異位性皮膚炎病人施打流感疫苗可以減少氣喘風險:全國世代研究

背景: 「過敏進行曲」即是嬰幼兒期的異位性皮膚炎會在將來發展成為過敏性鼻炎或是氣喘。呼吸道病毒感染會與過敏反應產生交互作用，進一步增加反覆性喘鳴(wheezing) 與氣喘的發生。本文章的目的想要確認是否流感疫苗的施打是否可以減少異位性皮膚炎患者未來氣喘的風險。方法: 這個世代追蹤研究(cohort study)利用健保資料庫(National Health Insurance Research Database (NHIRD))回溯性的從西元2000年至西元2012年找到新診斷的異位性皮膚炎患者(ICD-9-CM=691)。根據性別與年齡，配對一個有施打流感疫苗的個案與沒有施打疫苗的個案。觀察個案是否有氣喘(ICD-9-CM=493)的發生或至西元2013年12月31日止。結果: 這個研究共納入2,207名個案進入分析。個案平均年齡是53歲，43.8%為男性。氣喘發生密度在有施打流行性感冒疫苗的族群每1,000人年為12.6，而沒有施打流感疫苗的族群為15.1 (adjusted hazard ratio (aHR)=0.69 (95% CI=0.55-0.87))。有施打流行性感冒疫苗族群氣喘的累積發病率低於沒有施打流感疫苗的族群。在敏感度分析當中，最近七年內，流感疫苗均能顯著減少氣喘發生。（近三年aHR 0.61 (95% CI=0.47-0.81；近五年aHR 0.63 (0.49-0.81)；近七年aHR 0.66 (0.52-0.84) )。結論: 異位性皮膚炎的病人施打流感疫苗可以減少氣喘的風險。

Background: Atopic march refers to the natural history of atopic dermatitis (AD) in infancy followed by subsequent allergic rhinitis and asthma in later life. Respiratory viruses interact with allergic sensitization to promote recurrent wheezing and the development of asthma. We aimed to evaluate whether influenza vaccination reduces asthma risk in people with AD.Methods: This cohort study was conducted retrospectively from 2000 to 2013 by the National Health Insurance Research Database (NHIRD). Patients with newly diagnosed AD (International Classification of Diseases, Ninth Revision, Clinical Modification code 691) were enrolled as the AD cohort. We matched each vaccinated patient with one non-vaccinated patient according to age and sex. We observed each participant until their first asthma event, or the end of the study on December 31, 2013, whichever came first.Results: Our analyses included 2,207 people with a mean age of 53 years. Of these, 43.8% were male. The incidence density of asthma was 12.6 per 1,000 person-years for vaccinated patients, and 15.1 per 1000 person-years for non-vaccinated patients. The adjusted hazard ratio (aHR) of asthma in the vaccinated cohort relative to the non-vaccinated cohort was 0.69 (95% CI = 0.55–0.87). Vaccinated patients had a lower cumulative incidence of asthma than unvaccinated patients. In the last 7 years of the study, influenza vaccination significantly reduced the risk of incident asthma, with an aHR of 0.61 (95% CI = 0.47–0.81). Conclusion: Influenza vaccination was associated with lower asthma risk in patients with AD.