Hamilton Robert G, Peterson Edward L, Ownby Dennis R
Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
J Allergy Clin Immunol. 2002 Aug;110(2 Suppl):S47-56. doi: 10.1067/mai.2002.125334.
The accurate diagnosis of hypersensitivity to natural rubber latex is the initial step in the effective management of individuals with latex allergy and in ensuring the quality of epidemiologic studies. The diagnostic algorithm used in the evaluation of an individual with suspected latex allergy begins with a comprehensive clinical history during which risk factors (atopy, food allergies, hand dermatitis) and temporal relationships between symptoms and natural rubber product exposure are identified. If type IV hypersensitivity is suspected because of the delayed nature (hours to days) and confinement of symptoms to the skin-latex product contact areas, patch testing can be conducted to confirm the presence of activated T cells with specificity for rubber chemicals. If type I hypersensitivity is suspected because of ocular, upper and lower airway, and/or systemic symptoms that have rapid onset (minutes) after a definable latex exposure, a confirmatory skin or blood test for IgE antibody may be conducted to verify a state of sensitization within the individual. The definitive diagnosis would then be made only after consideration of the individual's clinical history and confirmatory in vivo and/or in vitro laboratory test results. If discordance remains between highly convincing latex-associated symptoms as identified in the history and repetitively negative confirmatory IgE antibody test results, then one of several types of in vivo provocation tests may be performed for adjudication. This overview examines the current state of the art in both in vivo and in vitro diagnostic methods for latex-specific IgE antibody detection in skin and blood. The performance, advantages, and limitations of each diagnostic method are compared.
准确诊断对天然橡胶乳胶的超敏反应是有效管理乳胶过敏个体以及确保流行病学研究质量的第一步。评估疑似乳胶过敏个体时所采用的诊断算法始于全面的临床病史采集，在此过程中确定风险因素（特应性、食物过敏、手部皮炎）以及症状与天然橡胶产品接触之间的时间关系。如果因症状延迟出现（数小时至数天）且局限于皮肤与乳胶产品接触区域而怀疑是IV型超敏反应，则可进行斑贴试验，以确认是否存在对橡胶化学物质具有特异性的活化T细胞。如果因在明确的乳胶接触后迅速出现（数分钟）眼部、上呼吸道和/或下呼吸道及/或全身症状而怀疑是I型超敏反应，则可进行IgE抗体的确诊皮肤或血液检测，以验证个体的致敏状态。只有在考虑个体的临床病史以及确诊的体内和/或体外实验室检测结果后，才能做出明确诊断。如果病史中确定的高度令人信服的乳胶相关症状与反复阴性的确诊IgE抗体检测结果之间仍存在不一致，则可进行几种体内激发试验中的一种以进行判定。本综述探讨了皮肤和血液中乳胶特异性IgE抗体检测的体内和体外诊断方法的当前技术水平。比较了每种诊断方法的性能、优点和局限性。
