CAP过敏原检测系统在高危哮喘儿中的应用

目的　探讨CAP过敏原检测系统在高危哮喘儿中的应用。方法　对 82例高危哮喘儿和 4 0例支气管肺炎患儿 (无过敏病史 )进行吸入性变应原过筛试验 (Phadiatop)、血清尘螨特异性IgE(sIgE)检测。结果　高危哮喘组Phadiatop阳性率为 5 6 1% ,支气管肺炎组Phadiatop阳性率为 2 0 0 % ,两组比较差异有显著意义 (χ2 =14 2 0 ,P <0 0 1) ;高危哮喘组尘螨sIgE阳性率为 4 7 6 % ,支气管肺炎组为 5 0 % ,两组比较差异亦有显著意义 (χ2 =2 1 85 ,P <0 0 1)。Phadiatop和尘螨sIgE检测的敏感性分别为 5 6 1%和 4 7 6 % ;特异性分别为 80 0 %和 95 0 % ;阳性符合率分别为 6 3 9%和 6 3 1% ;假阳性率分别为 2 0 0 %和 5 0 % ;两种检测方法一致率为 89 3% ,经一致性 χ2 检验 ,有较好的一致性 (χ2 =77 76 ,P <0 0 1)。结论　Phadiatop可用于高危哮喘儿的筛查 ;与Phadiatop相比 ,尘螨sIgE特异性高 ,假阳性较低 ,Phadiatop阳性者应行尘螨sIgE检测。尘螨是高危哮喘儿的常见致敏原。对于高危哮喘儿 ,CAP检测是一种可用于筛查和寻找过敏原的重要体外检测手段     

Phadiatop和Fx5E检测在婴幼儿哮喘中的应用

目的：近年来婴幼儿哮喘发病率逐渐增加，与环境因素(过敏原)有密切关系。该文探讨过敏原检测系统(CAP系统)中吸入性过敏原过筛Phadiatop试验和食物过敏原过筛Fx5E试验在婴幼儿哮喘的病因诊断中的价值。方法：对68例婴幼儿哮喘应用荧光酶联免疫，行Phadiatop试验和Fx5E试验并与传统的过敏原诊断方法皮肤试验相比较。 结果：①过敏因素是婴幼儿哮喘的一个重要因素，有48.5% 患儿血清Fx5E阳性，有 38.2% 患儿血清Phadiatop阳性；②Phadiatop的阳性率为 60.4% ，皮肤点刺试验阳性率 37.2% ，经χ 2检验，两种方法的阳性率差异有显著性(χ 2 = 4.65 ，P < 0.05 )；③婴幼儿哮喘患儿中食物IgE的阳性率比吸入IgE的阳性率更高。 结论：过敏因素是婴幼儿哮喘的一个重要因素；婴幼儿哮喘患儿中食物过敏情况比吸入物过敏更重要；Phadiatop试验和Fx5E试验是一项简便、可靠的过敏原过筛试验。     

婴幼儿哮喘患儿食物IgE抗体测定和分析

目的了解食物过敏在婴幼儿哮喘中所占的比例.方法对158例婴幼儿哮喘患儿血清中食物特异性IgE(sIgE)进行检查.结果43.0%的患儿血清中存在着食物sIgE;sIgE的血清浓度在3级(3.5ku/L)以上的患儿,鸡蛋白为8.1%、牛奶8.1%、花生5.4%、小麦4.0%及黄豆1.3%;患儿中牛羊肉sIgE阳性率很低.仅有2例患儿有明确的进食食物后,引起喘息发作的病史,其余则临床表现为哮喘伴湿疹、荨麻疹及过敏性鼻炎.对其中130例患儿同时进行的吸入过敏原筛查试验(Phadiatop)中,Phadiatop阳性为44例(33.8%),而混合食物抗原(fx5E)阳性的为58例(44.6%)(P＜0.05).结论在婴幼儿哮喘患儿中食物IgE阳性率比吸入物IgE阳性率更高.     

