McLelland J, Shuster S
University Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, U.K.
Br J Dermatol. 1990 May;122(5):623-30. doi: 10.1111/j.1365-2133.1990.tb07284.x.
We deduced on theoretical grounds that conventional patch testing would be inadequate for the detection of sensitivity to multiple allergens. Fourteen patients with positive patch tests to two unrelated allergens were studied and the response to those two allergens was measured when tested singly or in combination, using 10 different pair combinations from 15 common allergens. With serial dilutions in chloroform (14 patients) and paraffin (four patients), the response was related to the log-dose of the allergen, and change in skin-fold thickness corresponded well with clinical grading. Single allergens diluted below the threshold for a patch-test response gave a response when given in combination, the threshold for a response to one allergen being lowered by the presence of another. On the linear part of the dose-response curves the response to the mixture of allergens was additive, the combined response being the sum of the individual components. Approaching the plateau region the response to the combination was greater than to the individual allergens but less than the sum of the single responses. The same results were obtained with allergens in paraffin. We conclude that conventional single allergen patch testing by itself is inadequate for the diagnosis of contact dermatitis.
我们基于理论推断，传统的斑贴试验不足以检测对多种变应原的敏感性。对14例对两种不相关变应原斑贴试验呈阳性的患者进行了研究，使用来自15种常见变应原的10种不同配对组合，分别或联合检测这两种变应原时测量其反应。在氯仿中（14例患者）和石蜡中（4例患者）进行系列稀释时，反应与变应原的对数剂量相关，皮褶厚度变化与临床分级吻合良好。低于斑贴试验反应阈值稀释的单一变应原联合使用时会产生反应，另一种变应原的存在会降低对一种变应原反应的阈值。在剂量反应曲线的线性部分，对变应原混合物的反应是相加的，联合反应是各个成分反应之和。接近平台区时，对联合变应原的反应大于对单一变应原的反应，但小于单一反应之和。石蜡中的变应原也得到了相同结果。我们得出结论，传统的单一变应原斑贴试验本身不足以诊断接触性皮炎。
