流动辅助定量体外活化嗜碱性粒细胞在黄蜂毒液过敏诊断及黄蜂毒液免疫治疗随访中的应用

Flow-assisted quantification of in vitro activated basophils in the diagnosis of wasp venom allergy and follow-up of wasp venom immunotherapy.

作者信息

Ebo D G, Hagendorens M M, Schuerwegh A J, Beirens L M-N, Bridts C H, De Clerck L S, Stevens W J

机构信息

Department of Immunology, Allergology and Rheumatology, University of Antwerp, Belgium.

出版信息

Cytometry B Clin Cytom. 2007 May;72(3):196-203. doi: 10.1002/cyto.b.20142.

DOI:10.1002/cyto.b.20142

PMID:17111386

Abstract

BACKGROUND

Correct identification of the culprit venom is a prerequisite for specific venom immunotherapy (VIT). Despite the efficacy of VIT, issues as how to monitor treatment and when to discontinue maintenance therapy remain to be established.

METHODS

To evaluate diagnostic performances of the basophil activation test (BAT) in wasp venom allergy, 80 patients with a definite history of wasp venom anaphylaxis (systemic reactors) and 14 wasp-stung asymptomatic controls (stung controls) were enrolled. Venom-induced basophil activation was analyzed flow cytometrically by double-labeling with anti-IgE and anti-CD63. Results were compared to wasp IgE levels and results of a venom skin test (VST). To establish whether the BAT constitutes a candidate marker to monitor VIT, the BAT was repeated in 22 patients on the 5th day of a build-up course and after 6 months of maintenance VIT. Whether the BAT could contribute in the decision of discontinuing VIT was assessed in a cross-sectional analysis in 30 patients receiving treatment for 3 years.

RESULTS

Comparison between systemic reactors and stung controls revealed a sensitivity of 86.4% and specificity of 100% for venom IgE, and sensitivity of 81.8% for VST, respectively. In contrast to stung controls, patients demonstrated dose-dependent venom-induced basophil activation. The BAT attained a sensitivity of 83.8% and specificity of 100%. At the end of the build-up course, no effect of VIT on the BAT was demonstrable. When the BAT was repeated after 6 months of treatment, submaximal stimulation of the cells demonstrated a significant decreased CD63 expression (P < 0.04). Patients having VIT for 3 years also demonstrated significantly lower venom-induced CD63 expression (P < 0.001). After 3 years, 60% of the patients had a negative BAT for submaximal stimulation of the cells whereas only 17.9% of the patients had negativation of wasp IgE.

CONCLUSIONS

The BAT is a reliable instrument for the diagnosis of wasp venom anaphylaxis and might constitute an instrument to monitor wasp VIT.

摘要

背景

准确识别致病毒液是特异性毒液免疫疗法（VIT）的前提条件。尽管VIT疗效显著，但如何监测治疗以及何时停止维持治疗等问题仍有待确定。

方法

为评估嗜碱性粒细胞活化试验（BAT）在黄蜂毒液过敏诊断中的性能，招募了80例有明确黄蜂毒液过敏史的患者（全身反应者）和14例被黄蜂蜇伤的无症状对照者（蜇伤对照者）。通过用抗IgE和抗CD63双标记，采用流式细胞术分析毒液诱导的嗜碱性粒细胞活化。将结果与黄蜂IgE水平和毒液皮肤试验（VST）结果进行比较。为确定BAT是否构成监测VIT的候选标志物，对22例患者在累积疗程的第5天和维持VIT 6个月后重复进行BAT。在一项对30例接受3年治疗的患者的横断面分析中，评估BAT是否有助于决定停止VIT。

结果

全身反应者与蜇伤对照者的比较显示，毒液IgE的敏感性为86.4%，特异性为100%，VST的敏感性为81.8%。与蜇伤对照者不同，患者表现出剂量依赖性的毒液诱导的嗜碱性粒细胞活化。BAT的敏感性为83.8%，特异性为100%。在累积疗程结束时，未证明VIT对BAT有影响。治疗6个月后重复进行BAT时，细胞的次最大刺激显示CD63表达显著降低（P < 0.04）。接受VIT 3年的患者也显示毒液诱导的CD63表达显著降低（P < 0.001）。3年后，60%的患者在细胞次最大刺激时BAT为阴性，而只有17.9%的患者黄蜂IgE为阴性。