Santos A F, Shreffler W G
Department of Paediatric Allergy, King's College London/Guy's and St Thomas' Hospital, London, UK.
Department of Pediatrics, Division of Allergy and Immunology, Food Allergy Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Clin Exp Allergy. 2017 Sep;47(9):1115-1124. doi: 10.1111/cea.12964. Epub 2017 Aug 1.
The diagnosis of IgE-mediated food allergy based solely on the clinical history and the documentation of specific IgE to whole allergen extract or single allergens is often ambiguous, requiring oral food challenges (OFCs), with the attendant risk and inconvenience to the patient, to confirm the diagnosis of food allergy. This is a considerable proportion of patients assessed in allergy clinics. The basophil activation test (BAT) has emerged as having superior specificity and comparable sensitivity to diagnose food allergy, when compared with skin prick test and specific IgE. BAT, therefore, may reduce the number of OFC required for accurate diagnosis, particularly positive OFC. BAT can also be used to monitor resolution of food allergy and the clinical response to immunomodulatory treatments. Given the practicalities involved in the performance of BAT, we propose that it can be applied for selected cases where the history, skin prick test and/or specific IgE are not definitive for the diagnosis of food allergy. In the cases that the BAT is positive, food allergy is sufficiently confirmed without OFC; in the cases that BAT is negative or the patient has non-responder basophils, OFC may still be indicated. However, broad clinical application of BAT demands further standardization of the laboratory procedure and of the flow cytometry data analyses, as well as clinical validation of BAT as a diagnostic test for multiple target allergens and confirmation of its feasibility and cost-effectiveness in multiple settings.
仅基于临床病史以及针对全过敏原提取物或单一过敏原的特异性IgE检测结果来诊断IgE介导的食物过敏，往往并不明确，需要进行口服食物激发试验（OFC）来确诊食物过敏，而这会给患者带来相应风险和不便。在过敏门诊接受评估的患者中，这占了相当大的比例。与皮肤点刺试验和特异性IgE相比，嗜碱性粒细胞活化试验（BAT）在诊断食物过敏方面已显示出更高的特异性和相当的敏感性。因此，BAT可能会减少准确诊断所需的OFC数量，尤其是阳性OFC的数量。BAT还可用于监测食物过敏的缓解情况以及对免疫调节治疗的临床反应。鉴于进行BAT所涉及的实际情况，我们建议它可应用于病史、皮肤点刺试验和/或特异性IgE对食物过敏诊断不明确的特定病例。在BAT呈阳性的病例中，无需进行OFC即可充分确诊食物过敏；在BAT呈阴性或患者嗜碱性粒细胞无反应的病例中，仍可能需要进行OFC。然而，BAT的广泛临床应用需要进一步规范实验室操作和流式细胞术数据分析，以及对BAT作为多种目标过敏原诊断试验进行临床验证，并确认其在多种情况下的可行性和成本效益。
