Klemans R J B, van Os-Medendorp H, Blankestijn M, Bruijnzeel-Koomen C A F M, Knol E F, Knulst A C
Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
Clin Exp Allergy. 2015 Apr;45(4):720-30. doi: 10.1111/cea.12412.
The diagnostic accuracy of skin prick test (SPT) and specific IgE (sIgE) to peanut extract in diagnosing peanut allergy is suboptimal. Recent studies have evaluated sIgE to peanut components as a possible new diagnostic tool. The aim of our review was to systematically search the literature to assess the diagnostic value of sIgE to peanut components in diagnosing peanut allergy. A literature search was performed in PubMed, Embase and the Cochrane Library. Results were subsequently screened for in- and exclusion criteria. The quality of eligible studies was assessed using a standardized quality assessment tool (QUADAS-2). Data on sensitivity, specificity, and positive and negative likelihood ratios were extracted or calculated for a descriptive analysis. Twenty-two studies were eligible, of which 21 studies in paediatric populations. Most studies reported on sIgE to peanut extract (15) and sIgE to Ara h 2 (12), followed by SPT (9) and sIgE to Ara h 1 (7). All studies were at risk of bias or caused applicability concerns on at least one item of the quality assessment tool. The best combination of diagnostic accuracy measures of all diagnostic tests was found for sIgE to Ara h 2. This finding was independent of geographical location. Compared to SPT and sIgE to peanut extract, sIgE to Ara h 2 was mainly superior in diagnosing peanut allergy in case of a positive test result. Worst diagnostic accuracy measures were found in general for sIgE to Ara h 8 and sIgE to Ara h 9. sIgE to Ara h 2 showed the best diagnostic accuracy of all diagnostic tests to diagnose peanut allergy. Compared to the currently used SPT and sIgE to peanut extract, sIgE to Ara h 2 was superior in diagnosing peanut allergy and should therefore replace these tests in daily clinical practice, especially in children.
皮肤点刺试验（SPT）和针对花生提取物的特异性IgE（sIgE）在诊断花生过敏方面的诊断准确性欠佳。近期研究评估了针对花生成分的sIgE作为一种可能的新型诊断工具。我们综述的目的是系统检索文献，以评估针对花生成分的sIgE在诊断花生过敏中的诊断价值。在PubMed、Embase和Cochrane图书馆进行了文献检索。随后根据纳入和排除标准对结果进行筛选。使用标准化质量评估工具（QUADAS - 2）评估合格研究的质量。提取或计算敏感性、特异性以及阳性和阴性似然比的数据进行描述性分析。22项研究符合条件，其中21项针对儿科人群。大多数研究报告了针对花生提取物的sIgE（15项）和针对Ara h 2的sIgE（12项），其次是SPT（9项）和针对Ara h 1的sIgE（7项）。所有研究在质量评估工具的至少一项上存在偏倚风险或引发适用性问题。发现针对Ara h 2的sIgE在所有诊断测试的诊断准确性指标方面组合最佳。这一发现与地理位置无关。与SPT和针对花生提取物的sIgE相比，针对Ara h 2的sIgE在检测结果为阳性时诊断花生过敏方面主要更具优势。总体而言，针对Ara h 8的sIgE和针对Ara h 9的sIgE诊断准确性指标最差。针对Ara h 2的sIgE在所有诊断花生过敏的测试中显示出最佳诊断准确性。与目前使用的SPT和针对花生提取物的sIgE相比，针对Ara h 2的sIgE在诊断花生过敏方面更具优势，因此在日常临床实践中应取代这些测试，尤其是在儿童中。
