Vachová Martina, Panzner Petr, Malkusová Ivana, Hanzlíková Jana, Vlas Tomáš
Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic.
Allergy Asthma Proc. 2016 May;37(3):248-55. doi: 10.2500/aap.2016.37.3934.
A diagnosis of Hymenoptera venom allergy is based on clinical history and the results of skin tests and/or laboratory methods.
To analyze the utility of available laboratory tests in diagnosing Hymenoptera venom allergy.
Ninety-five patients with Hymenoptera venom allergy with a history of bee (35) or wasp (60) anaphylactic sting reaction and positive skin test with bee or wasp venom were included in this analysis. Specific immunoglobulin E (to bee venom extract, wasp venom extract, available recombinant molecules, and a basophil activation test with venom extracts were assessed in all the patients. Test sensitivity and specificity were calculated by using standard threshold values; then, receiver operating characteristic curve analysis was performed to compute optimal threshold values. Also, statistical analysis of the utility of different combinations of laboratory tests was performed.
The optimal threshold values were revealed to be the following: 1.0 kIU/L for bee venom extract (sensitivity, 97.14%; specificity, 100%), 0.35 kIU/L for rApi m 1 (sensitivity, 68.57%; specificity, 100%), 1.22 kIU/L for wasp venom extract (sensitivity, 88.33%; specificity, 95.45%), 0.7 kIU/L for rVes v 5 (sensitivity, 86.67%; specificity, 95.45%), 1.0 kIU/L for rVes v 1 (sensitivity, 56.67%; specificity, 95.45%), 6.5% for basophil activation test with bee venom extract (sensitivity, 80%; specificity, 95.45%), and 4.5% for basophil activation test with wasp venom extract (sensitivity, 91.53%; specificity, 95.45%). The best test combinations were found to be the following: bee venom extract plus rApi m 1 (sensitivity, 97.14%; specificity, 95.45%) in bee and either wasp venom extract plus rVes v 5, or rVes v 5 plus rVes v 1 (both sensitivity, 98.33%; specificity, 95.45%) in patients with wasp venom allergy.
Our analysis confirmed that currently used laboratory tests represent effective tools in diagnosing Hymenoptera venom allergy. Moreover, our probabilistic approach offered another way to interpret concrete values of laboratory test results and opened possible direction on how to optimize the laboratory diagnostic procedure.
膜翅目毒液过敏的诊断基于临床病史以及皮肤试验和/或实验室检查结果。
分析现有实验室检查在诊断膜翅目毒液过敏中的效用。
本分析纳入了95例膜翅目毒液过敏患者，这些患者有蜜蜂（35例）或黄蜂（60例）过敏蜇伤反应史，且蜜蜂或黄蜂毒液皮肤试验呈阳性。对所有患者评估了特异性免疫球蛋白E（针对蜜蜂毒液提取物、黄蜂毒液提取物、可用的重组分子）以及用毒液提取物进行的嗜碱性粒细胞活化试验。通过使用标准阈值计算试验敏感性和特异性；然后进行受试者操作特征曲线分析以计算最佳阈值。此外，还对实验室检查不同组合的效用进行了统计分析。
最佳阈值如下：蜜蜂毒液提取物为1.0 kIU/L（敏感性97.14%；特异性100%），rApi m 1为0.35 kIU/L（敏感性为68.57%；特异性100%），黄蜂毒液提取物为1.22 kIU/L（敏感性88.33%；特异性95.45%），rVes v 5为0.7 kIU/L（敏感性86.67%；特异性95.45%），rVes v 1为1.0 kIU/L（敏感性56.67%；特异性95.45%），用蜜蜂毒液提取物进行的嗜碱性粒细胞活化试验为6.5%（敏感性80%；特异性95.45%），用黄蜂毒液提取物进行的嗜碱性粒细胞活化试验为4.5%（敏感性91.53%；特异性95.45%）。发现最佳检查组合如下：蜜蜂毒液过敏患者中，蜜蜂毒液提取物加rApi m 1（敏感性97.14%；特异性95.45%）；黄蜂毒液过敏患者中，黄蜂毒液提取物加rVes v 5或rVes v 5加rVes v 1（敏感性均为98.33%；特异性95.45%）。
我们的分析证实，目前使用的实验室检查是诊断膜翅目毒液过敏的有效工具。此外，我们的概率方法为解释实验室检查结果的具体值提供了另一种方式，并为如何优化实验室诊断程序开辟了可能的方向。
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