Sabroe R A, Grattan C E, Francis D M, Barr R M, Kobza Black A, Greaves M W
Professorial Unit, St John's Institute of Dermatology, UMDS, St Thomas' Hospital, London SE1 7EH, U.K.
Br J Dermatol. 1999 Mar;140(3):446-52. doi: 10.1046/j.1365-2133.1999.02707.x.
One-third of patients with chronic idiopathic urticaria (CIU) have circulating functional autoantibodies against the high affinity IgE receptor FcepsilonRI, or IgE. The intradermal injection of autologous serum causes a weal and flare reaction in many patients with CIU, and this reaction forms the basis of the autologous serum skin test (ASST). We have determined the parameters of the ASST which define the optimal sensitivity and specificity for the identification of patients with autoantibodies. Two physicians (R.A. S. and C.E.H.G.) performed ASSTs in a total of 155 patients with CIU, 40 healthy control subjects, 15 patients with dermographism, nine with cholinergic urticaria and 10 with atopic eczema. Patients were classified as having functional autoantibodies by demonstrating in vitro serum-evoked histamine release from the basophils of two healthy donors. There were significant differences (P < 0.001) in the mean weal diameter, weal volume, weal redness and flare area of the intradermal serum-induced cutaneous responses at 30 min between patients with CIU with autoantibodies and either those without autoantibodies or control subjects. The optimum combined sensitivity and specificity of the ASST was obtained if a positive test was defined as a red serum-induced weal with a diameter of >/= 1.5 mm than the saline-induced response at 30 min. For R.A.S. and C.E.H.G., the ASST sensitivity was 65% and 71% and specificity was 81% and 78%, respectively. Using these criteria, the following subjects had positive ASSTs: none of 15 dermographics, none of 10 atopics, one of nine cholinergics and one of 40 controls.
三分之一的慢性特发性荨麻疹（CIU）患者体内存在针对高亲和力IgE受体FcepsilonRI或IgE的循环功能性自身抗体。对许多CIU患者进行皮内注射自体血清会引发风团和潮红反应，而这种反应构成了自体血清皮肤试验（ASST）的基础。我们已经确定了ASST的参数，这些参数定义了用于识别自身抗体患者的最佳敏感性和特异性。两位医生（R.A.S.和C.E.H.G.）对总共155例CIU患者、40名健康对照者、15例皮肤划痕症患者、9例胆碱能性荨麻疹患者和10例特应性皮炎患者进行了ASST。通过证明体外血清诱发两名健康供体嗜碱性粒细胞释放组胺，将患者分类为具有功能性自身抗体。在30分钟时，CIU伴自身抗体患者与无自身抗体患者或对照者之间，皮内血清诱导的皮肤反应的平均风团直径、风团体积、风团发红和潮红面积存在显著差异（P < 0.001）。如果将阳性试验定义为血清诱导的红色风团直径比30分钟时盐水诱导的反应直径≥1.5 mm，则ASST可获得最佳的综合敏感性和特异性。对于R.A.S.和C.E.H.G.，ASST的敏感性分别为65%和71%，特异性分别为81%和78%。使用这些标准，以下受试者ASST呈阳性：15例皮肤划痕症患者中无一例，10例特应性皮炎患者中无一例，9例胆碱能性荨麻疹患者中有1例，40名对照者中有1例。
