小麦I型アレルギーに及ぼすNonsteroidal Anti-Inflammatory Drugsや抗アレルギー薬の効果  [in Japanese] ENHANCEMENT OF NONSTEROIDAL, ANTI-INFLAMMATORY DRUGS AND PREVENTIVE EFFECT OF ANTIHISTAMINES AND DISODIUM CROMOGLYCATE ON WHEAT ALLERGY  [in Japanese]

【背景・目的】アスピリンは小麦I型アレルギーへの増強効果を示す薬剤として知られているが,今回その他のNSAIDsや抗アレルギー薬が及ぼす効果について検討した.【方法】経口負荷試験によりアスピリンの小麦アレルギーへの増強効果を認めた成人7例を対象としCAP-RAST,プリックテスト(SPT), NSAIDsや抗アレルギー薬を組み合わせた負荷試験を施行した.【結果】対象患者は小麦単独摂取によるアレルギー4例,小麦依存性サリチル酸誘発アナフィラキシー3例.CAP-RASTは4/7例,SPTは5/7例が小麦とグルテン共に陽性.負荷試験でジクロフェナクは1/2例で増強効果を示すもエトドラクは5/5例で増強効果を認めなかった.DSCGは4/4例で完全な抑制効果を認めず,うち1例は増強効果を示した.フェキソフェナジン,オロパタジン,クロルフェニラミン施行例全例で抑制効果を認めた.【結語】小麦アレルギーに対しエトドラクは増強効果を認めにくい.また抗アレルギー薬の方がDSCGより予防効果が高い傾向があった.

Background: Aspirin has been known to be an enhancer to wheat allergy, including wheat-dependent, exercise-induced anaphylaxis. Objective: To investigate whether nonsteroidal, anti-inflammatory drugs (NSAIDs) other than aspirin would enhance allergic reactions after wheat ingestion and whether antihistamines and disodium cromoglycate would prevent these reactions. Methods: Seven cases, whose reactions after wheat ingestion were enhanced by aspirin on challenge tests, were enrolled. Skin prick tests (SPT) and CAP-RAST were undergone for wheat and gluten. We used challenge tests of wheat after pretreatment of NSAIDs and preventive drugs. Results: Four cases were diagnosed with wheat allergy, 3 cases had wheat-dependent, salicytilic acid-induced anaphylaxis. SPT and CAP-RAST were positive for wheat and gluten in 5 of 7 cases and 4 of 7 cases, respectively. Dicrofenac enhaced the allergic reactions after wheat ingestion in 1 of 2 cases, whereas etodolac failed to enhance the symptoms in all 5 cases performed. Furthermore, disodium cromoglycate could not completely prevent the allergic reaction in all 4 cases and even enhanced the reaction in 1 case of them. To see an inhibitory effect of antihistamines on the symptoms, fexofenadine (in 2, 1 and 1 case, respectively), olopatadine, and chlorpheniramine were administrated before the challenge test, and as a result these drugs were found to have inhibitory effects on the allergic reaction. Conclusion: In this study, it was suggested that etodolac might be a relatively safe anti-inflammatory drug on wheat allergy and antihistamines could prevent allergic reactions more than DSCG in patients with wheat allergy.