#1
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Óâåëè÷èâàþò ëè äåòñêèå ïðèâèâêè ðèñê ðàçâèòèÿ àëëåðãè÷åñêèõ çàáîëåâàíèé?
Timing of routine immunisations and subsequent hay fever risk
S A Bremner, I M Carey, S DeWilde, N Richards, W C Maier, S R Hilton, D P Strachan, D G Cook Arch Dis Child 2005;90:567–573 Background: Suggestions that immunisation influences allergic disease risk, either positively (pertussis) or negatively (BCG) are of concern for vaccination policy. Aims: To determine whether DTP, MMR, and BCG vaccination in infancy influenced hay fever risk. Methods: Case-control study of 7098 hay fever cases and controls, within two primary care databases. One control per case was matched for practice, age, and sex. Odds ratios (OR) were derived using conditional logistic regression. Results: Compared to those completing in month 5 (base group) (39.3%), DTP unvaccinated children (4.3%) had a similar risk of hay fever (OR = 0.94, 95% CI 0.73 to 1.23). However, those completing after 12 months (4.2%) had a reduced risk (OR = 0.60, 95% CI 0.45 to 0.76) compared to the base group. Compared to those vaccinated in month 14 (base group) (29.5%), MMR unvaccinated children (2.3%) had an OR of 0.79 (95% CI 0.58 to 1.08). Completion of MMR after two years was associated with reduced hay fever risk (OR = 0.62, 95% CI 0.48 to 0.80) compared to the base group. The effects of late immunisation with DTP and MMR were independent. Those vaccinated with BCG by age 2 (2.4%) had an odds ratio of 1.28 (95% CI 0.96 to 1.70). Adjustment for consulting behaviour, social factors, or sibship size did not alter these associations. Conclusions: Immunisation against DTP or MMR does not increase the risk of hay fever. The lower confidence limit for BCG vaccination contradicts the hypothesised protective effect. The reduced risk of hay fever among children immunised late may be explained by a third factor causing both postponement and reduced risk such as intercurrent febrile illnesses. Authors’ affiliations: S A Bremner, I M Carey, S DeWilde, S R Hilton, D P Strachan, D G Cook, Department of Community Health Sciences, St George’s Hospital Medical School, London, UK N Richards, CompuFile Limited, Send, Surrey, UK W C Maier, Worldwide Epidemiology Group, GlaxoSmithKline, Greenford, Middlesex, UK Funding: Wellcome Trust grant 065177/Z/01/Z Competing interests: Nicky Richards is a director of CompuFile Ltd which markets DIN data to pharmaceutical companies. |
#2
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ÀÊÄÑ - ïðè÷èíà ïîëëèíîçà?
Ó ðîññèéñêèõ ó÷¸íûõ ñâî¸ ìíåíèå íà ýòîò ñ÷¸ò.
