原標(biāo)題:病例報(bào)告:用組份診斷重新評(píng)價(jià)一個(gè)之前診斷為榛子過(guò)敏病例
——來(lái)自浙大迪迅
我們報(bào)道了過(guò)敏門(mén)診對(duì)一個(gè)11歲女孩進(jìn)行的榛子過(guò)敏的重新評(píng)價(jià)。在嬰兒期,她成功地進(jìn)行了對(duì)牛奶、雞蛋的脫敏。隨后,她在另一個(gè)過(guò)敏門(mén)診,根據(jù)皮膚點(diǎn)刺試驗(yàn)和特異性IgE的含量,被建議嚴(yán)格規(guī)避花生和所有樹(shù)堅(jiān)果的食用,盡管臨床病史并沒(méi)有提示有樹(shù)堅(jiān)果的過(guò)敏。由于存在對(duì)樹(shù)堅(jiān)果的嚴(yán)重反應(yīng)的風(fēng)險(xiǎn),她還被提供一個(gè)自動(dòng)注射的腎上腺素注射劑,但是上述處置并沒(méi)有經(jīng)過(guò)食物挑戰(zhàn)試驗(yàn)的確認(rèn)。
第一次來(lái)我們過(guò)敏門(mén)診時(shí),女孩的母親給我們看了一個(gè)ISAC (Immuno Solid-phase Allergen Chip)試驗(yàn),操作特異性IgE檢測(cè)的同事建議得到更清晰的變態(tài)反應(yīng)結(jié)果。這次試驗(yàn)結(jié)果顯示,對(duì)塵螨、榛子、樺樹(shù)和草花粉中度陽(yáng)性,對(duì)Jugr3中度陽(yáng)性,對(duì)Cora1只是輕度陽(yáng)性。其它所有的花生和樹(shù)堅(jiān)果過(guò)敏原均陰性。榛子花粉點(diǎn)刺(陽(yáng)性,5mm),榛子提取物點(diǎn)刺試驗(yàn)結(jié)果陰性。因此,進(jìn)行了榛子的食物激發(fā)試驗(yàn),沒(méi)有出現(xiàn)即刻反應(yīng)。從此,食用榛子均無(wú)出現(xiàn)任何異常。
本案例突出了組份診斷在榛子過(guò)敏的診斷中的重要性。另外,我們強(qiáng)調(diào)了食物過(guò)敏診斷中正確診斷的重要性,正確的診斷不僅依賴(lài)于特異性IgE的高低或皮膚點(diǎn)刺試驗(yàn)的結(jié)果,而必需經(jīng)食物激發(fā)試驗(yàn)證實(shí)。
延伸閱讀
Clinical and Translation alAllergy
[IF:6.048]
Case Report: Revaluation of a previously diagnosed hazelnut allergy with component resolved diagnosis (CRD)
DOI:10.1186/2045-7022-4-S2-P39
Abstract:
Introduction
We report a case of an eleven years old girl who was referred to our Allergy Outpatient Clinic for the revaluation of a hazelnut allergy. During her infancy she was successfully desensitised to milk and egg. Afterward she had been followed by another Allergy Unit where, according to skin prick test and specific IgE dosage, it had been suggested to strictly avoid peanut and all treenuts, although clinical history was not suggestive of treenuts allergy. She was also provided with an auto-injectable adrenaline, due to the high risk of severe reactions to treenuts. No oral provocation test was performed to validate diagnosis and adrenaline prescription.
Methods and Results
At her first visit in our Allergy Outpatient Clinic, the girl's mother showed us an ISAC (Immuno Solid-phase Allergen Chip) test, suggested by the colleague who performed the specific IgE dosage to better clarify the allergological results. On this test, a moderate positivity to dust mites, hazel, birch and grass pollen, a moderate positivity to Jugr3 and only a mild positivity to Cora1 were identified. All other peanuts and treenuts allergens were negative. A prick test for hazel pollen (positive, 5 mm) was performed; hazelnut extract , hazelnut with prick-by-prick method all resulted negative. Therefore an oral provocation test was performed with hazelnut and no immediate reactions were observed. In the following days she ate hazelnut without any symptoms.
Conclusion
In this case-report we highlight the important role of CRD in the diagnosis of hazelnut allergy. Moreover, we underline the importance of a correct diagnosis of food allergy which has to rely not only on specific IgE dosage or skin prick test, but should be confirmed by an oral provocation test.
First Author:
Francesca Saretta
All Authors:
Francesca Saretta
Roberto Perini
Elio Tonutti
Daniela Visentini
2018-10-24 Article
創(chuàng)建過(guò)敏性疾病的科研、科普知識(shí)交流平臺(tái),為過(guò)敏患者提供專(zhuān)業(yè)診斷、治療、預(yù)防的共享平臺(tái)。