O'Driscoll B R, Powell G, Chew F, Niven R M, Miles J F, Vyas A, Denning D W
Salford Royal University Hospital, Salford, UK. ronan.o'
Clin Exp Allergy. 2009 Nov;39(11):1677-83. doi: 10.1111/j.1365-2222.2009.03339.x. Epub 2009 Aug 18.
It has been shown that patients with allergic bronchopulmonary aspergillosis (ABPA) and patients with severe asthma with fungal sensitization (SAFS) can benefit from antifungal therapy. It is not known whether allergy skin prick tests (SPT) or specific IgE tests are more sensitive in the identification of patients who are sensitized to fungi and who are therefore candidates for antifungal therapy.
To compare SPT and specific serum IgE tests for fungal sensitization in patients with severe asthma.
We have undertaken SPT and specific serum IgE tests to six fungi (Aspergillus fumigatus, Candida albicans, Penicillium notatum, Cladosporium herbarum, Alternaria alternata and Botrytis cineria) and specific serum IgE test for Trichophyton in 121 patients with severe asthma (British Thoracic Society/SIGN steps 4 and 5).
Sixty-six percent of patients were sensitized to one or more fungi based on SPT and/or specific serum IgE results. Positivity to SPT and/or specific serum IgE was as follows: A. fumigatus 45%, C. albicans 36%, P. notatum 29%, C. herbarum 24%, A. alternata 22%, B. cineria 18%, Trichophyton 17% (specific serum IgE only). Concordance between the tests was 77% overall but only 14-56% for individual fungi. Twenty-nine (24%) patients were sensitized to a single fungus and seven (6%) were sensitized to all seven fungal species. Fifty percent of patients were sensitized to fungal and non-fungal extracts, 21% were sensitized only to non-fungal extracts, 16% were sensitized only to fungal extracts and 13% had no positive tests.
This study is consistent with previous reports that fungal sensitization is common in patients with severe asthma. At present, it remains necessary to undertake both SPT and specific serum IgE testing to identify all cases of fungal sensitization. This may be important in the identification of patients with ABPA and SAFS who may benefit from antifungal therapy.
研究表明，变应性支气管肺曲霉病（ABPA）患者和重症真菌致敏性哮喘（SAFS）患者可从抗真菌治疗中获益。目前尚不清楚变应原皮肤点刺试验（SPT）或特异性IgE检测在识别真菌致敏患者（即抗真菌治疗候选者）方面是否更敏感。
比较重症哮喘患者真菌致敏的SPT和特异性血清IgE检测。
我们对121例重症哮喘患者（英国胸科学会/SIGN第4和5级）进行了针对6种真菌（烟曲霉、白色念珠菌、点青霉、草本枝孢霉、链格孢和灰葡萄孢）的SPT和特异性血清IgE检测，以及针对毛癣菌的特异性血清IgE检测。
根据SPT和/或特异性血清IgE结果，66%的患者对一种或多种真菌致敏。SPT和/或特异性血清IgE的阳性率如下：烟曲霉45%，白色念珠菌36%，点青霉29%，草本枝孢霉24%，链格孢22%，灰葡萄孢18%，毛癣菌17%（仅特异性血清IgE）。总体检测一致性为77%，但针对个别真菌的一致性仅为14% - 56%。29例（24%）患者对单一真菌致敏，7例（6%）患者对所有7种真菌致敏。50%的患者对真菌和非真菌提取物均致敏，21%的患者仅对非真菌提取物致敏，16%的患者仅对真菌提取物致敏，13%的患者检测均为阴性。
本研究与既往报道一致，即真菌致敏在重症哮喘患者中很常见。目前，仍有必要同时进行SPT和特异性血清IgE检测以识别所有真菌致敏病例。这对于识别可能从抗真菌治疗中获益的ABPA和SAFS患者可能很重要。
