Marković A Stipić, Ivković-Jureković I, Dodig S, Batišta I, Zrinski-Topić R, Barberić M, Topalušić I, Megla Ž Bukovec, Žižić V
Acta Med Croatica. 2015;69(2):75-96.
In vitro diagnostic procedure in allergology includes determination of serum levels of total and allergen specific IgE antibodies, allergen specific IgG antibodies, plasma tryptase, eosinophil cationic protein (ECP) and basophil activation test (BAT). In vitro tests should be used according to clinical history, physical examination, and in vivo methods for allergy testing. Clinical relevance of elevated total IgE in allergy diagnosis is modest, since it can be caused by other conditions. Elevated serum levels of allergen specific IgE antibodies, together with positive medical history, are indicative of clinically relevant allergy. A recommended laboratory method for total and specific IgE concentration measurement is the sandwich-type fluoroimmunoassay ImmunoCAP, considered as an ideal immunoassay. Serum levels of allergen specific IgG antibodies have no proved clinical relevance in food allergy diagnosis. They can be useful to monitor venom immunotherapy success, as well as to estimate the risk of venom induced anaphylaxis. Elevated plasma tryptase (subtype β) level is an indication of mast cell activation caused by specific allergen. It should be obtained within 4 hours after an anaphylactic episode. Elevated level of ECP can be detected in patient blood during late phase of allergic reaction. It can be used to monitor patients with chronic allergenic and inflammatory conditions in which eosinophils play a central role. BAT includes measurement of CD 63 (cluster of differentiation) and CD 203 antigens of the molecular surface by flow cytometry. It is useful in the diagnosis of venom, food and drug allergy, estimation of severity of allergic disease and natural tolerance to allergens. In vitro tests based on allergen extracts can be used for in vitro diagnosis in monosensitized patients with clear medical history and symptomatic treatment. Molecular allergy diagnosis should be performed in special clinical indications such as diagnosis of cross reactivity, prescription of specific immunotherapy (especially in polysensitized patients with complex symptoms), diagnosis of idiopathic or cofactor induced anaphylaxis, latex allergy, and assessment of the risk of allergic reaction to specific allergen.
变态反应学中的体外诊断程序包括测定血清中总IgE抗体和过敏原特异性IgE抗体、过敏原特异性IgG抗体、血浆类胰蛋白酶、嗜酸性粒细胞阳离子蛋白（ECP）的水平以及嗜碱性粒细胞活化试验（BAT）。体外检测应根据临床病史、体格检查以及体内过敏检测方法来使用。在过敏诊断中，总IgE升高的临床相关性不大，因为它可能由其他病症引起。过敏原特异性IgE抗体血清水平升高，再加上阳性病史，提示存在临床相关的过敏。推荐用于测定总IgE和特异性IgE浓度的实验室方法是夹心型荧光免疫测定法ImmunoCAP，它被认为是一种理想的免疫测定法。过敏原特异性IgG抗体的血清水平在食物过敏诊断中尚无已证实的临床相关性。它们可用于监测毒液免疫治疗的效果，以及评估毒液诱发过敏反应的风险。血浆类胰蛋白酶（β亚型）水平升高表明存在由特定过敏原引起的肥大细胞活化。应在过敏反应发作后4小时内采集样本。在过敏反应的晚期阶段，患者血液中可检测到ECP水平升高。它可用于监测以嗜酸性粒细胞起核心作用的慢性变应性和炎症性疾病患者。BAT包括通过流式细胞术测量分子表面的CD 63（分化簇）和CD 203抗原。它在毒液、食物和药物过敏的诊断、评估过敏性疾病的严重程度以及对过敏原的天然耐受性方面很有用。基于过敏原提取物的体外检测可用于有明确病史和对症治疗的单敏患者的体外诊断。分子过敏诊断应在特殊的临床指征下进行，如交叉反应性诊断、特异性免疫治疗的处方（特别是在症状复杂的多敏患者中）、特发性或辅因子诱导的过敏反应诊断、乳胶过敏以及评估对特定过敏原过敏反应的风险。