«Îáðàçîâàíèå àíòèòåë ê íåïðîòåêòèâíûì àíòèãåíàì âàêöèí. Êîðïóñêóëÿðíûå è ìíîãèå ðàñòâîðèìûå âàêöèíû ïðåäñòàâëÿþò ñîáîé íàáîð àíòèãåííûõ äåòåðìèíàíò, ÷èñëî êîòîðûõ â îäíîé âàêöèíå ìîæåò äîñòèãàòü íåñêîëüêèõ äåñÿòêîâ. Ëèøü íåáîëüøàÿ ÷àñòü ýòèõ äåòåðìèíàíò îáåñïå÷èâàåò ðàçâèòèå èíôåêöèîííîãî èììóíèòåòà. Îñòàëüíûå àíòèãåíû âûçûâàþò ïðîäóêöèþ àíòèòåë íå èãðàþùèõ ñóùåñòâåííîé ðîëè â ôîðìèðîâàíèè èììóíèòåòà. Òàêóþ áåñïîëåçíóþ ðàáîòó ïî ñèíòåçó àíòèòåë èììóííàÿ ñèñòåìà âûïîëíÿåò ïðè ââåäåíèè âàêöèí, ðàññ÷èòàííûõ ïðåèìóùåñòâåííî íà ñîçäàíèå êëåòî÷íîãî èììóíèòåòà. Íåëüçÿ èñêëþ÷èòü âîçìîæíîñòü, ÷òî âûñîêèé óðîâåíü òàêèõ àíòèòåë ñïîñîáåí âûçûâàòü íåæåëàòåëüíûå ÿâëåíèÿ, ñâÿçàííûå ñ îáðàçîâàíèåì èììóííûõ êîìïëåêñîâ. Âàêöèíû ñîäåðæàò ðàçíîîáðàçíûå àëëåðãåííûå ñóáñòàíöèè, îäíè èç íèõ âûçûâàþò ïðåèìóùåñòâåííî íåìåäëåííóþ àëëåðãèþ, äðóãèå — ïîâûøåííóþ ÷óâñòâèòåëüíîñòü çàìåäëåííîãî òèïà. Ïîâûøåííàÿ ÷óâñòâèòåëüíîñòü çàìåäëåííîãî òèïà, êàê ïðàâèëî, ñîïóòñòâóåò êëåòî÷íîìó èììóíèòåòó. Èíûå âçàèìîîòíîøåíèÿ ñêëàäûâàþòñÿ ìåæäó àíòèèíôåêöèîííûì èììóíèòåòîì è íåìåäëåííîé àëëåðãèåé. Ïîñëåäíÿÿ, ÷àùå âñåãî âûñòóïàåò â êà÷åñòâå íåáëàãîïðèÿòíîãî ôàêòîðà òå÷åíèÿ èíôåêöèîííîãî çàáîëåâàíèÿ. Ïîêàçàíî, ÷òî íå âñå äåòè ñ àëëåðãèåé ê ãåòåðîëîãè÷íîìó áåëêó (ÿè÷íîìó áåëêó, áû÷üåìó àëüáóìèíó, ñûâîðîòêå êðóïíîãî ðîãàòîãî ñêîòà è ïð.) äàþò àëëåðãè÷åñêèå ðåàêöèè íà âàêöèíó, ñîäåðæàùóþ ýòîò áåëîê, è ÷òî òàêèå äåòè ìîãóò áûòü âàêöèíèðîâàíû ýòèì ïðåïàðàòîì. Îòñþäà íå ñëåäóåò, ÷òî ââåäåíèå âàêöèíû, ñîäåðæàùåé ÷óæåðîäíûé áåëîê, íå ïðåäñòàâëÿåò îïàñíîñòè. Îïàñíîñòü çàêëþ÷àåòñÿ â òîì, ÷òî ââåäåíèå íåáîëüøîé äîçû ãåòåðîëîãè÷íîãî áåëêà ñîçäàåò ñåíñèáèëèçàöèþ, êîòîðàÿ ìîæåò ïðîÿâèòüñÿ âïîñëåäñòâèè ó ëèö, ïðåäðàñïîëîæåííûõ ê àëëåðãèè, ïðè ââåäåíèè áîëüøîé äîçû áåëêà èëè ïðèåìå åãî ñ ïèùåé. Ýòî æå îòíîñèòñÿ, õîòÿ è â ìåíüøåé ñòåïåíè, ê ìåðòèîëÿòó è àíòèáèîòèêàì, äîáàâëÿåìûì ê âàêöèíàì. Íåêîòîðûå âàêöèíû ïîâûøàþò óðîâåíü ñûâîðîòî÷íîãî IgE, ÷òî ñîçäàåò âîçìîæíîñòü ïîÿâëåíèÿ íåìåäëåííîé àëëåðãèè ê íåðîäñòâåííûì àíòèãåíàì. Ïðèìåðîì âàêöèí, îáëàäàþùèõ òàêèìè ñâîéñòâàìè, ÿâëÿþòñÿ ÀÊÄÑ-âàêöèíà, îñîáåííî å¸ êîêëþøíûé êîìïîíåíò. ÀÊÄÑ-âàêöèíà ìîæåò ñïîñîáñòâîâàòü ïîÿâëåíèþ àëëåðãè÷åñêèõ ðåàêöèé íà òàêèå àëëåðãåíû, êàê ïûëüöà ðàñòåíèé, äîìàøíÿÿ ïûëü è ò. ï. Âàêöèíàöèÿ àëëåðãè÷åñêèõ äåòåé ÀÄÑ-Ì àíàòîêñèíîì, êàê ïðàâèëî, íå ñîïðîâîæäàåòñÿ ïîÿâëåíèåì êëèíè÷åñêèõ ïðèçíàêîâ àëëåðãèè, õîòÿ â íåêîòîðûõ ñëó÷àÿõ íàáëþäàåòñÿ ïîâûøåíèå óðîâíÿ îáùåãî IgE». Í.Â. Ìåäóíèöèí. Âàêöèíîëîãèÿ. – Ì., «Òðèàäà-Õ», 1999. ISBN 5-8249-0008-6 |
#3
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Ìäÿ... Óâàæàåìûé sandro, Âû íå â êóðñå, íà àíàëèçå êàêîé âûáîðêè Í.Â.Ìåäóíèöûí ïðèøåë ê âûâîäó, âûäåëåííîìó Âàìè æèðíûì øðèôòîì? Êàê áûëî ñïëàíèðîâàíî èññëåäîâàíèå?
