世界过敏组织关于IgE介导过敏反应的诊断及过敏反应其他相关检测方法立场文件解读(一)——体内检测

目前,免疫球蛋白E (immunoglobulin E,IgE)的致敏性检测是诊断过敏性疾病的基础,也是管理过敏性疾病(包括过敏原规避、药物治疗及特异性免疫治疗)的关键。2020年,世界过敏组织(World Allergy Organization,WAO)发表了关于IgE介导过敏反应诊断方法(包括体内检测和体外检测)...     

儿童特应性皮炎血过敏原检测及分析

目的 了解引起儿童特应性皮炎的主要原因,提出相应的预防治疗措施.方法 对350例特应性皮炎患儿,采用瑞典UniCAP100系统荧光酶联免疫法及其专用体外变应原试剂,进行血过敏原及总IgE、特异性IgE测定,分析其过敏因素和临床特征.结果 350例患儿中,总IgE升高161例(占46.00%),特异性IgE升高254例(占72.57%),食物过敏185例(占52.86%),Fx5E阳性175例(占50.00%).吸入过敏178例(占50.86%).3岁以下儿童以食物过敏为主,尤以牛奶、鸡蛋白为甚;3岁以上儿童以吸入过敏为主,尤以螨虫为甚.结论 应用UniCAP100系统进行体外血过敏原测定安全、方便、快速.3岁以下儿童主要检测食物过敏原,建议首次检测总IgE、Fx5E和F1、F2、Phadiatop;3岁以上儿童主要检测吸入过敏原,建议首次检测总IgE、Phadiatop,Fx5E和d1,再根据结果检测特异性IgE.随着家庭宠物的增加,3岁以下婴幼儿猫毛、狗毛吸入过敏有所增加.     

Phadiatop和sIgE检测在儿童哮喘诊断中的应用

目的：探讨CAP过敏原检测系统中吸入性过敏原过筛试验(Phadiatop)检测和特异性IgE(sIgE)检测在小儿哮喘病因诊断中的价值。方法：应用荧光酶联免疫法,对153例小儿哮喘、40例支气管肺炎进行Phadiatop,sIgE和血清总IgE检测。结果：哮喘患儿Phadiatop和尘螨sIgE阳性率分别为 66.01%和59.48%,而支气管肺炎患儿两者阳性率分别为 12.5%和7.5%,两组间差异有显著性(P<0.05)。Phadiatop,sIgE灵敏度分别为0.66和0.59,特异度分别为0.88和0.93,两种检测的一致性高。结论：Phadiatop检测是哮喘病因诊断简便、可靠的体外过筛试验,Phadiatop阳性患儿应进一步作sIgE检测。     

血清特应性变应原及总IgE抗体与抽动障碍发病的关系

目的抽动障碍(TD)病因尚不明确,通过对TD患儿血清总IgE及特应性变应原IgE进行检测,探讨TD与过敏反应的关系。方法本研究对62例TD患儿进行血清总IgE抗体和特应性变应原检测。收集TD患儿静脉血3 mL,采用欧蒙医学实验诊断股份公司的特应性变应原中国组合3检测试剂盒(欧蒙印迹法)进行总IgE抗体、吸入性和食物变应原特异性IgE抗体(sIgE)检测。结果本研究中TD患儿90.32%以眨眼、挤眼等眼部表现和鼻咽部抽动症状起病。患TD儿童血清总IgE抗体阳性者52例,阳性率为83.87%。血清特异性变应原sIgE检测阳性44例,阳性率为70.97%。吸入性变应原sIgE阳性率高于食物变应原,TD患儿常见变应原有屋尘、树组合(榆树/梧桐树/柳树/杨树/柏树)、尘螨组合(屋尘螨/粉尘螨)、牛奶/巧克力混合、海鲜组合(蟹,扇贝,虾,蛤)。总IgE等级分布与病程长短无关。结论血清特应性变应原及高总IgE抗体可能是引起TD的一个重要原因。     

荧光酶联免疫法和免疫印迹法检测特异性IgE的阳性检出率比较分析

目的:比较荧光酶联免疫法(简称ImmunoCAP法)和免疫印迹法(简称敏筛法)对主要吸入过敏原和食物过敏原特异性IgE(specific IgE,sIgE)检测结果的阳性检出率,为临床合理应用检测方法和解读检验结果提供依据。方法:收集2017年10月至2019年4月北京儿童医院过敏反应科门诊送检sIgE的458例过敏性...     

