過敏體質的診斷
楊惟婷整理
由於高度工業化的經濟變遷，造成都市人口集中，對環境產生了許多衝擊。同時，也誘發了人體產生過敏體質。所以，了解過敏症形成病因，並進一步預防過敏體質的產生，應是現代人必須知道的常識。
一、什麼是過敏體質？
所謂的過敏體質，事實上是身體免疫系統對外來異物（這些外來物多半含有蛋白質成分，稱為 allergen ──過敏原，會引發免疫系統的反應）的一個過度反應（ hyper-reactive ）的狀態。
我們身體的免疫系統，為了保護身體，會在外來物侵入時產生一個發炎現象（inflammation）的反應，即利用白血球及一些化學物質將外來物消滅。
對一般人而言，這個反應不會對身體正常的組織產生傷害；然而，在有過敏體質的人身上，因為某種錯誤，使得免疫系統會將正常的組織誤認為外來物；或是在外來物被消滅、發炎反應該停下來的時候卻沒有停下來，身體的組織反而成為發炎反應的另一個攻擊目標，這就是免疫系統的過度反應狀態，過敏性疾病也因之而起。
二、過敏性疾病有哪些？症狀有哪些？
相信很多人有如下的就診經驗，明明是咳嗽、流鼻水、鼻塞等感冒的症狀，為什麼醫師在問完病史，做完身體檢查後會跟你說：你可能有過敏的問題。
免疫系統的過度發炎反應，最常造成人體組織的過敏症反應，主要有鼻粘膜（過敏性鼻炎）、皮膚（異位性皮膚炎、蕁麻疹）以及氣管管壁平滑肌及黏膜（ ASTHMA，氣喘）三種。 因此，所謂的過敏體質或過敏性疾病，基本上指的就是過敏性鼻炎、異位性皮膚炎以及氣喘三種疾病。
1.過敏性鼻炎會有以下的症狀：
經常、慢性的鼻塞；晨起時特別容易打噴嚏、流鼻水（如果有鼻膿表示有感染）；鼻子癢、眼睛癢、流眼淚；下眼框黑黑 的；其他較少見的症狀包括慢性咳嗽或疲勞等。
2.氣喘則是因為呼吸道過度反應， 因而引起氣管平滑肌收縮，使呼吸道變窄; 並加上氣管管壁發炎及腫脹。典型的症狀包括：
哮喘，咳嗽，呼吸困難，痰量及黏性增加等。長期的半夜咳嗽或劇烈運動後咳嗽也可能是氣喘所引發，如果有上述症狀，即可能是氣喘。
典型的氣喘發作通常可聽到喘鳴聲，很容易診斷。如果缺乏典型的喘鳴聲，則需要臨床醫師根據病史、家族史及臨床 症狀來診斷。
久咳不癒（尤其夜間、晨醒或季節變化時）也是氣喘的一個主要診斷依據。
3.異位性皮膚炎則是指乾燥、容易發癢的皮膚。典型的症狀包括：
受影響的皮膚看起來很乾，會有鱗屑，如果因為抓搔引起細菌感染，則會有發炎、紅腫的現象。
三、如何判斷兒童是否有過敏病呢？
要如何診斷是否有過敏，一般可依據下列幾種情形而高度懷疑：
(1) 明顯的家族病史：
家庭成員如果有過敏病，新生嬰兒有過敏體質的機會也較常人為高，而且並非父母沒有氣喘就不會生出氣喘兒；只要父母有上述三種過敏病症，下一代也有可能罹患上述的任何一種或一種以上，因為這三種過敏症狀只是同一種病的三個不同表徵而已。
(2)小時候即有異位性皮膚炎，長大後罹患其他過敏疾病的機會大增。
(3)每次感冒皆伴隨喘鳴。
(4)慢性咳嗽，尤其半夜、清晨時症狀特別明顯。
(5)清晨起床後常會連續打噴涕、覺得喉嚨有痰。
(6)時常覺得鼻子癢、鼻塞、眼睛癢，特別在整理物品、衣物時。
(7)運動後或吃了冰冷食物會劇烈咳嗽。
(8)固定的皮膚癢疹，冬天或夏天流汗時感到特別癢。
除了上述的情形及症狀可做為診斷的參考外，目前有幾項實驗室檢查可提供更客觀的証據。
(1)嗜依紅性白血球，在正常人身上約佔所有白血球的百分之一到三。但在有過敏或者有寄生蟲感染的時候其比例會上升。
(2) 可以測IgE（過敏性球蛋白）：
若 IgE（過敏性球蛋白）濃度超過 1.0U/ml，那麼這個嬰兒日後罹患過敏的機會就很高了。
IgE抗體，即第一型過敏反應，當過敏原進入體內後IgE抗體會大量產生，所以偵測血中IgE抗體的量(正常人小於150 KU/L)即可推測是否有過敏的情形。
此外，更有一些方法可進一步得知究竟是對什麼東西過敏。傳統檢驗過敏原的方法是皮膚試驗，即俗稱「蓋印章」。將過敏原粹取物直接與皮膚作用，再依照皮膚局部發炎紅腫的情形來判讀。
目前比較方便的作法，是抽血檢驗血清中過敏原之IgE抗體濃度，以此方法一次抽血便可檢測多種過敏原，而且可信度不比皮膚試驗差。
總之，當你懷疑有過敏的情形時，應該尋求過敏專科醫師的幫忙，透過各種檢查便可得知確切的結果。如此才能即早診斷，對症下藥，也才不致延誤了治療的時機。
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