#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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Öèòàòà:
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#8
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Ðåïëèêà
Öèòàòà:
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