原標(biāo)題：基于重組小麥面粉蛋白特異性IgE的面包師過(guò)敏癥的組份診斷
　?、賹?duì)小麥面粉的敏感性在面包師哮喘的進(jìn)展和診斷中扮演重要的角色。②我們對(duì)面包師過(guò)敏癥的致敏物（小麥過(guò)敏原組份）進(jìn)行了評(píng)估，并考慮了與草花粉的交叉反應(yīng)。③以101名面粉過(guò)敏面包師(40名德國(guó)面包師、37名荷蘭面包師、24名西班牙面包師)和29名花粉敏感的對(duì)照受試者（小麥特異性IgE陽(yáng)性但無(wú)職業(yè)暴露）為研究對(duì)象，采用CAP-FEIA法測(cè)定了血清19種重組小麥粉蛋白和2種交叉反應(yīng)碳水化合物特異性IgE的含量。用小麥粉、黑麥粉和草花粉抑制IgE與單組分的結(jié)合。單組份過(guò)敏原和混合過(guò)敏原IgE檢測(cè)的診斷效率是通過(guò)基于ROC分析的識(shí)別面包師過(guò)敏癥患者和對(duì)照受試者的能力來(lái)評(píng)估的。④ 80%的面包師的特異性IgE水平為0.35 kUA/L或更高，91%的面包師的特異性IgE水平為0.1 kUA/L或更高，而且至少對(duì)21種過(guò)敏原中的一種敏感。硫醇還原酶(Tri a 27)和小麥二聚α-定粉酶抑制劑0.19(Tri a 28)被發(fā)現(xiàn)是IgE結(jié)合頻率最高的組份。9個(gè)組分表現(xiàn)出與草花粉存在交叉反應(yīng)，18個(gè)組分與黑麥粉存在交叉反應(yīng)。Tri a 27、Tri a 28,四聚物α-定粉酶抑制劑CM2(Tri a 29.02),絲氨酸蛋白酶抑制劑樣過(guò)敏原(Tri 39),和1-半胱氨酸-類(lèi)過(guò)氧化物酶(Tri a 28),這 5個(gè)組份的IgE聯(lián)合檢測(cè), 在ROC分析中,產(chǎn)生最大曲線下面積(AUC = 0.84)，但這仍低于小麥-黑麥面粉-特異性 IgE的AUC值 (分別是0.89或0.88,)。⑤組分診斷有助于區(qū)分血清小麥特異性IgE陽(yáng)性是由職業(yè)性面粉暴露引起的還是由于與草花粉存在的交叉反應(yīng)引起的。然而，對(duì)面包師過(guò)敏癥的常規(guī)診斷，使用全麥和黑麥面粉提取物進(jìn)行過(guò)敏原特異性IgE檢測(cè)仍然是必需的，因?yàn)槠湓\斷敏感性更高。
延伸閱讀
JACI:
Component-resolved diagnosis of baker's allergy based on specific IgE to recombinant wheat flour proteins?
https://doi.org/10.1016/j.jaci.2014.11.021Abstract:
Background
Sensitization to wheat flour plays an important role in the development and diagnosis of baker's asthma.
Objectives
We evaluated wheat allergen components as sensitizers for bakers with work-related complaints, with consideration of cross-reactivity to grass pollen.
Methods
Nineteen recombinant wheat flour proteins and 2 cross-reactive carbohydrate determinants were tested by using CAP-FEIA in sera of 101 bakers with wheat flour allergy (40 German, 37 Dutch, and 24 Spanish) and 29 pollen-sensitized control subjects with wheat-specific IgE but without occupational exposure. IgE binding to the single components was inhibited with wheat flour, rye flour, and grass pollen. The diagnostic efficiencies of IgE tests with single allergens and combinations were evaluated by assessing their ability to discriminate between patients with baker's allergy and control subjects based on receiver operating characteristic analyses.
Results
Eighty percent of bakers had specific IgE levels of 0.35 kUA/L or greater and 91% had specific IgE levels of 0.1 kUA/L or greater to at least one of the 21 allergens. The highest frequencies of IgE binding were found for thiol reductase (Tri a 27) and the wheat dimeric α-amylase inhibitor 0.19 (Tri a 28). Cross-reactivity to grass pollen was proved for 9 components, and cross-reactivity to rye flour was proved for 18 components. A combination of IgE tests to 5 components, Tri a 27, Tri a 28, tetrameric α-amylase inhibitor CM2 (Tri a 29.02), serine protease inhibitor–like allergen (Tri a 39), and 1-cys-peroxiredoxin (Tri a 32), produced the maximal area under the curve (AUC = 0.84) in receiver operating characteristic analyses, but this was still lower than the AUC for wheat- or rye flour–specific IgE (AUC = 0.89 or 0.88, respectively).
Conclusions
Component-resolved diagnostics help to distinguish between sensitization caused by occupational flour exposure and wheat seropositivity based on cross-reactivity to grass pollen. For routine diagnosis of baker's allergy, however, allergen-specific IgE tests with whole wheat and rye flour extracts remain mandatory because of superior diagnostic sensitivity.
All Author:
IngridSanderPhDaHans-PeterRihsPhDaGertDoekesPhDbSantiagoQuirceMDcEsmeraldaKropPhDbPeterRozynekMScaVeravan KampenPhDaRolfMergetMDaUrsulaMeureraThomasBrüningMDaMonikaRaulfPhDa
　　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)。