① IgG4相关疾病(IgG4-RD)是一种全身性疾病，其特点是血清IgG4浓度升高，多个病灶内大量IgG4阳性浆细胞浸润。已有报道IgG4-RD病变表现为Th2型细胞免疫。患者通常有过敏史和/或过敏症状。本研究旨在探讨IgG4-RD患者的过敏反应情况。②对富山大学附属医院就诊的IgG4-RD患者进行回顾性研究。根据综合诊断标准对IgG4-RD进行诊断。我们分析了鼻炎、支气管哮喘的过敏病史、血清IgG4、IgE以及对16种气传过敏原的特异性IgE(CAP RAST)。③在67例明确诊断的IgG4-RD患者中，过敏性鼻炎20例(29.9%)，支气管哮喘18例(26.9%)，皮肤过敏9例(13.4%)。诊断时血清IgG4 (> 135mg/dl)和IgE (> 170 U/ml)升高的病例分别占97.0%和89.4%，血清IgG4和IgE中位水平分别为485 mg/dl和500 U/ml。IgG4与IgE无显著相关性。48例患者中存在特异性IgEs, 79%的患者对16种气传敏原的一种或多种特异性IgEs呈阳性。④我们的研究表明，IgG4-RD患者表现出多种过敏性表现，表现为鼻炎和/或支气管哮喘。然而，我们在这些患者中没有观察到针对任何特定空气过敏原的IgEs。进一步分析过敏临床表现可能有助于阐明IgG4-RD的发病机制。
Allergy in IgG4-related disease
IgG4-related disease (IgG4-RD) is a systemic disorder, which is characterized by elevated serum IgG4 concentrations and infiltration of abundant IgG4 positive plasma cells in the multiple lesions. It has been reported the lesions of IgG4-RD present Th2 dominant immunity. And the patient often shows allergic history and/or symptoms. The aim of this study is to investigate allergic involvement in patients with IgG4-RD.
A retrospective study on patients with IgG4-RD in Toyama University Hospital was performed. The diagnosis of IgG4-RD was made based on the comprehensive diagnostic criteria. We analyzed allergic history of rhinitis, and bronchial asthma, serum IgG4, IgE and Specific IgEs to 16 aeroallergens (CAP RAST).
Sixty-seven patients with ‘definite’ IgG4-RD were analyzed. Twenty patients (29.9%) had allergic rhinitis, 18 patients (26.9%) bronchial asthma, and 9 patients (13.4%) skin allergy in their past or present history. Serum IgG4 (> 135mg/dl) and IgE (> 170 U/ml) at the diagnosis were elevated in 97.0% and 89.4%, respectively, and the median serum levels of IgG4 and IgE were 485 mg/dl and 500 U/ml, respectively. There was no significant correlation between IgG4 and IgE. Specific IgEs were available in 48 patients, and 79% of them showed positive one or more specific IgEs to 16 aeroallergens.
Our study suggests that the patients with IgG4-RD show various allergic involvements, presenting rhinitis and/or bronchial asthma. However, we observed no IgEs directed against any specific aeroallergen in these patients. Further analysis of allergic manifestations might be helpful in elucidating the pathogenesis of IgG4-RD.
All Authors：Shoko Matsui, Seisuke Okazawa, Kohtaro Tokui, Kenta Kambara, Shingo Imanishi, Chihiro Taka, Tohru Yamada, Minehiko Inomata, Toshiro Miwa, Ryuji HayashiUniversity of Toyama, Toyama