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。     

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。     

中国儿童过敏原检测临床应用专家共识(2021版)

儿童过敏性疾病发病率呈逐年上升趋势,罹患哮喘、过敏性鼻炎和湿疹等过敏性疾病不仅降低了儿童生活质量,而且增加家庭与社会的经济负担。过敏原检测可以明确致敏变应原,为个体化管理过敏性疾病提供依据。常用的过敏原检测方法包括过敏原皮肤点刺试验和血清特异性IgE检测。不同过敏原检测方法的适应证及其结果判断在儿科临床亟待规范。本共识以儿童过敏原检测相关的临床常见问题为导向,查阅相关文献,经多学科临床专家通过德尔菲投票方法达成共识,形成10个临床问题的推荐建议。     

食物特异性IgE在儿童食物过敏中的应用

儿童食物过敏的发病率为 5 %～ 7.5 %,且近年来呈上升趋势 ,影响儿童的生长发育和生活质量。目前诊断食物过敏的“金标准”仍是双盲食物激发试验 ,不过随着体外技术尤其体外定量检测食物过敏原特异性IgE技术的进步如放射过敏原吸附试验 ,CAP(测定帽 )变应原检测系统等方法 ,对于食物特异性IgE介导的I型超敏反应的诊断价值显著提高 ,而且可用于儿童食物过敏的预后判断和过敏高危婴幼儿的早期筛查     

50例儿童哮喘特异性IgE定性检测分析

支气管哮喘是一种常见的慢性呼吸道变应性炎症,近年来发病率有增加趋势,检测过敏原的目的能发现和明确诱发哮喘的过敏原因,以便在日常生活中避免与之接触,从而防止哮喘发作。血清特异性IgE(s-IgE)测定是通过检测大部分常见的过敏原或血清IgE定性来察看过敏反应情况,随后可用明确的过敏原制成浸出液作脱敏疗法,以期减少或减轻甚至终止哮喘发作。     

Comparison of MAST with radioallergosorbent and skin tests for diagnosis of allergy in children

The multiple allergosorbent test system (MAST) is a method for measuring total and allergen-specific IgE levels, using autoradiography and densitometry. The purpose of this study was to compare the results of MAST tests with those of radioallergosorbent (RAST) and skin tests as an adjunct to the diagnosis of allergy in children. Twenty children, aged 4 to 19 years, were studied. Total serum IgE level measured by the paper radioimmunosorbent test (PRIST) method ranged from 7 to 1,333 units/mL (geometric mean, 155 units/mL). Total serum IgE level by MAST significantly correlated with the PRIST IgE level. Quantities of allergen-specific IgE measured by MAST and RAST were also significantly correlated. When the diagnostic levels by MAST and RAST were compared with skin test reactions for ragweed, grass, house dust, and mite, MAST had a sensitivity of 59%, a specificity of 97%, and an efficiency of 72%, compared with 67%, 97%, and 78%, respectively, for the RAST analysis. We conclude that MAST and RAST are similar in their ability to measure allergen-specific IgE level, but that neither method is as sensitive as skin tests for detection of allergen-specific IgE.     

Diagnostic testing in the evaluation of food allergy

Food-related symptoms are frequent in childhood, and pediatricians are often requested to initiate a food allergy diagnostic workup. A careful history is the cornerstone for assessing whether tests are needed and which diagnostic procedures are most appropriate. Skin prick tests should be performed only according to standard procedures by a skilled health professional. Determining serum IgE levels (in vitro tests) are available for a wide range of foods. Of utmost importance is the need to correlate test results to the clinical picture. When a conclusion cannot be reached, oral food challenges should be performed for a definite diagnosis.     