温州地区402例哮喘患儿特应质现象分析

目的 对温州地区15岁以下哮喘患儿特应质现象进行分析,探讨其临床及理论价值.方法 回顾性分析402例哮喘患儿皮肤过敏原诊断试验、血清特异性IgE、总IgE、个人过敏史、家族史、过敏原检出率、类型及与年龄关系.结果 哮喘发病有家族聚集倾向,家族过敏史总阳性率为52.74%.个人过敏史总阳性率为61.69%.过敏原皮肤诊断试验和过敏原血清特异IgE阳性率达83.58%,吸人性过敏原阳性人数占检测患儿的74.13%,其中以粉尘螨(61.44%)、屋尘螨(58.96%)为主;食人性过敏原阳性占24.38%,以小虾(16.67%)、牛奶(8.46%)为主.血清总IgE阳性率87.9%,总IgE阳性组和阴性组的哮喘患儿血清嗜酸性细胞阳离子蛋白(ECP)、户尘螨sIgE(D1)、粉尘螨sIgE(D2),皮肤过敏原诊断试验(pt)、家族过敏史、个人过敏史差异有统计学意义(P均≤0.05).哮喘患儿3岁前、后过敏原分布不同,3岁以后吸人性过敏原阳性为主.发病诱因中以上呼吸道感染为最多,哮喘症状发作的时间主要集中在临睡、夜晚、清晨.结论 儿童哮喘存在明显特应质现象,对其的正确认识和诊断对哮喘免疫机制的深入研究、综合治疗如在糖皮质激素吸入治疗的基础上,增加患儿教育、过敏原避免、特异性的免疫治疗等具有实用和理论指导意义.     

不同年龄组喘息患儿体外过敏原分析

目的 分析不同年龄组喘息患儿的过敏情况.方法 对505例喘息性疾病患儿按婴儿组、幼儿组、儿童组进行食物和吸入物过敏原筛查(Fx5E试验和Phadiatop试验),并抽取Fx5E阳性和Phadiatop阳性各30例行血清IgE测定.结果 婴儿组、幼儿组、儿童组Fx5E阳性率分别为25%、55%、17%;Phadiatop阳性率分别为8%、45%、48%.Fx5E阳性过敏原主要是牛奶、鸡蛋白;Phadiatop阳性主要是尘螨、屋尘.结论 咳喘婴儿以食物过敏为主,其阳性率随年龄的增长而升高,至幼儿期后,又随年龄的增长而降低.吸入物过敏则随年龄而增多,幼儿期吸入物过敏的发生率与食物过敏比例已接近,至儿童期则以吸入物过敏为主.体外过敏原检测是一种用于筛查和寻找变应原的较为准确的方法.     

婴幼儿变应原过筛试验在儿童变态反应性疾病检测中的应用

目的了解婴幼儿变应原过筛试验（phadiatop infant）作为筛查吸入物抗原及常见食物抗原血清中特异性IgE（sIgE）的工具，在儿童IgE介导的变态反应性疾病中检测的意义，并同时与吸入性变应原过筛试验（phadiatop）和儿童常见食物sIgE测定进行比较。方法临床诊断为湿疹、哮喘和变应性鼻炎等变态反应性疾病的0—12岁患儿560例，使用法玛西亚UniCAP100全自动免疫荧光系统进行血清phaditop infant和phadiatop测定。在phaditop infant筛查试验阳性的患儿中随机抽取112名进行牛奶、鸡蛋白、鱼、小麦、花生、黄豆、虾及牛肉8种常见食物的sIgE测定。结果560例患儿中328例phadiatop infant阳性，占59％；phadiatop阳性213例，占38％。所有phadiatop检测阳性的患儿phadiatop infant均阳性；而phadiatop infant检测阳性的患儿中115名phadiatop结果为阴性；小于3岁组患儿phadiatop infant检测的阳性率显著高于phadiatop检测阳性率（x^2=240．88；P〈0．001）。患儿血清phadiatop infant的IgE浓度（kU／L）与各种食物sIgE浓度之和呈正相关（r=0．67，P〈0．001），phadiatop infant和phadiatop均阳性的患儿IgE水平明显相关性（r=0．55，P〈0．001）。结论Phadiatop infant可以有效地检测血清中吸入物及食物特异性IgE；3岁以下儿童中phadiatop infant的阳性率明显高于phadiatop，可用此单一的检测除外婴幼儿和儿童非sIgE介导的相关性疾病，是体外变应原筛查的理想方法。     

