Division of Pulmonary, Critical Care and Sleep Medicine, University of Pennsylvania Health System, Philadelphia, PA.
Department of Medicine, Drexel University College of Medicine; and Department of Medicine, University of Pennsylvania Health System, Philadelphia, PA.
Chest. 2015 Jan;147(1):251-258. doi: 10.1378/chest.12-0072.
Asthma is a chronic inflammatory disease that affects an estimated 25 million people in the United States. In 70% to 90% of cases, asthma is associated with IgE-mediated mechanisms, which have proved central to allergen-induced inflammation in preclinical and clinical models. The importance of IgE levels in patients with moderate to severe asthma has been confirmed in randomized controlled studies with a targeted IgE blocker. Advances in laboratory methods to detect and quantify allergen-specific IgE antibodies have allowed for a quick-and-easy diagnosis of allergic IgE-mediated sensitivities in the office. Pulmonologists tend to order in vitro tests to measure allergen-specific IgE rather than to perform allergen skin testing, which is seen as the purview of allergists. This article reviews the importance of allergen testing in patients with asthma—whether by skin testing or by in vitro methods—and highlights the advantages, limitations, and interpretation of results derived from each method. Additionally, this article includes suggested documentation and administrative details for physician reporting in the office setting.
哮喘是一种慢性炎症性疾病，据估计影响了美国约 2500 万人。在 70%至 90%的病例中，哮喘与 IgE 介导的机制有关，这已被证明是临床前和临床模型中变应原诱导炎症的核心。在针对 IgE 阻断剂的随机对照研究中，已证实中度至重度哮喘患者的 IgE 水平的重要性。实验室方法的进步可用于检测和定量过敏原特异性 IgE 抗体，从而在办公室中快速简便地诊断过敏 IgE 介导的敏感性。肺科医生倾向于开体外试验来测量过敏原特异性 IgE，而不是进行过敏原皮肤试验，后者被认为是过敏症医生的职责范围。本文综述了在哮喘患者中进行过敏原检测的重要性——无论是通过皮肤试验还是体外方法，并强调了每种方法的优势、局限性和结果解读。此外，本文还包括了针对医生在办公室环境下报告的建议文档和行政细节。