Allergy testing in childhood: using allergen-specific IgE tests

A variety of triggers can induce common pediatric allergic diseases which include asthma, allergic rhinitis, atopic dermatitis, food allergy, and anaphylaxis. Allergy testing serves to confirm an allergic trigger suspected on the basis of history. Tests for allergen-specific immunoglobulin E (IgE) are performed by in vitro assays or skin tests. The tests are excellent for identifying a sensitized state in which allergen-specific IgE is present, and may identify triggers to be eliminated and help guide immunotherapy treatment. However, a positive test result does not always equate with clinical allergy. Newer enzymatic assays based on anti-IgE antibodies have supplanted the radioallergosorbent test (RAST). This clinical report focuses on allergen-specific IgE testing, emphasizing that the medical history and knowledge of disease characteristics are crucial for rational test selection and interpretation.     

Comparison of two IgE antibody tests with skin test and clinical history in asthmatic patients

The multiple allergosorbent chemiluminescent assay (MAST-CLA) is a system to measure total and allergen-specific IgE in human serum by means of a chemiluminescent immuno-enzymatic system. The test has been compared with skin test, RAST and clinical history in 67 atopic, asthmatic children. The individual percentage agreement between MAST-CLA and skin test was grass pollen 67%, tree pollen 82%, cat 76%, dog 84%, house dust mite 87%, alternaria 64%, aspergillus 79%, cladosporium 84%, penicillium 93%, milk 78% and egg 76% and between MAST-CLA and RAST was grass pollen 62%, tree pollen 72%, cat 75%, dog 72% and mite 87%. The total IgE levels on MAST-CLA did not agree with PRIST results. MAST-CLA was randomly duplicated and proved repToducible in 85% of tests. Changes between positive and negative results occurred in only 4% of tests. Clinical history predicted allergy diagnosis accurately in 21 (31. 5%) cases whilst MAST-CLA provided additional information in 14 (21%). MAST-CLA proved least reliable for grass pollen allergy diagnosis, which has prompted a change in allergen composition for this assay. MAST-CLA is a simple in vitro test for specific IgE to 35 allergens which compares favourably with RAST. The variation in correlates with other techniques of allergy diagnosis, however, indicates that there are differences in credibility for each result within the multiple test system.     

Blood tests and histological correlates in children with eosinophilic oesophagitis

Aim: To determine the relationship between blood tests and oesophageal histology in Eosinophilic oesophagitis (EoE). Methods: All children diagnosed with EoE at one hospital from 2000 to 2009 were considered for inclusion in this study. Three blood test results were analysed, blood eosinophil count, serum total immunoglobulin E (IgE) and radioallergosorbent tests (RAST) to common food allergens. Oesophageal histology was prospectively re‐reviewed, and mean eosinophil counts were enumerated. Blood test results were correlated with oesophageal eosinophil counts using Spearman’s rank test. Results: Forty children (70% boys) were included in this study, median age at diagnosis 6.5 years (range 0–15). At the time of diagnosis, 78% of children had a raised blood eosinophil count, 90% had a raised serum total IgE and 83% had one or more positive RAST tests. The mean oesophageal eosinophil count was significantly correlated with both blood eosinophil count (p = 0.008) and serum total IgE level (p = 0.008). Conclusion: This study shows that blood tests are often abnormal in children with EoE at the time of diagnosis. Our data demonstrate an association between histological abnormalities and blood test results in children with EoE.     

