Van Hoeyveld Erna, Nickmans Silvie, Ceuppens Jan L, Bossuyt Xavier
Laboratory Medicine, Immunology, University Hospitals, KU Leuven, Belgium.
Allergy and Clinical Immunology, University Hospitals, KU Leuven, Belgium.
Clin Chim Acta. 2015 Oct 23;450:46-50. doi: 10.1016/j.cca.2015.07.023. Epub 2015 Jul 29.
Cut-off values and predictive values are used for the clinical interpretation of specific IgE antibody results. However, cut-off levels are not well defined, and predictive values are dependent on the prevalence of disease. The objective of this study was to document clinically relevant diagnostic accuracy of specific IgE for inhalant allergens (grass pollen and birch pollen) based on test result interval-specific likelihood ratios. Likelihood ratios are independent of the prevalence and allow to provide diagnostic accuracy information for test result intervals.
In a prospective study we included consecutive adult patients presenting at an allergy clinic with complaints of rhinitis or rhinoconjunctivitis. The standard for diagnosis was a suggestive clinical history of grass or birch pollen allergy and a positive skin test. Specific IgE was determined with the ImmunoCAP Fluorescence Enzyme Immuno-Assay.
We established specific IgE test result interval related likelihood ratios for clinical allergy to inhalant allergens (grass pollen, rPhl p 1,5, birch pollen, rBet v 1). The likelihood ratios for allergy increased with increasing specific IgE antibody levels. The likelihood ratio was <0.03 for specific IgE <0.1 kU/L, between 0.1 and 1.4 for specific IgE between 0.1 kU/L and 0.35 kU/L, between 1.4 and 4.2 for specific IgE between 0.35 kU/L and 3.5 kU/L, >6.3 for specific IgE>0.7, and very high (∞) for specific IgE >3.5 kU/L.
Test result interval specific likelihood ratios provide a useful tool for the interpretation of specific IgE test results for inhalant allergens.
临界值和预测值用于特定IgE抗体结果的临床解读。然而，临界水平定义不明确，且预测值取决于疾病的患病率。本研究的目的是基于检测结果区间特异性似然比，记录针对吸入性变应原（草花粉和桦树花粉）的特异性IgE的临床相关诊断准确性。似然比独立于患病率，能够为检测结果区间提供诊断准确性信息。
在一项前瞻性研究中，我们纳入了连续就诊于过敏诊所、主诉鼻炎或鼻结膜炎的成年患者。诊断标准为提示草或桦树花粉过敏的临床病史及阳性皮肤试验。采用免疫捕获荧光酶免疫分析法测定特异性IgE。
我们建立了针对吸入性变应原（草花粉，rPhl p 1、5；桦树花粉，rBet v 1）临床过敏的特异性IgE检测结果区间相关似然比。过敏的似然比随特异性IgE抗体水平升高而增加。特异性IgE<0.1 kU/L时似然比<0.03，特异性IgE在0.1 kU/L至0.35 kU/L之间时似然比在0.1至1.4之间，特异性IgE在0.35 kU/L至3.5 kU/L之间时似然比在1.4至4.2之间，特异性IgE>0.7时似然比>6.3，特异性IgE>3.5 kU/L时似然比极高（∞）。
检测结果区间特异性似然比为解读吸入性变应原的特异性IgE检测结果提供了一个有用的工具。
