Hill D J, Hosking C S, Reyes-Benito L V
Department of Allergy, Royal Children's Hospital, Flemington Road, Melbourne, Victoria 3052, Australia.
Clin Exp Allergy. 2001 Jul;31(7):1031-5. doi: 10.1046/j.1365-2222.2001.01113.x.
Double-blind placebo-controlled food challenges (DBPCFC), the gold standard for the diagnosis of food hypersensitivity, are time-consuming and not without risk. We have recently reported skin prick test (SPT) weal diameters to cow's milk, egg and peanut above which infants and young children referred for investigation of suspected food allergy showed an adverse reaction on food challenge. We have termed these the "100% diagnostic SPT levels". In this study, we compare in vivo with in vitro measurement of IgE antibody levels to three common food allergens--cow's milk, egg and peanut--in infants and young children with suspected food allergy, in order to reduce the need for food challenges.
SPT and Enzyme Allergo-sorbent Test (EAST) (from 1992 to 1998) and CAP values (from 1999 to 2000) were performed in 820 children < 2 years of age with suspected allergy to cow's milk and/or egg and/or peanut. SPT levels previously shown to be diagnostic of challenge-proven allergy to cow's milk, egg and peanut were used as the "100% diagnostic SPT levels" and compared with EAST and CAP values associated with IgE food allergy according to the manufacturer's definition.
McNemar's test showed a significant difference between the "100% diagnostic SPT levels" and positive EAST in identifying patients who did not require food challenge for cow's milk (P = 0.01), egg (P < 10-6) and peanut (P < 10-6), and a significant difference between the "100% diagnostic SPT levels" and positive CAP (P < 10-6) for egg and peanut but not cow's milk. Twenty-three per cent of food challenges which, based on the results of EAST and CAP, would have been necessary to confirm the diagnosis of food allergy were avoided by the use of the "100% diagnostic SPT levels" .
The use of the "100% diagnostic SPT levels" compared with in vitro measurement of IgE antibody to cow's milk, egg and peanut reduces the need for food challenge in young children with suspected food allergy.
双盲安慰剂对照食物激发试验（DBPCFC）是诊断食物过敏的金标准，但耗时且存在风险。我们最近报道了对牛奶、鸡蛋和花生的皮肤点刺试验（SPT）风团直径，超过该直径的疑似食物过敏婴幼儿在食物激发试验中出现了不良反应。我们将这些称为“100%诊断性SPT水平”。在本研究中，我们比较了疑似食物过敏婴幼儿体内针对三种常见食物过敏原——牛奶、鸡蛋和花生——的IgE抗体水平的体内测量值与体外测量值，以减少食物激发试验的需求。
对820名2岁以下疑似对牛奶和/或鸡蛋和/或花生过敏的儿童进行了SPT以及酶联免疫吸附试验（EAST）（1992年至1998年）和化学发光免疫分析法（CAP）检测（1999年至2000年）。先前显示可诊断经激发试验证实的牛奶、鸡蛋和花生过敏的SPT水平被用作“100%诊断性SPT水平”，并与根据制造商定义与IgE食物过敏相关的EAST和CAP值进行比较。
McNemar检验显示，在识别无需进行牛奶（P = 0.01）、鸡蛋（P < 10⁻⁶）和花生（P < 10⁻⁶）食物激发试验的患者方面，“100%诊断性SPT水平”与阳性EAST之间存在显著差异，对于鸡蛋和花生，“100%诊断性SPT水平”与阳性CAP之间存在显著差异（P < 10⁻⁶），但牛奶不存在此差异。通过使用“100%诊断性SPT水平”，基于EAST和CAP结果原本需要进行以确诊食物过敏的食物激发试验中有23%得以避免。
与针对牛奶、鸡蛋和花生的IgE抗体体外测量值相比，使用“100%诊断性SPT水平”可减少疑似食物过敏幼儿的食物激发试验需求。
