Fiocchi Alessandro, Bouygue Gabriel R, Terracciano Luigi, Sarratud Teresita, Martelli Alberto
Department of Child and Maternal Medicine, The Melloni University Hospital, University of Milan Medical School, 52 Via Melloni, 20129 Milan, Italy.
Allergy Asthma Proc. 2006 Jul-Aug;27(4):306-11. doi: 10.2500/aap.2006.27.2924.
When a child presents with an allergic symptom, the general pediatrician needs to discriminate which patient has to be sent to the specialist for an allergologic evaluation. If referred, the child will undergo not only skin-prick test, but also more complex specialistic evaluations that we define here as "the march of allergic children." The objective of this article is to overview the clinical evidence about possible diagnostic interventions to avoid unuseful referrals of children reported with allergy from the general to the specialist level. Data sources include PubMed, using a search algorithm selecting for diagnostic studies of respiratory and food allergy in all children to August 2005. Also included are commentaries based on the authors' clinical experience in the allergy unit of a University Hospital in Italy. No study prospectively assessed the rule-out efficacy of clinical history, physical evaluation, and skin-prick test panels on the allergic disease. Three prospective studies on in vitro panels of specific IgE sensitization matched entry criteria. Diverse trial designs and diagnostic criteria precluded meta-analytic methods. The use of in vitro panels proved effective in ruling out the allergic condition in children. The screening efficacy of panels of food and respiratory skin-prick tests remains to be evaluated. With sensitivities and negative predictive values exceeding 90%, in vitro panels can inform the decisions of pediatricians in their capacity as gateway to specialist care. Avoiding the march of allergic children from the GPs to the secondary level is a more realistic goal than preventing the allergic march.
当儿童出现过敏症状时，普通儿科医生需要辨别哪些患者需要转诊给专科医生进行过敏学评估。如果转诊，儿童不仅要接受皮肤点刺试验，还要接受更复杂的专科评估，我们在此将其定义为“过敏儿童的诊疗流程”。本文的目的是概述关于可能的诊断干预措施的临床证据，以避免将报告有过敏症状的儿童从普通科室不必要地转诊到专科科室。数据来源包括PubMed，使用搜索算法筛选截至2005年8月所有儿童的呼吸道和食物过敏诊断研究。还包括基于作者在意大利一家大学医院过敏科临床经验的评论。没有研究前瞻性地评估临床病史、体格检查和皮肤点刺试验组合对过敏性疾病的排除效果。三项关于特异性IgE致敏体外检测组合的前瞻性研究符合纳入标准。不同的试验设计和诊断标准排除了荟萃分析方法。体外检测组合被证明在排除儿童过敏状况方面有效。食物和呼吸道皮肤点刺试验组合的筛查效果仍有待评估。由于敏感度和阴性预测值超过90%，体外检测组合可为儿科医生作为专科护理把关者的决策提供参考。避免过敏儿童从全科医生处转诊到二级科室是一个比预防过敏进程更现实的目标。
