原標(biāo)題：花生組分在IgE介導(dǎo)的花生過(guò)敏的不同人群中的診斷作用
　?、俦尘霸絹?lái)越多的數(shù)據(jù)表明，對(duì)花生組分特異性IgE的分析對(duì)花生過(guò)敏的臨床診斷有一定的幫助，可能比全花生特異性IgE的分析更為準(zhǔn)確。然而，并不是所有研究都使用了前瞻性樣本、多種組分和花生激發(fā)試驗(yàn)。②目的 我們?cè)噲D確定花生組分特異性IgE檢測(cè)在花生過(guò)敏診斷上的作用，使用一個(gè)標(biāo)準(zhǔn)化的商業(yè)化試劑盒，在口服花生激發(fā)試驗(yàn)之前，對(duì)來(lái)自?xún)蓚€(gè)不同國(guó)家不同人群的疑似花生過(guò)敏患者進(jìn)行了檢測(cè)。③方法 對(duì)來(lái)自?xún)蓚€(gè)國(guó)家的4個(gè)不同隊(duì)列過(guò)敏患者的血清，在雙盲安慰劑激發(fā)試驗(yàn)前進(jìn)行全花生提取物特異性IgE和花生組分Ara h 1, 2, 3, 8 特異性IgE檢測(cè)。④結(jié)果 對(duì)患者(n = 167，中位年齡11.7歲，四分位差范圍7-15）血清進(jìn)行全花生及花生組分特異性IgE分析，并完成對(duì)花生的口服食物激發(fā)試驗(yàn)?；ㄉ鶬gE敏感性最高(0.93)，Ara h 2特異性最高(0.92)且陽(yáng)性預(yù)測(cè)值最高(0.94)。通過(guò)ROC分析(曲線(xiàn)下面積，0.84;P < . 05)顯示，Ara h 2的診斷價(jià)值最好。⑤結(jié)論 在疑似花生過(guò)敏的患者中，全花生特異性IgE敏感較好，但特異性不足。在本次抽樣的疑似花生過(guò)敏患者中，Ara h 2特異性IgE檢測(cè)是一種特異更好、更準(zhǔn)確的診斷性檢測(cè)。鑒于每次檢測(cè)不同的情況，引入組分檢測(cè)可以為臨床醫(yī)生提供一種過(guò)敏性疾病診斷的新方法，盡量減少花生激發(fā)試驗(yàn)的應(yīng)用。
延伸閱讀
JACI
The Utility of Peanut Components in the Diagnosis of IgE-Mediated Peanut Allergy Among Distinct Populations
https://doi.org/10.1016/j.jaip.2012.11.002
Background
Increasing data suggest that analysis of IgE to peanut components can be clinically helpful and possibly more accurate than IgE to whole peanut. Not all studies examining this topic, however, have used prospective samples, multiple components, and peanut challenges.
Objective
We sought to determine the utility of peanut component testing, using a standardized, commercially available test done before oral peanut challenge in various populations of patients with suspected peanut allergy from 2 different countries.
Methods
IgE to whole peanut and the recombinant allergen components Ara h 1, 2, 3, and 8 were analyzed from serum samples drawn before double-blind peanut challenge from 4 distinct cohorts of patients with suspected peanut allergy from 2 nations (United States and Sweden).
Results
Patients (n = 167; median age, 11.7 years; interquartile range, 7.0-15.0 years) had serum analyzed for peanut components and completed an oral food challenge to peanut. Although IgE to peanut was the most sensitive test (0.93), Ara h 2 was the most specific (0.92) and provided the best positive predictive value (0.94) of all the tests. Ara h 2 was also the best overall diagnostic test by receiver operating characteristic analysis (area under the curve, 0.84; P < .05).
Conclusions
In patients with suspected peanut allergy, IgE to peanut is a sensitive test but is not specific. IgE to Ara h 2 is a more specific and more accurate diagnostic test in this sampling of patients with suspected peanut allergy. Given each tests attributes, a stepwise approach to testing may provide clinicians with a way to minimize the need for peanut challenges.
All Author:
A.LiebermanMDa?SusanneGlaumannMDbcSofiaBatelsonMDcMagnus P.BorresMD, PhDdeHugh A.SampsonMDaCarolineNilssonMD, PhDbc
　　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)。