Yin Jia, Wang Rui-qi, He Hai-juan, Xu Tao, Yue Feng-min, Wang Liang-lu, Zhang Hong-yu, Ye Shi-tai
Department of Allergy, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Yi Xue Za Zhi. 2006 Jul 18;86(27):1906-11.
To evaluate the values of intradermal skin test (IDT) and serum specific IgE detection in diagnosing Humulus scandens sensitivity in Chinese patients with autumnal hay fever.
1150 patients, 504 males and 646 females, aged 5 approximately 75, were evaluated as with autumnal rhinitis and asthma by experienced physicians. Then the patients underwent IDT by using 20 kinds of aeroallergen extracts, at the concentration of 1:1000 (w/v) for Artemisia spp. and ragweed or at the concentration of 1:100 (w/v) for Humulus scandens and others. The Humulus sIgE level was performed in all patients. A diagnosing criteria was established according to typical history, symptoms, and any one of the following findings: (1) wheal > or = 5 mm in diameter by IDT and sIgE to Humulus of the concentration > or = 0.35 kUa/L at same time; (2) wheal > or = 10 mm in diameter by IDT alone; and (3) sIgE to Humulus of the concentration > or = 0.70 kUa/L alone.
When using the above diagnosing criteria as the reference standard, IDT had better sensitivity (97.2%), positive predictive value (PV+) (77.9%), negative predictive value (PV-) (90.6%) and efficiency (80.4% than using sIgE > or = 0.35 kUa/L alone as the reference criteria of IDT, however, had a lower specificity (49.8%); and sIgE detection had better sensitivity (89.0%), specificity (97.5%), PV+ (98.8%), PV- (88.0%) and efficiency (92.0%) than using wheal > or = 5 mm in diameter alone as the reference criteria of sIgE detection. The false positive rate of IDT decreased from 59.9% to 17.4% when using wheal diameter > or = 10 mm as the positive criteria. In the 288 patients with a negative sIgE result and a positive IDT result 84 cases had stronger positive IDT result (with the wheal diameter > or = 10 mm).
IDT is correlated well with sIgE detection in diagnosing Humulus scandens pollinosis, but the false positive rate of IDT is higher than that of sIgE test. The false positive rate of IDT can be decreased by increasing the positive criteria to higher grading reaction. The immunotherapy according to the lower grading positive result of IDT alone or sIgE alone should be avoided.
评估皮内皮肤试验（IDT）和血清特异性IgE检测在中国秋季花粉症患者中诊断葎草过敏的价值。
1150例患者，年龄5至75岁，其中男性504例，女性646例，由经验丰富的医生评估为患有秋季鼻炎和哮喘。然后患者使用20种气传变应原提取物进行IDT，蒿属植物和豚草提取物浓度为1:1000（w/v），葎草及其他提取物浓度为1:100（w/v）。对所有患者检测葎草特异性IgE水平。根据典型病史、症状以及以下任何一项结果建立诊断标准：（1）IDT风团直径≥5 mm且葎草特异性IgE浓度≥0.35 kUa/L；（2）仅IDT风团直径≥10 mm；（3）仅葎草特异性IgE浓度≥0.70 kUa/L。
以上述诊断标准为参考标准时，IDT具有更好的敏感性（97.2%）、阳性预测值（PV+）（77.9%）、阴性预测值（PV-）（90.6%）和效率（80.4%）；与单独使用sIgE≥0.35 kUa/L作为IDT的参考标准相比，IDT的特异性较低（49.8%）；与单独使用风团直径≥5 mm作为sIgE检测的参考标准相比，sIgE检测具有更好的敏感性（89.0%）、特异性（97.5%）、PV+（98.8%）PV-（88.0%）和效率（92.0%）。当以风团直径≥10 mm作为阳性标准时，IDT的假阳性率从出现59.9%降至17.4%。在288例sIgE结果为阴性而IDT结果为阳性的患者中，84例IDT结果阳性更强（风团直径≥mm）。
在诊断葎草花粉症方面，IDT与sIgE检测相关性良好，但IDT的假阳性率高于sIgE检测。通过将阳性标准提高到更高等级反应可降低IDT的假阳性率。应避免仅根据IDT或sIgE的较低等级阳性结果进行免疫治疗。