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#4
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sandro!  ìåäèöèíå íåëüçÿ áûòü ãîñëîâíûì, åñëè ÷òî òî óòâåðæäàåòñÿ, òî ýòî äîëæíî áûòü äîêàçàíî èññëåäîâàíèÿìè, ïðè÷åì íå íà óðîâíå ñòóäåí÷åñêîãî íàó÷íîãî êðóæêà. Èç Âàøåãî ïîñòà ÿñíî îäíî, ÷òî "ìîæåò áûòü, ìîæåò ñïîñîáñòâîâàòü" - íå áîëåå ÷åì óìîçàêëþ÷åíèÿ.
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#5
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Íàñ÷¸ò ãîëîñëîâèÿ è ïëàíèðîâàíèÿ èññëåäîâàíèé - ê ìûøîâåäàì. Ýòî ó÷åáíèê, êñòàòè âûøëî âòîðîå èçäàíèå! Íà ÷òî îðèåíòèðîâàòüñÿ ïðàêòè÷åñêèì âðà÷àì, åñëè ïîä ñîìíåíèå ñòàâÿòñÿ àêàäåìè÷åñêèå çíàíèÿ?
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#6
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Íà òî, ÷òî äîêàçàíî.
Àêäåìè÷íîñòü óâû, - íå âñåãäà ïîêàçàòåëü.
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Ñ óâàæåíèåì Âëàäèìèð Ìèõàéëîâè÷ Ïîäêîëçèí |
#7
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Íå âñ¸ íà àãëèöêîì - äîêàçàòåëüñòâî.
Conclusions: Immunisation against DTP or MMR does not increase the risk of hay fever. The lower confidence limit for BCG vaccination contradicts the hypothesised protective effect. The reduced risk of hay fever among children immunised late may be explained by a third factor causing both postponement and reduced risk such as intercurrent febrile illnesses.
Çàêëþ÷åíèÿ: Èììóíèçàöèÿ DTP èëè MMR íå óâåëè÷èâàåò ðèñê ñåííîé ëèõîðàäêè. Áîëåå íèçêèé äîâåðèòåëüíûé èíòåðâàë äëÿ BCG ïðîòèâîðå÷èò âåðîÿòíîìó çàùèòíîìó ýôôåêòó. Óìåíüøåíèå ðèñêà ðàçâèòèÿ ñåííîé ëèõîðàäêè ñðåäè áîëåå ïîçäíî èììóíèçèðîâàííûõ äåòåé ìîæíî îáúÿñíèòü òðåòüèì ôàêòîðîì, âûçûâàþùèì îòñðî÷êó è óìåíüøåíèå ðèñêà ñëó÷àéíûõ ëèõîðàäî÷íûõ áîëåçíåé. There can be my English not so is good, how this article? Ïðîñòî ñîáðàíèå ïåðëîâ îò «âåðîÿòíîãî çàùèòíîãî ýôôåêòà» äî «ñëó÷àéíûõ ëèõîðàäîê»! Ìûøåâåäû íà èõ ôîíå ïðîñòî ãðàìîòåè! Ýòî ëåêàðñòâî äîêàçàëî ýôôåêòèâíîñòü äëÿ ïðîôèëàêòèêè áîëåçíåé, êîòîðûå åù¸ íå ðàçâèëèñü! Íóæíî ïîñìîòðåòü ÷òî çà «Funding: Wellcome Trust grant 065177/Z/01/Z», ì. á. òàì ñîáàêà çàðûòà? |
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#9
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Âîò åùå îäíî èññëåäîâàíèå íà ñõîäíóþ òåìó. Ïîëíûé òåêñò ñòàòüè äîñòóïåí áåñïëàòíî ïî àäðåñó: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
Transient Suppression of Atopy in Early Childhood Is Associated With High Vaccination Coverage Pediatrics 2003;111:e282-e288 Christoph Gruber, MD*; Sabina Illi, MPH‡; Susanne Lau, MD, PhD*; Renate Nickel, MD*; Johannes Forster, MD, PhD§; Wolfgang Kamin, MD II; Carl-Peter Bauer, MD, PhD¶; Volker Wahn, MD, PhD#; and Ulrich Wahn, MD, PhD*; and the MAS-90 Study Group ABSTRACT. Objective. To analyze prevalences of allergic sensitization and atopic disease in relation to vaccination coverage. Methods. A German atopy risk-enhanced birth cohort of 1314 neonates who were born in 1990 in 5 German cities was studied. A total of 943 children participated in the follow-up visit at 5 years of age. Atopic symptoms and diagnoses (derived from structured interviews), total serum immunoglobulin E, and specific