儿童哮喘与过敏原、血清总IgE水平相关性分析

目的探讨儿童哮喘与过敏原、血清总IgE水平的关系。方法将120例哮喘患儿设为实验组,对照组为同期无呼吸系统疾病、过敏性疾病及家族遗传史的儿童,计48例;采用敏筛过敏原检测方法,观察两组儿童致敏物阳性率及血清总IgE水平。结果实验组过敏原阳性率为88.33%,吸入性致敏物中户尘螨粉尘螨的阳性率最高,食入性致敏物中牛奶阳性率最高;对照组过敏原阳性率为12.5%,两组儿童过敏原阳性率比较,差异有统计学意义(P<0.01);实验组血清总IgE升高112例(93.33%),对照组血清总IgE升高6例(12.5%),两组儿童血清总IgE水平比较,差异有统计学意义(P<0.01)。结论哮喘患儿对多种过敏原有阳性反应,其中以吸入性过敏原为主,及早避免接触过敏原,对防治儿童哮喘有重大意义;血清总IgE水平对支气管哮喘的诊断起到协助作用。     

体内和体外变应原测定在过敏性哮喘诊断中的联合应用

目的分析变应原皮肤点刺试验(SPT)和血清吸入性变应原筛查(Phadiatop)及特异性IgE测定联合应用在过敏性哮喘变应原诊断中优势。方法对57例诊断哮喘患儿进行吸入性变应原SPT测定和Phadiatop测定。对其中33例进行血清户尘螨特异性IgE测定。分析本组哮喘患儿SPT结果分布,SPT与Phadiatop结果符合率,户尘螨SPT与其特异性IgE结果符合率。结果儿童哮喘吸入性致敏原分布最常见的为尘螨、真菌、宠物等室内变应原。本组SPT和Phadiatop阳性检出率分别为86%、79%,SPT与Phadiatop符合率86%。5例Phadiatop阴性患儿经SPT和真菌特异性IgE测定证实存在真菌过敏。户尘螨SPT和特异性IgE结果符合率为97%。结论在儿童哮喘相关吸入性变应原诊断中,联合应用体内和体外变应原测定方法可互为补充,有助于提高变应原诊断的敏感性和特异性。     

湿疹患儿变应原皮肤点刺试验及血清特异性IgE检测结果分析

目的评价变应原皮肤点刺试验(SPT)和血清特异性IgE(sIgE)检测方法在儿童湿疹中的临床应用。方法对605例湿疹患儿随机进行变应原皮肤点刺试验和血清特异性IgE检测。其中SPT 233例,sIgE 372例,根据年龄分为<3岁组,3～6岁组和>6岁组,分析比较不同年龄组间2种检测方法所得变应原sIgE阳性率。结果 233例患儿进行SPT检测,163例(70%)阳性,其中最常见吸入性和食物性变应原分别为粉尘螨、屋尘螨、真菌和鸡蛋、鳕鱼、牛奶、花生及小虾。372例患儿进行sIgE检测,291例(78.2%)总IgE阳性,257例(69.1%)sIgE阳性,其中最常见吸入性和食物性变应原分别为屋尘螨、真菌、屋尘、猫狗毛皮屑和牛奶、鸡蛋白、虾、蟹及腰果。对2种方法检测的相同变应原进行比较,除豚草、狗毛上皮、牛奶和鱼,其余阳性率在不同年龄组间比较差异均无统计学意义。结论 SPT和sIgE检测均可作为儿童湿疹变应原检测的方法,因SPT快速简便可作为变应原检测首选方法。     

哮喘儿童过敏原抗体调查

为了解江苏省苏、锡、常、宁、杨地区哮喘患儿过敏原，用Phadiatop全自动检测仪检测正常儿童、肺炎及哮喘患儿血清过敏原抗体。吸入性过敏原过筛包括D1、H1、EX1、MX2、TX4、WX1、16；食物性过敏原过筛主要是FX5E。结果显示正常、肺炎、哮喘3例组吸入性过敏原阳性率分别为28．13％、19．05％、78．27％。食物性过敏原阳性率分别为9．38％、11．34％、27．17％。哮喘组与正常组、肺炎组间吸入性过敏原、食物性过敏原差异均有显著性（P＜0．005），正常组与肺炎组间差异无显著性。哮喘组D1呈现高水平趋势，且其阳性率随年龄增长而增长，呈正相关。哮喘组部分患儿对蟑螂等过敏，其食物与年龄之间未能显示明显规律性。提示哮喘患儿主要对尘螨、屋尘等吸入性过过敏原过敏，小部分对蟑螂等吸入性和食物性过敏原过敏。     

