特应性斑贴试验在诊断特应性皮炎患儿鸡蛋、牛奶过敏中的价值

目的 探讨特应性斑贴试验(APT)在诊断特应性皮炎(AD)患儿食物过敏中的价值.方法 以中国儿童最常见的过敏食物--鸡蛋、牛奶为抗原,同时采用APT和皮肤点刺试验(SPT)对68例AD患儿进行鸡蛋和牛奶变应原的诊断性检测,并以开放性食物激发试验验证.结果 本组68例AD患儿中,经食物激发试验证实鸡蛋过敏58例(85.3%),牛奶过敏40例(58.8%),两者同时过敏34例(50.0%).98例阳性食物激发试验47例表现为迟发反应,10例为速发反应,41例为混合反应.APT诊断鸡蛋(牛奶)过敏的敏感性、特异性、阳性预测值、阴性预测值和与食物激发试验的一致率分别为96.6%(67.5%)、90.0%(82.1%)、98.2%(84.4%)、81.8%(63.9%)和95.6%(73.5%),而SPT为37.9%(30.0%)、100.0%(89.3%)、100.0%(80.0%)、21.7%(47.2%)和47.1%(54.4%).APT诊断迟发反应的阳性率显著高于SPT(P<0.01). APT、SPT联合与APT单独应用在诊断鸡蛋和牛奶过敏的差异无统计学意义(并联诊断与APT单独诊断敏感性比较:鸡蛋x2=0.509,牛奶x2=0.549,P>0.05;串联诊断与APT单独诊断特异性比较:鸡蛋P=1.000,牛奶x2=3.514,P>0.05).结论 APT对以迟发反应为主要临床表现的食物过敏的诊断价值显著优于SPT.联合APT和SPT较之单独应用APT并不能提高诊断AD鸡蛋/牛奶过敏的效能.     

特应性斑贴试验在诊断特应性皮炎患儿鸡蛋、牛奶过敏中的价值

目的 探讨特应性斑贴试验（APT）在诊断特应性皮炎（AD）患儿食物过敏中的价值。方法 以中国儿童最常见的过敏食物--鸡蛋、牛奶为抗原,同时采用APT和皮肤点刺试验（SPT）对68例AD患儿进行鸡蛋和牛奶变应原的诊断性检测,并以开放性食物激发试验验证。结果 本组68例AD患儿中,经食物激发试验证实鸡蛋过敏58例（85.3%）,牛奶过敏40例（58.8%）,两者同时过敏34例（50.0%）。98例阳性食物激发试验47例表现为迟发反应,10例为速发反应,41例为混合反应。APT诊断鸡蛋（牛奶）过敏的敏感性、特异性、阳性预测值、阴性预测值和与食物激发试验的一致率分别为96.6%（67.5%）、 90.0%（82.1%）、98.2%（84.4%）、81.8%（63.9%）和95.6%（73.5%）,而SPT为37.9%（30.0%）、100.0%（89.3%）、100.0%（80.0%）、21.7%（47.2%）和47.1%（54.4%）。APT诊断迟发反应的阳性率显著高于SPT（P < 0.01）。APT、SPT联合与APT单独应用在诊断鸡蛋和牛奶过敏的差异无统计学意义（并联诊断与APT单独诊断敏感性比较：鸡蛋χ2 = 0.509,牛奶χ2 = 0.549,P > 0.05;串联诊断与APT单独诊断特异性比较：鸡蛋P = 1.000,牛奶χ2 = 3.514,P > 0.05）。结论 APT对以迟发反应为主要临床表现的食物过敏的诊断价值显著优于SPT。联合APT和SPT较之单独应用APT并不能提高诊断AD鸡蛋/牛奶过敏的效能。     

特应性皮炎患者尘螨特应性斑贴试验结果分析

目的 分析尘螨变应原不同蛋白浓度的特应性斑贴试验结果,并对诊断价值进行评价.方法 85例特应性皮炎患者,以两个厂家提供的变应原原液进行尘螨变应原的特应性斑贴试验(APT),同时以尘螨变应原的皮肤点刺试验(SPT)及血清特异性IgE测定(SIgE)作为对照,比较APT、SPT、SIgE测定的灵敏度、特异度及阳性预测值,并比较5组不同浓度变应原(3 000、5 000、7 000、10 000、12 000 pnu/g)APT结果,及两个厂家提供的变应原原液间的差异.结果 以SIgE为金标准.1组:APT、SPT检测尘螨的灵敏度分别为79.41％、73.53％;特异度分别为76.12％、80.95％;阳性预测值分别为64.29％、67.57％.2组:APT、SPT检测尘螨的灵敏度分别为81.53％、76.02％;特异度分别为77.78％、79.85％;阳性预测值分别为65.09％、66.07％.以SPT为金标准.1组:APT、SIgE检测尘螨的灵敏度分别为78.38％、67.57％;特异度分别为77.42％、84.21％;阳性预测值分别为67.44％、73.53％.2组:APT、SIgE检测尘螨的灵敏度分别为79.25％、61.07％;特异度分别为80.63％、82.54％;阳性预测值分别为69.55％、77.21％.两组试剂间差异无统计学意义.另外,5种不同浓度的阳性率分别为1组:8.24％、22.35％、29.41％、44.71％、41.18％;2组:3.53％、23.53％、31.76％、34.12％、35.29％,两组试剂间差异无统计学意义(P＞0.05).而两组试剂的各组间APT阳性率差异有统计学意义(P＜0.05),即尘螨变应原浓度的增加会提高APT阳性率,但当浓度达到一定值后阳性率升高不明显.结论 APT诊断尘螨变应原的灵敏度较高,增加变应原蛋白浓度可提高APT阳性率,但达到适宜浓度后阳性率不再升高.     