immunoglobulin E against 9 common allergens (CAP Radio-Allergo-Sorbent Test Fluoro-Enzyme Immunoassay) were evaluated. Children were grouped into dose percentiles according to cumulative doses of any vaccine given up to 5 years of age (<10%, 0–11 doses; 10%–50%, 12–14 doses; 51%–90%, 15–20 doses; >90%, 21–27 doses). Results. The cumulative vaccine dose was inversely related to atopic dermatitis prevalences at 6 months (13.8%, 5.2%, 5.1%, and 4.5%), 2 years (16.9%, 10.9%, 7.4%, and 3.7%), 3 years (27.6%, 16.4%, 13.5%, and 4.5%), and 5 years (28.3%, 16.0%, 9.3%, and 11.9%). Asthma followed a similar pattern at age 3 (22.4%, 8.6%, 6.7%, and 6.3%), age 4 (20.0%, 8.6%, 8.9%, and 8.1%), and age 5 (20.8%, 12.6%, 10.3%, and 5.5%). Allergic sensitization rates were inversely related to the cumulative vaccine dose at age 2 (37.5%, 29.1%, 23.8%, and 12.9%). Conclusion. Children with a higher vaccination coverage seemed to be transiently better protected against development of atopy in the first years of life. From the *Department of Pediatric Pneumology and Immunology, Charite-Humboldt University, Berlin, Germany; ‡Department of Pulmonology and Allergology, Ludwig Maximilians University, Munich, Germany; §St. Hedwig Hospital, Freiburg/Breisgau, Germany; II Department of Pediatric Pneumology, Johannes Gutenberg University, Mainz, Germany; ¶University Children’s Hospital, Technical University, Munich, Germany; and #Klinikum Uckermark, Schwedt/Oder, Germany. Reprint requests to (C.G.) Department of Pediatric Pneumology and Immunology, Charite-Humboldt University, Augustenburger Platz 1, D-13353 Berlin, Germany. E-mail: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#10
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Óâàæàåìûé AlexGold! Áîëüøîå ñïàñèáî çà èíòåðåñíûå ññûëêè! Íàäåþñü íà äèñêóññèþ, à íå íà ôëóä âàêöèíàòîðîâ è àíòèâàêöèíàòîðîâ. Âàø àíãëèéñêèé, ïðàâäà, íàâåðíîå ëó÷øå ìîåãî, íî ÿ ïðîø¸ëñÿ äàëüøå ïî ññûëêàì, åù¸ ðàç ñïàñèáî, è ó ìåíÿ ñëîæèëîñü ìíåíèå, ÷òî âàêöèíàöèÿ, êàê è ñïåöèôè÷åñêàÿ ãèïîñåíñèáèëèçàöèÿ ñïîñîáñòâóåò óìåíüøåíèþ JgÅ - çàâèñèìûõ ðåàêöèé è òðàíñôîðìàöèè èììóííîãî îòâåòà â ñòîðîíó M è G çàâèñèìûõ ðåàêöèé, ÷òî êëèíè÷åñêè ïðîÿâëÿåòñÿ óìåíüøåíèåì ïðîÿâëåíèé ìåñòíûõ àëëåðãè÷åñêèõ ðåàêöèé è ôîðìèðîâàíèåì àóòîèììóííîé ïàòîëîãèè. Ýòî ïîêà ãîëîñëîâíîå çàÿâëåíèå, ìíå òðåáóåòñÿ âðåìÿ äëÿ ïåðåâîäà ýòèõ ñòàòåé è àðãóìåíòàöèè.
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#11
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#12
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#13
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Óâàæàåìûé Àëåêñàíäð! Ñïàñèáî çà âðàçóìèòåëüíûé îòâåò. Òåïåðü ÿñíû íàì¸êè äåæóðíûõ ïñèõèàòðîâ è ÿñíî èõ ïîñòîÿííîå ïðèñóòñòâèå. ß òîæå íå âèæó ñâåòèë ñ ìèðîâûì èìåíåì. Òåàòð îäíîãî àêòåðà - íå äèñêóññèîííûé êëóá! Òåìà çàêðûòà, ïîãðóæàþñü â ñàìàòè.
Óâàæàåìàÿ Èðà! Íàçíà÷àþ Âàì ñâèäàíèå. Ìîæíî ïîãîâîðèòü ó Âàñ â òîïèêå? Òåìà òî àêòóàëüíàÿ. Íåäàâíî ïðî÷èòàë, ÷òî âàêöèíû íå òîëüêî àëëåðãèþ ïðîôèëàêòèðóþò, íî è ñòàð÷åñêîå ñëàáîóìèå, ìíå äî ïåíñèè íåäàëåêî! |
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#15
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