Internal Medicine, Giovanni Paolo II Hospital, Sciacca and University of Palermo, Palermo, Italy.
Clin Chem Lab Med. 2013 Jun;51(6):1257-63. doi: 10.1515/cclm-2012-0609.
The diagnosis of food hypersensitivity (FH) in adult patients with gastrointestinal symptoms, beyond the immediate IgE-mediated clinical manifestations, is very often difficult. The aims of our study were to: 1) evaluate the frequency of FH in patients with irritable bowel syndrome (IBS)-like clinical presentation; and 2) compare the diagnostic accuracy of two different methods of in vitro basophil activation tests.
Three hundred and five patients (235 females, age range 18-66 years) were included and underwent a diagnostic elimination diet and successive double-blind placebo-controlled (DBPC) challenges. Two different methods of in vitro basophil activation tests (BAT) (CD63 expression after in vitro wheat or cow's milk proteins stimulation) were evaluated: one was performed on separated leukocytes, and the other on whole blood.
Ninety patients of the 305 studied (29.5%) were positive to the challenges and were diagnosed as suffering from FH. BAT on separate leukocytes showed a sensitivity of 86% and a specificity of 91% in FH diagnosis. BAT on whole blood showed a sensitivity of 15%-20% and a specificity of 73% in FH diagnosis (p<0.0001 compared to the other method).
About one third of the IBS patients included in the study were suffering from FH and were cured on the elimination diet. The BAT based on CD63 detection on whole blood samples did not work in FH diagnosis and showed a significantly lower sensitivity, specificity and diagnostic accuracy than the assay based on separated leukocytes.
对于有胃肠道症状的成年患者，除了即时 IgE 介导的临床表现之外，食物过敏（FH）的诊断通常非常困难。我们研究的目的是：1）评估具有肠易激综合征（IBS）样临床表现的患者中 FH 的频率；2）比较两种不同的体外嗜碱性粒细胞激活试验（BAT）方法的诊断准确性。
共纳入 305 例患者（235 例女性，年龄 18-66 岁），并进行诊断性排除饮食和随后的双盲安慰剂对照（DBPC）挑战。评估了两种不同的体外嗜碱性粒细胞激活试验（BAT）方法（体外小麦或牛奶蛋白刺激后 CD63 表达）：一种在分离的白细胞上进行，另一种在全血上进行。
在 305 例研究患者中，有 90 例（29.5%）对挑战呈阳性，并被诊断为患有 FH。分离白细胞上的 BAT 对 FH 诊断的敏感性为 86%，特异性为 91%。全血上的 BAT 对 FH 诊断的敏感性为 15%-20%，特异性为 73%（与另一种方法相比，p<0.0001）。
在研究中纳入的 IBS 患者中，约有三分之一患有 FH，并通过排除饮食得到治愈。基于全血样本中 CD63 检测的 BAT 不适用于 FH 诊断，其敏感性、特异性和诊断准确性均明显低于基于分离白细胞的检测。