Value of a multiantigen radioallergosorbent test in diagnosing atopic disease in young children

The purpose of this study was to investigate the value of a new multiantigen radioallergosorbent test, Phadiatop Paediatric, in the diagnosis of atopy in children less than 7 years of age. The diagnosis of atopic disease was established by history, physical examination, total serum IgE concentration, and the results of prick skin tests or radioallergosorbent tests or both, and then compared with the result of the Phadiatop Paediatric test for each patient. One hundred two patients (62 boys) between the ages of 4 months and 7.3 years were enrolled (median age 3.2 years). After the history and physical examination, 42% of the patients were believed to be atopic and 32% to be nonatopic; the diagnosis was uncertain in 26%. Skin prick test reactions to a variety of foods and inhalants were positive in 41 of 63 children tested; results of radioallergosorbent tests were positive in 35 of 61 children. Overall, atopy was diagnosed in 53 children and 49 were found to be nonatopic. When the clinical diagnosis was used as the gold standard, the Phadiatop test resulted in a correct diagnosis of atopy in 49 of 53 cases and of no atopy in 43 of 49 cases: sensitivity = 92%, specificity = 88%, and efficiency = 90%. Although the Phadiatop Paediatric test does not indicate specific sensitivities, it provides the clinician with a useful screening test for atopic disease in children 7 years of age or less, and the researcher with a means of validating atopic populations.     

Use of Phadiatop® Infant in diagnosis of specific sensitization in young children with wheeze or eczema

Wheezing and eczema are common symptoms in young children and it is important to disclose sensitization for correct management. The objective of this study was to assess the diagnostic values of Phadiatop Infant, an in vitro test for graded determination of immunoglobulin E (IgE) antibodies to food and inhalant allergens. One-hundred and forty-nine children (median age 1.4 yr) with symptoms of wheezing (51%) eczema (28%) or a combination of both (21%) were classified as atopic or non-atopic based on case history, atopic history, physical examination and determination of IgE antibodies. The clinical performance of Phadiatop Infant was evaluated for 145 children against this classification in a blinded manner to the allergist. Fifty-one children were classified as atopic of which Phadiatop Infant identified 49. Ninety-four were non-atopic of which the test identified 90. This resulted in a sensitivity of 96%, a specificity of 96%, a positive and a negative predictive value of 94% and 98%, respectively. Logistic regression showed that probability had to be assessed as atopic increased with increasing Phadiatop Infant values. These results suggest that Phadiatop Infant can be recommended as an adjunct to the clinical information in the differential diagnosis on IgE-mediated allergy in young children. The test thus provides an opportunity for early correct diagnosis and identification of subjects at risk for whom intervention may be necessary.     

Detection of respiratory allergies using the Phadiatop test in children 1 to 6 years of age

Phadiatop, a new test for detecting hypersensitivity to airborne allergens, was used in 83 children aged 9 months to 6 years with recurrent respiratory manifestations, i.e. recurrent expiratory obstruction and/or recurrent respiratory infections. A good correlation was found between this test and both the prick tests (95%) and the specific IgE assays (91% for RASTS of classes greater than or equal to 1, and 95% for RASTS of classes greater than or equal to 2). However, the correlation was less strong with the total IgE level (68%). The overall correlation with the specialist's prediction based on history and physical evaluation was excellent (94%). In this study, Phadiatop was found to have a 90% sensitivity and a 98% specificity. Furthermore, this test costs 40% less than the often used strategy combining skin tests and determinations of total and specific IgE levels. In the age group studied, Phadiatop is most useful above the age of two, since in younger patients true respiratory allergies are fairly infrequent in recurrent ENT and lower respiratory tract infections, whereas infections are far more common.     

