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Journal of Thai Traditional & Alternative Medicine Vol. 7 No. 1 January-April 2009 ˜Û

Ò. ªí®®—¬ “‡Àμÿ·Ωß (predisposing factor) ∑’ˇªìπ Û. ªí®®—¬∑ÿ쑬¿Ÿ¡‘À√◊Õªí®®—¬Àπÿπ (secondary or pre-

“‡ÀμÿÀ≈—°¢Õß‚√§π’È ‰¥â·°à æ—π∏ÿ°√√¡ ‚¥¬ºŸâªÉ«¬¿“«–¿Ÿ¡‘·æâ cipitating factors) ‰¥â·°à ‡Àμÿ∑’ËÀπÿπ„Àâ· ¥ßÕ“°“√ÕÕ°¡“
(atopy) ¡’§«“¡º‘¥ª√°μ‘¢ÕßÀπ૬æ—π∏ÿ°√√¡μÕ∫ πÕß À√◊Õ„Àâ¡’Õ“°“√¡“°¢÷È𠇙àπ ‚√§μ‘¥‡™◊ÈÕ, “√√–§“¬‡§◊Õßμà“ßÊ
(immune response gene; IR - gene) ´÷Ëß∑”Àπâ“∑’˧«∫§ÿ¡ (°≈‘Ëπ©ÿπ, §«—πμà“ß Ê, ΩÿÉπ≈–ÕÕß∑ÿ°ª√–‡¿∑), °“√ÕÕ°°”≈—ß

°“√ √â“ß¿Ÿ¡‘§ÿâ¡°—π¢Õß√à“ß°“¬. Àπ૬æ—π∏ÿ°√√¡∑’˺‘¥ª√°μ‘π’È °“¬, °“√‡ª≈’ˬπ·ª≈ßÕÿ≥À¿Ÿ¡‘Õ¬à“ß√«¥‡√Á«, ªí®®—¬∑“ß®‘μ ‡™àπ
ÒÒ
“¡“√∂∂à“¬∑Õ¥‰ª¬—ß≈Ÿ°À≈“π‰¥â §«“¡‡§√’¬¥, §«“¡«‘μ°°—ß«≈, §«“¡º‘¥ª√°μ‘∑“ß°“¬«‘¿“§
Ú. ªí®®—¬ “‡Àμÿª∞¡¿Ÿ¡‘À√◊Õ “‡Àμÿ®”‡æ“– (primary or „π®¡Ÿ° ‚¥¬‡©æ“–ºπ—ß°—Èπ™àÕß®¡Ÿ°§¥À√◊Õ¡’‡¥◊Õ¬¬◊Ëπ.

specific factor) ‡ªì𠓇Àμÿ‚¥¬μ√ß. ‘Ëß∑’˺ŸâªÉ«¬·æâ À√◊Õ “√ ‡√‘Ë¡®“°√–¬–°àÕ¿Ÿ¡‘‰« (sensitization phase) ·≈â«
°àÕ¿Ÿ¡‘·æâ (antigen, allergen) ™π‘¥∑’Ë°àÕÕ“°“√‰¥â∫àÕ¬§◊Õ μ“¡¥â«¬√–¬–Õ“°“√∑“ߧ≈‘π‘° (clinical phase) (√Ÿª∑’Ë Ú). ‚¥¬

“√°àÕ¿Ÿ¡‘·æâ„πÕ“°“» (aeroallergen) ∑’ˇ¢â“ Ÿà√à“ß°“¬‚¥¬ ºŸâªÉ«¬∑’Ë¡’æ—π∏ÿ°√√¡‚π⡇Ւ¬ß∑’Ë®–‡ªìπ‚√§¿Ÿ¡‘·æâ ¡’°“√ √â“ß IgE
°“√À“¬„® ‡™àπ ΩÿÉπ∫â“π, ‰√ΩÿÉπ∫â“π, ‡° √æ◊™, ™‘Èπ à«π À√◊Õ ‡¡◊ËÕ —¡º— “√°àÕ¿Ÿ¡‘·æâ ‡√’¬°«à“ ç°“√°àÕ¿Ÿ¡‘‰« (sensitization)é.
‘Ëߢ—∫∂à“¬¢Õß·¡≈ß∑’ËÕ“»—¬Õ¬Ÿà„π∫â“𠇙àπ ·¡≈ß “∫, ¬ÿß, À≈—ß®“°π—Èπ ‡´≈≈å‡ πÕ·Õπ쑇®π (antigen-presenting cells)

·¡≈ß«—π, ¡¥. “√°àÕ¿Ÿ¡‘·æâ∑’Ë ”§—≠∑’Ë ÿ¥„πΩÿÉπ §◊Õμ—«‰√ΩÿÉ𠇙àπ ·¡‚§√‡ø® À√◊Õ‡´≈≈凥π¥√‘μ‘° (dendritic cells) ®–
´÷Ëß “√°àÕ¿Ÿ¡‘·æâπ—Èπ ¡’Õ¬Ÿà„πμ—«‰√·≈–„π ‘Ëߢ—∫∂à“¬¢Õß¡—π. π”·Õπ쑇®π‰ª‡ πÕ„À⇴≈≈凌≈‡ªÕ√å∑’ (T-helper cells; TH

欓∏‘ √’√«‘∑¬“
Phase 1: Phase 2:

Sensitization phase Clinical phase

Early-phase response Late-phase response

Antigen Antigen- presenting cell • Induction of adhesion molecules
Antigen
• Cellular infiltration

Ig E Late-phase
Processed Mast cell
antigen reaction Hyper-
responsiveness
Mediator release Eosinophils
B cell T-helper cells Basophils Priming
Monocytes
IL-4, IL-13 from TH-2 Lymphocytes
Nasal end organ (blood vessels, nerves, glands)

Plasma cell Ig E
Sneezing, rhinorrhea, congestion, itching

√Ÿª∑’Ë Ú ·ºπ¿Ÿ¡‘欓∏‘ √’√«‘∑¬“¢Õß°“√Õ—°‡ ∫®“°¿Ÿ¡‘·æâ : √–¬–·√° ¡’°“√ √â“ß IgE À≈—ß —¡º— “√°àÕ¿Ÿ¡‘·æâ. √–¬–∑’Ë Ú ‡¡◊ËÕ¡’°“√ —¡º—
“√°àÕ¿Ÿ¡‘·æâπ—ÈπÕ’° °Á®–‡°‘¥ªØ‘°‘√‘¬“μÕ∫ πÕß√–¬–μâπ ª√–°Õ∫¥â«¬°“√°√–μÿâπ ·≈–¡’°“√À≈—Ëß “√μ—«°≈“ß. À≈—ß®“°π—Èπ®–¡’
‡´≈≈å·∑√°´÷¡ ∑”„À⇰‘¥°“√μÕ∫ πÕß√–¬–≈à“ ·≈–°“√μÕ∫ πÕ߇°‘πμàÕ ‘Ëß°√–μÿâπ∑’ˇªìπ·Õπ쑇®π ·≈–∑’ˉ¡à„™à·Õπ쑇®π. º≈¢Õß
°√–∫«π°“√¥—ß°≈à“« Õ“®À“¬‡Õ߉¥â À√◊Õ∑”„À⇰‘¥¿“«–·∑√°´âÕπ‰¥â.