原標(biāo)題：過(guò)敏原組分分析是診斷和治療職業(yè)性過(guò)敏的一種手段
要點(diǎn)
　　目前已鑒定出400多種職業(yè)致敏劑，但其中只有少數(shù)被進(jìn)行在分子水平上的特征描述。
天然膠乳(NRL)過(guò)敏是利用重組主要變應(yīng)原改善sIgE測(cè)定的一個(gè)很好的范例。
面包師哮喘患者的IgE 致敏情況顯示出很大的個(gè)體間差異。
對(duì)于面包師哮喘的診斷，基于提取的診斷仍然是推薦的。
增加職業(yè)過(guò)敏原的知識(shí)，并在臨床實(shí)踐中實(shí)施和評(píng)估標(biāo)準(zhǔn)化的工具是必要的
概述
　　我們正處于“分子變應(yīng)學(xué)”的時(shí)代，大量臨床相關(guān)的變應(yīng)原分子可用于改善體外變應(yīng)原試驗(yàn)和變應(yīng)原檢測(cè)方法的性能。本文綜述了職業(yè)性變應(yīng)原的特征及其在職業(yè)性變態(tài)反應(yīng)的體外診斷和變應(yīng)原檢測(cè)中的應(yīng)用。
超過(guò)400種職業(yè)性致敏劑被鑒定為“呼吸敏化劑”，但目前只有有限數(shù)量的過(guò)敏原在分子水平上被鑒定并能以天然或重組過(guò)敏原的形式用于常規(guī)診斷。但有一個(gè)例外，即來(lái)自巴西橡膠樹(shù)的天然膠乳(NRL)仍然是重要的職業(yè)性過(guò)敏原來(lái)源。
對(duì)15個(gè)天然橡膠乳膠（NRL）變應(yīng)原的表征導(dǎo)致了對(duì)NRL材料中過(guò)敏原含量測(cè)定方法的發(fā)展和針對(duì)特異性IgE抗體測(cè)定的組分診斷(component- resolution diagnosis, CRD)的出現(xiàn)。使用重組或天然過(guò)敏原的微陣列芯片或單點(diǎn)檢測(cè)是診斷NRL過(guò)敏的可靠工具。
此外，NRL過(guò)敏是一種利用穩(wěn)定的重組主要變應(yīng)原rHev b5擴(kuò)增NRL提取物制劑改進(jìn)基于提取物的特異性IgE測(cè)定的優(yōu)良模式。盡管人們做了很多努力來(lái)確定與職業(yè)相關(guān)的小麥過(guò)敏原對(duì)面包師哮喘的影響，但結(jié)果卻非常多樣化。面包師哮喘是最常見(jiàn)的職業(yè)性哮喘。
面包師傅的小麥致敏譜表現(xiàn)出較大的個(gè)體差異，沒(méi)有一種小麥過(guò)敏原能被認(rèn)為是主要過(guò)敏原。對(duì)于面包師哮喘的診斷，全麥提取物仍然是特異性IgE測(cè)定的最佳選擇。但是單一的小麥過(guò)敏原可能有助于區(qū)分小麥引起的食物過(guò)敏、草花粉過(guò)敏和面包師哮喘。對(duì)于工作場(chǎng)所相關(guān)的過(guò)敏原，如咖啡、木材、大豆、海鮮和霉菌等，過(guò)敏原雖被表征，但很少有可用的，其與職業(yè)致敏途徑的相關(guān)性有待進(jìn)一步研究驗(yàn)證。
延伸閱讀
Molecular Immunology                              
Allergen component analysis as a tool in the diagnosis and management of occupational allergy
https://doi.org/10.1016/j.molimm.2018.03.013
Highlights
More than 400 occupational sensitizers are identified, but only a limited number of them are characterized on the molecular level.
Natural rubber latex (NRL) allergy is an excellent model for improving sIgE measurement with recombinant major allergen.
IgE-sensitization profile in patients with baker’s asthma showed great inter-individual variation.
For diagnosis of baker’s asthma extract-based diagnostic is still recommended.
Increasing the knowledge of occupational allergens and implement and evaluate standardized tools in clinical practice is necessary.
Abstract
We are now in the epoch of “molecular allergology” and numerous clinically relevant allergenic molecules are available improving the performance of in vitro allergen tests and allergen detection methods. This review is focusing on characterized occupational allergens and their implementation into the in vitro diagnosis for occupational allergy and in allergen detection methods.
More than 400 occupational agents are identified and documented as being ‘respiratory sensitizers’, but currently only a limited number of them are characterized on the molecular level and available for routine diagnosis as native or recombinant allergens. One exception, however, is natural rubber latex (NRL) from Hevea brasiliensis still remaining an important occupational allergen source.
Characterization of 15 NRL allergens led to the development of assays for the determination of allergen content of NRL materials and the implementation of component-resolved diagnosis (CRD) for specific IgE antibody measurement. Microarray or singleplex using recombinant or native allergens are reliable tools for NRL allergy diagnosis.
In addition, NRL allergy is an excellent model for improving extract-based specific IgE measurement by amplification of NRL extract preparation with stable recombinant major allergen rHev b 5. Despite the many efforts to characterize the occupationally relevant wheat allergens for baker’s asthma, the most frequently occurring forms of occupational asthma, the results are highly diverse.
Wheat sensitization profiles of bakers showed great interindividual variability and no wheat allergen could be classified as the major allergen. For diagnosis of baker’s asthma, a whole wheat extract is still the best option for specific IgE determination. But single wheat allergens might help to discriminate between wheat-induced food allergy, grass pollen allergy and baker’s asthma. For workplace-related allergens like coffee, wood, soybean, seafood and moulds allergens are characterized and few of them are available, but their relevance for occupational sensitization routes should be verified in the further studies.
Author:
MonikaRaulf
　　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)敏患者提供專業(yè)診斷、治療、預(yù)防的共享平臺(tái)。