Associations between atopic markers in asthma and intestinal helminth infections in Cuban schoolchildren

Total serum IgE (tIgE), allergen-specific IgE (sIgE), and skin prick test (SPT) are commonly used markers for atopy and atopic disease. The association between these measures and their relationship to clinical symptoms differs in affluent and non-affluent countries. We investigated the role of intestinal helminth infections in observed variations in atopic markers and asthma, and possible diagnostic and epidemiological consequences. A cross-sectional study was conducted in Cuban schoolchildren (n = 1285; 4-14 yrs). Atopy was determined by SPT, sIgE, and tIgE; asthma by International Study of Asthma and Allergies in Childhood questionnaire; and intestinal helminth infections by stool examination. Percentages of tIgE, sIgE, and SPT positives were 88.9%, 25.5%, and 16.5%, respectively. Asthma was found in 20.8%, and helminth infections in 20.9% of the children. All three atopic markers were significantly associated with each other and with asthma. Median tIgE levels were higher in helminth-infected than in uninfected children, irrespective of their status of atopy/asthma. Discordant results between SPT and sIgE were observed in 22.6% of the children. Among SPT positives, 41% were sIgE negative. The proportion of SPT negatives among sIgE positives was 74% in helminth-infected and 58.4% in uninfected children (p < 0.05). Helminth infections affected tIgE levels, reconfirming the limited value of tIgE for diagnosis of atopy and asthma in tropical areas. Higher frequencies of sIgE than positive SPTs were observed, especially in helminth-infected children. This corresponds with current hypothesis on the role of helminths in atopy. However, the observed proportion of sIgE negatives among children with positive SPT suggests that other mechanisms may also be involved.     

温州地区儿童血清特异性过敏原检测的临床意义

目的了解温州地区不同年龄组儿童哮喘及过敏性疾病的过敏原状况,以指导临床防治。方法采用体外过敏原检测系统(法玛西亚CAP系统)对我院呼吸科门诊及住院患儿468例进行过敏原特异性IgE(sIgE)抗体检测,将所有受检儿童分为婴幼儿、学龄前、学龄期3组,对过敏原状况进行分析比较。结果哮喘发病主要集中于学龄前和婴幼儿期,过敏性鼻炎主要发生于学龄儿童;各种过敏性疾病中过敏性鼻炎sIgE阳性检出率最高,其次是哮喘和过敏性咳嗽;婴幼儿以食物过敏为主,较大年龄儿童以吸入性过敏为主,学龄前儿童两者均可发生;温州地区吸入性过敏原以尘螨为主,食入性以虾为主;在螨sIgE阳性者中哮喘比率最高,其次是过敏性鼻炎和过敏性咳嗽。结论螨及虾是温州地区儿童最常见过敏原。哮喘应在婴幼儿及学龄前期及早进行针对性防治,体外血清过敏原特异性抗体检测CAP系统是婴幼儿及学龄前儿童过敏原检测的方法之一。     

Comparison of ADVIA Centaur® and Pharmacia UniCAP® tests in the diagnosis of food allergy in children with atopic dermatitis

In a study comprising 63 children diagnosed with atopic dermatitis, the results of the ADVIA Centaur system was compared with the results obtained with the Pharmacia UniCAP100 system, which has been widely considered as a reference method for seric specific IgE (sIgE) measurements. The individual immunization against the most common food allergens [egg (f1), cow milk (f2), cod (f3), wheat (f4), peanut (f13) and soy bean (f14)] was determined by in vitro serum IgE testing and skin prick test (SPT). The comparison of the sIgE titers revealed a good concordance between the Centaur and the UniCAP tests for f1, f3, and f13 (94 %, 91 %, and 96 % respectively). However, the concordance was lower for f2, f4, and f14 (76 %, 77 %, and 77 % respectively) because of discrepancies between the two techniques. When compared with SPT and clinical diagnosis, on the 40 discordant cases found between the Centaur and the UniCAP, the Centaur showed concordance with the patients food reaction and SPT in 34/40 cases, and UniCAP in only 6/40 cases. Accordingly, the Centaur test displayed a statistically significantly better performance on specificity and concordance with SPT for f2, f4, and f14 (concordance/specificity = 70%/71%, 76%/75% and 90%/88% respectively), than the CAP test (49%/54%, 51%/52% and 67%/65% respectively).     

