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IgE-Api m 4 有助于鉴定蜂毒过敏的特定表型。

IgE-Api m 4 Is Useful for Identifying a Particular Phenotype of Bee Venom Allergy.

机构信息

Maimonides Biomedical Research Institute of Cordoba (IMIBIC).

Department of Allergology, Reina Sofia University Hospital, Córdoba, Spain.

出版信息

J Investig Allergol Clin Immunol. 2016;26(6):355-361. doi: 10.18176/jiaci.0053.

Abstract

BACKGROUND AND OBJECTIVE

Different clinical behaviors have been identified in patients allergic to bee venom. Compound-resolved diagnosis could be an appropriate tool for investigating these differences. The aims of this study were to analyze whether specific IgE to Api m 4 (sIgE-Api m 4) can identify a particular kind of bee venom allergy and to describe response to bee venom immunotherapy (bVIT).

METHODS

Prospective study of 31 patients allergic to bee venom who were assigned to phenotype group A (sIgE-Api m 4 <0.98 kU/L), treated with native aqueous (NA) extract, or phenotype group B (sIgE-Api m 4 ≥0.98 kU/L), treated with purified aqueous (PA) extract. Sex, age, cardiovascular risk, severity of preceding sting reaction, exposure to beekeeping, and immunological data (intradermal test, sIgE/sIgG4-Apis-nApi m 1, and sIgE-rApi m 2-Api m 4 were analyzed. Systemic reactions (SRs) during bVIT build-up were analyzed. Immunological and sting challenge outcomes were evaluated in each group after 1 and 2 years of bVIT.

RESULTS

Phenotype B patients had more severe reactions (P=.049) and higher skin sensitivity (P=.011), baseline sIgE-Apis (P=.0004), sIgE-nApi m 1 (P=.0004), and sIgG4-Apis (P=.027) than phenotype A patients. Furthermore, 41% of patients in group B experienced SRs during the build-up phase with NA; the sting challenge success rate in this group was 82%. There were no significant reductions in serial intradermal test results, but an intense reduction in sIgE-nApi m 1 (P=.013) and sIgE-Api m 4 (P=.004) was observed after the first year of bVIT.

CONCLUSION

Use of IgE-Api m 4 as the only discrimination criterion demonstrated differences in bee venom allergy. Further investigation with larger populations is necessary.

摘要

背景与目的

对蜂毒过敏的患者表现出不同的临床特征。复合分辨率诊断可能是研究这些差异的合适工具。本研究的目的是分析特异性 IgE 至 Api m 4(sIgE-Api m 4)是否可以识别特定类型的蜂毒过敏,并描述蜂毒免疫治疗(bVIT)的反应。

方法

对 31 名对蜂毒过敏的患者进行前瞻性研究,根据血清 IgE-Api m 4 值将患者分为表型 A 组(sIgE-Api m 4<0.98 kU/L),接受天然水提物(NA)治疗,或表型 B 组(sIgE-Api m 4≥0.98 kU/L),接受纯化水提物(PA)治疗。分析性别、年龄、心血管风险、先前蜇伤反应的严重程度、接触养蜂、免疫数据(皮内试验、sIgE/sIgG4-Apis-nApi m 1、sIgE-rApi m 2-Api m 4)。分析 bVIT 诱导期的全身性反应(SRs)。在 bVIT 治疗 1 年和 2 年后,评估每组的免疫和蜇伤挑战结果。

结果

表型 B 患者的反应更严重(P=.049),皮肤敏感性更高(P=.011),基线时 sIgE-Apis(P=.0004)、sIgE-nApi m 1(P=.0004)和 sIgG4-Apis(P=.027)水平也高于表型 A 患者。此外,41%的表型 B 患者在 NA 诱导期出现 SRs,该组的蜇伤挑战成功率为 82%。皮内试验结果无明显变化,但 bVIT 治疗 1 年后,sIgE-nApi m 1(P=.013)和 sIgE-Api m 4(P=.004)显著降低。

结论

仅使用 IgE-Api m 4 作为唯一的鉴别标准,表明蜂毒过敏存在差异。需要进一步进行更大规模人群的研究。

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