyle, and health behaviors. We observed temporal associations between the pandemic period and declining sIgE positivity rates; however, causality cannot be established due to the retrospective observational design. Distinguishing between asymptomatic sensitization (positive specific IgE without clinical symptoms) and true allergic disease remains critical. This study aims to describe the trends in allergen-specific IgE (sIgE) positivity-as a marker of sensitization-in the Xiamen population from 2019 to 2023, a surrogate marker of sensitization that does not equate to clinical allergy, providing insights into population-level immunological changes during the pandemic.
METHODS: We performed a retrospective cross-sectional analysis of 3,207 serum sIgE testing records (3,210 initial records minus 3 exclusions) from patients who underwent allergen screening at our hospital between January 2019 and December 2023. These records include repeated tests from some individuals; a subset of 2,784 records from 2,750 unique patients was used for GEE modeling to account for within-individual correlation. Data on sensitization to inhalant allergens (e.g., dust mites, cat dander, cockroach) and food allergens (e.g., egg white, crab, milk) were analyzed. Age and sex distributions were examined, though detailed information on clinical symptoms (e.g., eczema, rhinitis), comorbidities, and longitudinal follow-up of individual patients was not available.
RESULTS: Among 3,207 testing records, 1,454 (45.34%) were positive for sIgE to one or more allergens. The annual positivity rate declined sharply from 76.07% (89/117) in 2019 to 32.26% (519/1,609) in 2023 (p < 0.001). Dust mites were the most prevalent inhalant allergens, with about a third of all testing records showing sensitivity (35.30%, 1,035/3,207), followed by cockroach and cat hair. For food allergens, egg white, crab, and milk ranked highest. Males showed higher positivity rates for both inhalant and food allergens compared to females, and the difference was statistically significant (p < 0.01). Most allergens showed age-related differences, with the exception of cat hair, dog epithelium, crb and ragweed; cockroach showed statistically significant differences across age groups (χ 2 = 32.89, p < 0.001). We observed temporal associations between the pandemic period and declining sIgE positivity rates; however, these findings should be interpreted with caution due to the observational study design and potential selection bias.
CONCLUSION: This study documents a significant decline in sIgE positivity rates for both inhalant and food allergens in Xiamen from 2019 to 2023. To our knowledge, this is the first report from Xiamen spanning the full COVID-19 pandemic period, providing foundational data for future hypothesis-driven research. Sex- and age-specific differences in sensitization patterns were observed. However, based on the current dataset alone, it is not possible to determine whether these changes reflect true shifts in clinical allergic disease or result from alterations in testing practices, population composition, or other confounders. Future research must integrate detailed clinical phenotyping (including age-stratified symptom data, comorbidities such as eczema, and longitudinal follow-up) and lifestyle/environmental measurements to identify modifiable factors for preventing allergy development-not merely managing sensitization.