Allergy testing: in vivo versus in vitro

Table 4 briefly summarizes the relative advantages and disadvantages of skin tests versus in vitro tests for detecting allergen-specific IgE. The skin test remains unexcelled as a sensitive and cost efficient test for specific IgE. The high degree of skin test sensitivity is very important when a patient must be evaluated for potentially life-threatening allergies such as to penicillin or stinging insects. The results of both skin tests and in vitro assays depend very much on the quality of the allergen extracts used for the tests. Although the quality of extracts is improving, there is still little standardization. Both skin tests and in vitro assays are difficult to quality control. Practicing allergists rely on experience, and the correlation between patient histories and skin tests results for quality control of the results. Although this system suffices for common allergens, the results for uncommon allergens may be misleading. Quality control is also difficult for in vitro tests. Participation in quality control programs, such as that being offered by the College of American Pathologists, will increase and lead to better quality and standardization of in vitro test results. At the present time, properly performed skin tests are the best available method for detecting the presence of allergen specific IgE. They are rapid, sensitive, and inexpensive on a per test basis. In vitro tests are acceptable substitutes for skin tests in some circumstances. If the patient does not have normal skin, cannot discontinue interfering medications, or is so sensitive by history that anaphylaxis seems possible, in vitro tests are preferred. In vitro tests are better when it is necessary to test a difficult patient such as a combative, mentally retarded adult. In vitro tests also have been invaluable in many allergy research studies. Physicians must remember that positive tests for allergen-specific IgE do not diagnose allergy. They only indicate the presence of IgE molecules with a particular immunologic specificity. A decision whether the specific IgE molecules are responsible for clinically apparent disease must be made by a well-trained physician. The ultimate standard for the diagnosis of allergic disease remains the combination of: (1) positive double-blind challenge, (2) the presence of specific IgE, and (3) demonstration that the symptoms are the result of IgE-mediated inflammation.     

Diagnosis of food allergy

The diagnosis of food allergy requires obtaining a detailed medical history and consideration of differential diagnosis. The offending food(s) may be identified by the medical history, trials of elimination diets, SPT, food-specific IgE measurement, or some combination. However, the reliability of these methods is usually suboptimal, and confirmation of the offending food(s) requires well-designed challenge tests.     

The diagnosis of IgE-mediated food allergy in childhood

IgE-mediated food allergy is a common condition in childhood and a recognized public health concern. An accurate diagnosis of food allergy facilitates the avoidance of the allergen – and cross-reactive allergens – and allows for safe dietary expansion. The diagnosis of food allergy relies on a combination of rigorous history, physical examination, allergy tests [skin prick tests (SPT) and/or serum-specific IgE] and oral food challenges. Diagnostic cut-off values for SPT and specific IgE results have improved the diagnosis of food allergy and thereby reduced the need to perform oral food challenges. This clinical case series seeks to highlight a contemporary approach to the diagnosis of food allergy in children strategies.     

Peanut allergy]

Clinical manifestations of peanut allergy are miscellanous extending from simple itching to anaphylactic shock. They may appear early in life. The diagnosis relies upon history, prick tests, specific IgE dosage, and if necessary oral challenge test. Most often peanut allergy is longstanding requiring a complete exclusion of peanut from the food. In addition peanut oil being a frequent hidden allergen, it is recommended that any patient with recognized peanut allergy carries a first aid kit to be used in case of allergic accident.     

Evaluation of the need for routine preoperative latex allergy tests in children

BACKGROUND: Recently, there was a great increase in allergic reactions to latex and this brought relatively more concern to the latex allergy. In this prospective study we aimed to identify the frequency of latex allergy in preoperative patients, and tried to clarify whether it is necessary to perform latex allergy tests routinely in the preoperative period or not. METHODS: A total of 188 children, aged 1-14, who were admitted for various operations, were randomly included in this study and of them, 181 completed the study. Latex specific history was taken from all patients. Latex skin prick tests, challenge tests with latex gloves, total IgE and latex specific IgE measurements were performed. RESULTS: Of 181 children, two (1.1%) had positive latex skin prick tests. Latex challenge tests were negative in all children. Latex specific IgE was positive in 12 children (6.6%) as class II or higher, but no patient had allergic reactions in operations. History of repeated operations was a risk factor for latex sensitization. The risk was higher in the presence of both history of repeated operations and history of allergic disease. However, the risk was not higher in patients with the history of only allergic disease, compared to ones who had a history of neither repeated operations nor allergic disease. CONCLUSION: We conclude that routine preoperative latex allergy tests seem to be not necessary because of no allergic reactions during operation in spite of the sensitization of 6.6% detected by latex specific IgE. However, this should be investigated in larger studies.