特应性斑贴试验的临床应用

对特应性斑贴试验的临床研究发现，特应性斑贴试验在特应性皮炎变应原的诊断、发病机理的探讨以及治疗和预防效果的评估方面均表现出较高的临床价值。目前临床应用特应性斑贴试验时亟待解决的问题是其方法学的标准化。     

光疗在特应性皮炎中的研究进展

特应性皮炎（atopicdermatitis,AD）是一种慢性、复发性、炎症性皮肤病。其发病与遗传和环境关系密切,心理因素也可发挥一定作用。现有的治疗药物包括糖皮质激素、钙调神经磷酸酶抑制剂、抗组胺药物、Janus激酶抑制剂及生物制剂等。以上药物在起效的同时常可伴有一些不良反应。光疗作为安全有效的治疗方法,不良反应较少,不仅能达到有效缓解AD临床表现及症状的目的,在调整AD患者的心理健康方面也可能发挥作用。该文综述光疗在AD中治疗机制、治疗方法、不良反应及其在成人和特殊人群中的治疗进展,为临床医师提供应用指导。     

食物过敏与儿童特应性皮炎相关性及其诊断

大约1/3中到重度特应性皮炎患儿存在食物过敏,但食物过敏是否会诱发或加重特应性皮炎患儿的湿疹样皮损仍存在争议.食物过敏可以诱发特应性皮炎患儿的两种反应,非湿疹样反应和湿疹样反应.前者为IgE介导,诊断相对比较简单,多数情况下借助病史、皮肤点刺试验及特异性IgE抗体水平等即可明确诊断.后者为细胞介导,诊断必须借助口服食物激发试验.如果没有条件做食物激发试验时,也可以借助诊断性的饮食回避来明确可疑过敏食物.     

食物过敏与儿童特应性皮炎相关性及其诊断

大约1/3中到重度特应性皮炎患儿存在食物过敏,但食物过敏是否会诱发或加重特应性皮炎患儿的湿疹样皮损仍存在争议.食物过敏可以诱发特应性皮炎患儿的两种反应,非湿疹样反应和湿疹样反应.前者为IgE介导,诊断相对比较简单,多数情况下借助病史、皮肤点刺试验及特异性IgE抗体水平等即可明确诊断.后者为细胞介导,诊断必须借助口服食物激发试验.如果没有条件做食物激发试验时,也可以借助诊断性的饮食回避来明确可疑过敏食物.     

特应性斑贴试验的临床应用

对特应性斑贴试验的临床研究发现 ,特应性斑贴试验在特应性皮炎变应原的诊断、发病机理的探讨以及治疗和预防效果的评估方面均表现出较高的临床价值。目前临床应用特应性斑贴试验时亟待解决的问题是其方法学的标准化     

特应性皮炎某些免疫学进展

特应性皮炎是一种瘙痒性、炎症性的皮肤病,常始发于婴幼儿时期,呈慢性反复发作的病程,现认为是特应件体质(遗传过敏体质)早期的临床表现.特应性皮炎可分为两种类型:外源型和内源型,均有嗜酸粒细胞增多.获得性免疫方而涉及常驻细胞和浸润细胞间一系列复杂的相互作用,由多种促炎症细胞因子和趋化因子构成的复杂网络所介导.天然免疫缺陷可能导致微生物定植、感染皮肤.     

特应性皮炎光疗进展

特应性皮炎(atopic dermatitis,AD)是一种具有家族遗传倾向的慢性、复发性、炎症性皮肤病.光疗法在AD的治疗中一直占有较为重要的地位.近年来随着对AD病因学和发病机制的深入了解,以及光疗法在皮肤科应用研究的进展,AD的光治疗法有了一些新策略,现将其作一概述.     

