Saltabayeva Ulbosin, Garib Victoria, Morenko Marina, Rosenson Rafail, Ispayeva Zhanat, Gatauova Madina, Zulus Loreta, Karaulov Alexander, Gastager Felix, Valenta Rudolf
International Network of Universities for Molecular Allergololgy and Immunology, Vienna, Austria.
Int Arch Allergy Immunol. 2017;173(2):93-98. doi: 10.1159/000477442. Epub 2017 Jun 28.
Allergen molecule-based diagnosis has been suggested to facilitate the identification of disease-causing allergen sources and the prescription of allergen-specific immunotherapy (AIT). The aim of the current study was to compare allergen molecule-based IgE serology with allergen extract-based skin testing for the identification of the disease-causing allergen sources. The study was conducted in an area where patients are exposed to pollen from multiple sources (trees, grasses, and weeds) at the same time to compare the diagnostic efficiency of the 2 forms of diagnosis.
Patients from Astana, Kazakhstan, who suffered from pollen-induced allergy (n = 95) were subjected to skin prick testing (SPT) with a local panel of tree pollen, grass pollen, and weed pollen allergen extracts and IgE antibodies specific for marker allergen molecules (nArt v 1, nArt v 3, rAmb a 1, rPhl p 1, rPhl p 5, rBet v 1) were measured by ImmunoCAP. Direct and indirect costs for diagnosis based on SPT and marker allergen-based IgE serology as well as direct costs for immunotherapy depending on SPT and serological test results were calculated.
The costs for SPT-based diagnosis per patient were lower than the costs for allergen molecule-based IgE serology. However, allergen molecule-based serology was more precise in detecting the disease-causing allergen sources. A lower number of immunotherapy treatments (n = 119) was needed according to molecular diagnosis as compared to extract-based diagnosis (n = 275), which considerably reduced the total costs for diagnosis and for a 3-year treatment from EUR 1,112.30 to 521.77 per patient.
The results from this real-life study show that SPT is less expensive than allergen molecule-based diagnostic testing, but molecular diagnosis allowed more precise prescription of immunotherapy which substantially reduced treatment costs and combined costs for diagnosis and treatment.
基于变应原分子的诊断有助于识别致病变应原来源，并为变应原特异性免疫疗法（AIT）的处方提供依据。本研究旨在比较基于变应原分子的IgE血清学检测与基于变应原提取物的皮肤试验，以识别致病变应原来源。该研究在一个患者同时接触多种来源（树木、草和杂草）花粉的地区进行，以比较这两种诊断形式的诊断效率。
对来自哈萨克斯坦阿斯塔纳的95例花粉诱导性过敏患者进行了皮肤点刺试验（SPT），使用当地的一组树木花粉、草花粉和杂草花粉变应原提取物，并通过免疫捕获法检测针对标记变应原分子（nArt v 1、nArt v 3、rAmb a 1、rPhl p 1、rPhl p 5、rBet v 1）的IgE抗体。计算了基于SPT和基于标记变应原的IgE血清学诊断的直接和间接成本，以及根据SPT和血清学检测结果进行免疫治疗的直接成本。
基于SPT的诊断每位患者的成本低于基于变应原分子的IgE血清学检测成本。然而，基于变应原分子的血清学检测在检测致病变应原来源方面更精确。与基于提取物的诊断（n = 275）相比，根据分子诊断所需的免疫治疗次数较少（n = 119），这大大降低了每位患者的诊断总成本和3年治疗总成本，从1,112.30欧元降至521.77欧元。
这项实际研究的结果表明，SPT比基于变应原分子的诊断检测成本更低，但分子诊断能够更精确地开具免疫治疗处方，从而大幅降低治疗成本以及诊断和治疗的综合成本。
