原標(biāo)題：從癥狀到分子或從分子到癥狀的過敏診斷：一個臨床比較研究
　　從“癥狀到分子” 的經(jīng)典過敏診斷包括：1）臨床病史，2）皮膚點刺試驗，3）最近的新方法：分子學(xué)過敏診斷。我們的目的是檢驗“從分子到癥狀”這個新的替換方法的診斷的精確性，這個方法在一個回顧性的研究中得到歐洲過敏與臨床免疫學(xué)會的推薦。
　　在應(yīng)用“ISAC- first”方法【即先用免疫固相過敏原芯片112檢測組份特異性IgE隨后進行選擇性的皮膚點刺試驗（SPT）】或SPT-first”方法【即先進行皮膚點刺試驗隨后進行微陣列檢測】的兩處醫(yī)療機構(gòu)中，抽取202例臨床疑似過敏病人的檔案。
　　在過敏的診斷中，ISAC-first程序中進行SPT的機率明顯要少（平均4:14），ISAC-first組中19%，SPT-first組中34%的病人額外的吸入過敏原ISAC微陣列檢測為陰性(p?=?0.014)。ISAC-first 組中有18%的額外ISAC微陣列檢測敏感性，而SPT-first組中有32%的額外ISAC微陣列檢測敏感性(p?=?0.016)。在兩組中，食物過敏原13%和12%額外敏感性被微陣列而不是被皮膚點刺試驗檢測到(p?=?0.800)。ISAC-first組中，沒有額外食物過敏原被SPT發(fā)現(xiàn)，而在SPT- first組中一級陽性（+）病例的6%在微陣列中檢測結(jié)果為陰性。
　　ISAC-first隨后（很少）進行SPT的過敏診斷方法迎合病人特定的需求，因此能被認為相當(dāng)于把皮膚點刺試驗作為首選隨后進行IgE檢測的傳統(tǒng)的過敏篩查方法。
　　對臨床疑似過敏的診斷確認， 新理念“從分子到臨床”在較短時間內(nèi)提供了一個可靠的診斷方法。由于其需要點刺的病例較少，特別適用于幼兒和年長者，特應(yīng)性病人以及皮試困難或結(jié)果不可靠的病人。


　　延伸閱讀
World Allergy Organization journal
Allergy diagnosis from symptoms to molecules, or from molecules to symptoms: a comparative clinical study
DOI: doi.org/10.1186/s40413-018-0199-y
Abstract:
Abstract
Background
Classical allergy diagnostic workup “from symptoms to molecules” comprises 1) clinical investigation, 2) skin prick- and IgE- testing, and recently, 3) molecular allergy testing. We aimed to examine the diagnostic fidelity of the alternative approach “from molecules to symptoms”, which was recently suggested in the EAACI Molecular Allergology User’s Guide, in a retrospective clinical study.
Methods
Records from 202 patients with clinically suspected allergic sensitizations were extracted from files at two sites applying either the “ISAC-first” workup with IgE-testing by immuno-solid phase allergen chip ISAC112 followed by selected skin prick tests (SPT) or the “SPT-first” starting with SPT followed by the microarray test.
Results
In the ISAC-first procedure significantly less SPTs were performed during allergy diagnosis (median 4 vs. 14). By SPT in 19% of patients in the ISAC-first group and in 34% in the SPT-first group additional respiratory allergens (p?=?0.014) were detected not positive in ISAC microarray. By ISAC microarray test 18% additional sensitizations were found in the ISAC-first, and 32% in SPT-first cohort (p?=?0.016). For food allergens 13 and 12% additional sensitizations were detected by the microarray not detected by SPT in the two groups (p?=?0.800). No additional food allergen was found by SPT in the ISAC-first group, while in 6% of the cases in the SPT-first group detected sensitizations were negative in the microarray.
Discussion
The ISAC-first approach followed by (fewer) SPTs meets the demands for a patient’s tailored diagnostic work-up and therefore can be considered equivalent to the conventional way using the skin prick test as first screening tool, followed by IgE diagnosis.
Conclusions
For the diagnostic verification of clinically suspected allergy, the novel concept “from molecules to clinic” offers a reliable diagnostic workup in shorter time. Due to lower skin test numbers it is especially applicable for young children and seniors, in atopic patients, and whenever skin tests get difficult or unreliable.
First Author:
N. Mothes-Luksch
Correspondence:
Jensen-Jarolim
All Authors:
N. Mothes-Luksch G. Jordakieva, L. Hinterh?lzl , A. N. Jensen  P. K. Hallmann,  M. KundianE. Jensen-Jarolim
　　創(chuàng)建過敏性疾病的科研、科普知識交流平臺，為過敏患者提供專業(yè)診斷、治療、預(yù)防的共享平臺。