評價特應(yīng)性斑貼試驗，皮膚點刺試驗以及總lgE和特異性IgE檢測在牛奶過敏診斷中的應(yīng)用
Ozlem Keskin
Ayfer Tuncer
Gonul Adalioglu
關(guān)于特應(yīng)性斑貼試驗（APT）在食物過敏診斷中的應(yīng)用的信息源于對特應(yīng)性皮炎患兒的研究。
目的
評估APT在牛奶過敏（CMA）診斷中的有效性，以及確定外周血單核細胞產(chǎn)生白細胞介素4和干擾素-γ的有效性。
方法
使用雙盲安慰劑對照食物挑戰(zhàn)（DBPCFCs）以及牛奶特異性IgE，皮膚刺破的表現(xiàn)評估了37名患有疑似CMA且患有多種器官系統(tǒng)癥狀的兒童（中位年齡，11個月）。測試（SPT）和APT確定。為了尋找診斷測試和TH1 / TH2免疫應(yīng)答之間的可能關(guān)系，我們測量了外周血單核細胞培養(yǎng)物上清液中的干擾素-γ和白細胞介素4水平。
結(jié)果
具有陽性DBPCFC結(jié)果的17名兒童和具有過敏反應(yīng)史的6名兒童被診斷為患有CMA。 APT和SPT的聯(lián)合使用靈敏度為100％，陰性預(yù)測值為100％，但特異性為50％，陽性預(yù)測值為76％。向APT和SPT添加乳特異性IgE測定并未改善這些值。細胞因子分泌的模式與APT陽性或?qū)BPCFC的特異性反應(yīng)無關(guān)。
結(jié)論
在特應(yīng)性皮炎以外的過敏性表現(xiàn)的兒童中，特應(yīng)性斑貼試驗可能是SPT排除CMA的有用輔助手段。但是，在存在陽性測試結(jié)果的情況下，DBPCFC仍然是必需的。
以下原文：
Evaluation of the utility of atopy patch testing, skin prick testing, and total and specific IgE assays in the diagnosis of cow's milk allergy
Ozlem Keskin, MD, Ayfer Tuncer, MD, Gonul Adalioglu, MD, Bulent E. Sekerel, MD, Cansin Sackesen, MD, Omer Kalayci, MDcorrespondenceEmail the author MD Omer Kalayci
PlumX Metrics
https://doi.org/10.1016/S1081-1206(10)61133-7
Article Info click to expand contents
Background
Information on the utility of atopy patch testing (APT) in the diagnosis of food allergy is derived from studies of children with atopic dermatitis.
Objective
To evaluate the usefulness of APT in the diagnosis of cow's milk allergy (CMA) and to determine interleukin 4 and interferon-γ production by peripheral blood mononuclear cells.
Methods
Thirty-seven children (median age, 11 months) with suspected CMA who had a variety of symptoms that involved many organ systems were evaluated using double-blind placebo-controlled food challenges (DBPCFCs), and the performances of milk specific IgE, skin prick testing (SPT), and APT were determined. To search for a possible relationship between the diagnostic tests and the TH1/TH2 immune response, we measured interferon-γ and interleukin 4 levels in the supernatants of peripheral blood mononuclear cell cultures.
Results
Seventeen children with positive DBPCFC results and 6 with a history of anaphylaxis were diagnosed as having CMA. The combined use of APT and SPT had a sensitivity of 100% and a negative predictive value of 100% but a specificity of 50% and a positive predictive value of 76%. The addition of milk specific IgE assays to APT and SPT did not improve these values. Pattern of cytokine secretion was not associated with APT positivity or a specific response to DBPCFC.
Conclusions
Atopy patch testing may be a useful adjunct to SPT in excluding CMA in children who have allergic manifestations other than atopic dermatitis. However, DBPCFCs are still necessary in the presence of positive test results.
Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine and Ihsan Dogramaci Children's Hospital, Hacettepe, Ankara, Turkey. This study was funded by grant OOT06101002 from Hacettepe University.