Patch testing with egg represents a useful integration to diagnosis of egg allergy in children with atopic dermatitis

Our aim was to investigate atopy patch and skin prick test reactions to egg in 85 children with atopic dermatitis, and to evaluate their relevance by performing repeated open challenges with egg. Thirty-one percent of our patients showed an eczematous response to the challenge. Positive reactions to atopy patch and skin prick tests were recorded in 37% and 19%, respectively. Atopy patch test sensitivity proved significantly higher than that of skin prick test (79.6% vs. 46.2%), whereas specificity was lower (81.4% vs. 93.2%). Our data suggest that combined skin prick and patch testing improves screening for egg allergy in affected children, identifying 92% of those who were challenge positive among our patients.     

皮炎湿疹类皮肤病斑贴试验69例分析

本文对６９例皮炎湿疹类患者以１９项２６种抗原进行斑试，结果表明４８小时阳性率６０．９％，７２小时总阳性率４０．６％。４０例具有过敏素质者阳性率为６７．５％，提示本法是寻找本组疾病致敏原的可靠方法，其主要致敏原是对苯二胺１２例、香料（含Ｉ、Ⅱ）１０例、橡胶（含Ｉ、Ⅱ）９例、重铬酸钾７例及硫酸镍４例。     

A method for the analysis of milk and egg allergens for the atopy patch test

Abstract:  The patch test with food antigens (atopy patch test, APT) has been reported as a more specific method than prick or RAST for the early detection of cow's milk and/or egg sensitizations in children. Standardization of APT extracts is a major issue on the road towards full clinical exploitation of this assay. Here, we used sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) to characterize sensitivity and specificity of commercial preparations of APT for milk and egg allergies, which are expected to improve the reliability of this test, when compared with fresh food allergen sources. We found that: (i) SDS-PAGE is an appropriate technique for quality control of APT and (ii) commercial milk and egg APT are equivalent to fresh food preparations in terms of allergen content. Clinical trials aimed at characterizing sensitivity and specificity of APT in the diagnosis of food allergy in children will benefit from this technique.     

Epicutaneous patch test reactions in atopic dermatitis patients

During the 1998-2003 period, patch testing was carried out in 65 atopic dermatitis patients, 20 (31%) male and 45 (69%) female, mean age 34.7 (range 6-77) years. Twenty-six (40%) patients, 7 (27%) male and 19 (73%) female, showed positive reaction to one or more allergens. Allergic reactions were more common in women. The most common allergens were nickel (33.3%), cobalt (11.1%), fragrance mix (11.1%), white mercury precipitate (8.4%), and others (36.1%). There was a significant association between nickel allergy and cobalt allergy. It is concluded that contact hypersensitivity is not rare in patients with atopic dermatitis.     

Adult-onset atopic dermatitis in a patch test population

BACKGROUND: Epidemiological studies about atopic dermatitis (AD) almost exclusively relate to childhood disease with little mention of adult-onset disease. In clinical practice, however, patients who have AD and in whom the onset of disease occurs in adult life are sometimes seen. OBJECTIVE: Because the subjects with a chronic and recalcitrant eczema are frequently patch tested, the aim of this study was to evaluate the prevalence of adult-onset AD in a patch test population and the differences existing between the early- and adult-onset subsets. METHODS: This retrospective analysis was performed on 502 adults (458 males, 44 females) affected by eczematous dermatitis, consecutively examined in the Department of Dermatology of the Italian Navy Hospital in Taranto. In this department, all the eczematous subjects are routinely submitted to the following tests: standard series (GIRDCA or SIDAPA with integrative haptens), prick test with environmental aeroallergens and common food allergens and dosage of total serum IgE. If it is required, additional series of patch tests are also applied. Many patients are also submitted to the atopy patch test (APT) with whole bodies of house dust mites at a concentration of 20%. In the AD patients, diagnosed according to the criteria of Hanifin and Rajka, the ages of onset were subdivided into the following categories: infancy (0-3 years); childhood (4-11 years); adolescence (> or =12 years). We arbitrarily also used the age of 18 years as the cut-off mark to allocate the patients to the adult-onset group (AOG) and defined as early-onset group (EOG) the cases encompassed in the aforesaid categories (i.e. onset < or =17 years). RESULTS: 8.8% of all eczemas were adult-onset ADs. 28 (5.6% of all eczemas) adult-onset ADs were 'sole' ADs, while 22 cases (3.2% of all eczemas) were adult-onset ADs in which a contact sensitization was detected. The mean SCORAD indexes, according to the age-of-onset groups, decreased when the age of onset increased. No statistical difference was detected between the EOG and AOG with regard to true contact sensitization, clinically relevant or non-relevant contact sensitization, prevalence of 'pure' AD and 'mixed' AD, and outcome of the APT. The hands were the most frequently affected site in the AOG. CONCLUSION: A small but significant number of patch-test-negative eczematous cases could be adult-onset ADs and, in this instance, the other two allergological tests (i.e. prick tests and dosage of total serum IgE) and an accurate evaluation according to stated clinical criteria should be performed. However, other studies on large series of patients are required to confirm our observation.