Accuracy of ImmunoCAP® Rapid in the diagnosis of allergic sensitization in children between 1 and 14 years with recurrent wheezing: The IReNE study

It is estimated that at least one out of three children with recurrent wheezing is atopic. Reliable diagnostic tools are needed in primary care that allow for adequate identification of these children. The purpose of this study was to assess the value of ImmunoCAP^® Rapid (ICR) Wheeze‐Rhinitis Child in the identification of atopy with the use of 10 selected allergens in children with recurrent episodes of wheezing. A multicenter population study is based on primary care. It included children managed consecutively at the health center, who had three or more episodes of wheezing, at least one of them in the last 12 months. Each child completed a physical examination, an epidemiological survey, one capillary blood sampling (110 μl) for ICR, and one venous blood sampling for determination of Phadiatop Infant, total IgE and 10 specific IgE measurements. The children were identified as atopic, based on their clinical signs and symptoms and at least one positive specific IgE (0.35 kU_A/l or higher), before knowing the results of ICR, Phadiatop Infant and total IgE. ICR was read by two independent observers. Six classes were evaluated, negative without any color and five positive degrees of pink‐red color. Two hundred and fifteen children aged between 1 and 14 years were studied (138 boys); 50.7% were identified as atopic, 39.1% were sensitized only to inhalant allergens, 6.5% to food allergens and 5.1% to both. The predominant allergen was the dust mite (39.3%). For ICR, there were 2134 valid double observations. The Kappa index, comparing the negative results vs. any positive result, was 0.91 (95% CI: 0.88–0.94). The intraclass correlation coefficient was 0.98 (95% CI: 0.98–0.99). In the identification of a child as atopic, the positive post‐test probability of ICR depended on the color degrees considered: 88.4% for any positive and 97.6% for the most intense tones. The positive post‐test probability of Phadiatop Infant and total IgE was 95.6% and 68.2% respectively. ICR showed good reliability for the most prevalent allergen, the dust mite, with a sensitivity of 90.5% (95% CI: 82.1–95.8) and specificity of 88.5% (95% CI: 81.7–93.4). The analysis of the other allergens was limited by the small number of sensitized children. The analysis of receiver operating characteristic curves revealed an area under the curve of 0.84 (95% CI 0.80–0.88) for the cut‐off point of specific IgE of 0.35 kU_A/l and of 0.94(CI 0.91–0.97) for 2 kU_A/l. A greater intensity of color of the lines of ICR was related to higher levels of specific IgE in blood. ICR is a reliable test for the identification of atopy in children, which identifies most children as atopic, and shows a good correlation in allergen‐by‐allergen identification. This suggests that it should be regarded as a first‐rate tool, in the primary care clinic, for the evaluation of children with recurrent wheezing.     

吸入变应原sIgE在不同气道过敏性疾病儿童中的分布特征

目的了解不同气道过敏性疾病患儿吸入变应原血清特异性Ig E(slg E)的分布特征。方法应用Uni CAP250变应原定量Ig E检测系统的荧光酶联免疫法,对256例3~14岁气道过敏疾病患儿测定9种常见吸入变应原的血清slg E。256例患儿按临床诊断分为:变应性鼻炎组(简称"鼻炎组",37例)、支气管哮喘组(简称"哮喘组",82例)和变应性鼻炎合并支气管哮喘组(简称"鼻炎并哮喘组",137例)。比较3组患儿9种吸入变应原阳性检出率的分布差异,并比较3组患儿变应原致敏级别和致敏种类数的差异。结果哮喘组、鼻炎组和鼻炎并哮喘组患儿吸入变应原血清s Ig E的阳性检出率分别为57.3%(47/82)、86.5%(32/37)、82.5%(113/137),3组间比较差异有统计学意义(P0.05)。哮喘组、鼻炎组、鼻炎并哮喘组患儿常见变应原均依次为霉菌类(32.9%、54.1%、48.9%)、尘螨类(30.5%、45.9%、46.0%)、花粉类(26.8%、35.1%、32.8%)、宠物类(12.2%、27.0%、18.2%)、蟑螂(9.8%、5.4%、5.8%)。鼻炎组和鼻炎并哮喘组患儿霉菌混合的阳性检出率均高于哮喘组,差异有统计学意义(均P0.0166)。3组患儿9种变应原的致敏级别和致敏种类数比较差异无统计学意义。结论支气管哮喘、变应性鼻炎或二者合并患儿前3位吸入变应原均依次是霉菌类、尘螨类、花粉类;与支气管哮喘相比,霉菌致敏可能与变应性鼻炎关系更密切;这3种常见气道过敏性疾病吸入变应原的致敏分布具有相似性。