Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany; Division of Allergy and Clinical Immunology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil.
Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany.
J Allergy Clin Immunol Pract. 2013 Jul-Aug;1(4):394-8. doi: 10.1016/j.jaip.2013.05.010. Epub 2013 Jun 28.
To avoid unnecessary oral food challenges, which are time consuming, stressful, and risky, improved in vitro diagnostic methods for food allergy such as component resolved diagnostics are still under investigation.
To investigate the role of whole peanut- and peanut-component (Ara h 1, Ara h 2, Ara h 3, Ara h 6 and Ara h 8)-specific IgE levels in the diagnostic procedure of peanut allergy as well as the diagnostic properties of peanut-specific IgG and IgG4.
Sixty-one children underwent oral peanut challenge tests for diagnostic purposes irrespective of their peanut-specific IgE levels. Peanut-specific serum IgE, IgG, and IgG4 levels were determined by ImmunoCAP FEIA and specific IgE against individual peanut proteins by Immuno Solid-phase Allergen Chip.
Thirty-four of 61 patients (56%) had a peanut allergy. No significant difference was observed for peanut-specific IgG or peanut-specific IgG4 levels between patients who were allergic and tolerant patients, whereas peanut-specific IgE was significant higher in patients who were allergic than in tolerant patients (P < .005). Twenty-five of 61 children had peanut-specific IgE above a previously proposed cutoff level of 15 kUA/L; however, 7 of these 25 children (28%) were clinically tolerant. Ara h 2-specific IgE was significantly lower in tolerant than in patients with allergies (P < .0001). Interestingly, 94% of the patients with peanut allergies showed IgE-binding to Ara h 2. Unfortunately, 26% of the sensitized but tolerant patients have shown IgE binding to Ara h 2 too.
Neither the level of specific IgE to peanut nor to Ara h 2 was able to clearly distinguish patients with clinical relevant peanut allergy from those who were clinical tolerant in our population. As expected, peanut-specific IgG and IgG4 did not improve the diagnostic procedure.
为了避免耗时、紧张且有风险的不必要的口服食物挑战，人们仍在研究改良的食物过敏体外诊断方法，如成分分辨诊断。
研究花生特异性 IgE 水平在花生过敏诊断程序中的作用，以及花生特异性 IgG 和 IgG4 的诊断特性。
61 名儿童进行了口服花生挑战试验，无论其花生特异性 IgE 水平如何，均用于诊断目的。通过 ImmunoCAP FEIA 测定花生特异性血清 IgE、IgG 和 IgG4 水平，通过 Immuno Solid-phase Allergen Chip 测定针对单个花生蛋白的特异性 IgE。
61 例患者中有 34 例（56%）为花生过敏。过敏患者与耐受患者之间的花生特异性 IgG 或 IgG4 水平无显著差异，而过敏患者的花生特异性 IgE 显著高于耐受患者（P <.005）。61 例儿童中有 25 例的花生特异性 IgE 高于之前提出的 15 kUA/L 截断值；然而，这 25 例儿童中有 7 例（28%）为临床耐受。耐受患者的 Ara h 2 特异性 IgE 明显低于过敏患者（P <.0001）。有趣的是，94%的花生过敏患者显示 IgE 与 Ara h 2 结合。不幸的是，26%的致敏但耐受患者也显示出与 Ara h 2 的 IgE 结合。
在我们的人群中，无论是花生特异性 IgE 水平还是 Ara h 2 特异性 IgE 水平都无法明确区分有临床相关花生过敏的患者与临床耐受的患者。如预期的那样，花生特异性 IgG 和 IgG4 并未改善诊断程序。
