Institute of Allergy, Immunology and Pediatric Pulmonology, Assaf-Harofeh Medical Center, Zerifin, Israel.
Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Clin Exp Allergy. 2018 Aug;48(8):1025-1034. doi: 10.1111/cea.13174. Epub 2018 Jun 13.
The prevalence of sesame food allergy (SFA) has increased over recent years, with the potential of anaphylactic reactions upon exposure. Oral food challenge (OFC) remains the diagnostic standard, yet its implementation may be risky. Commercial skin prick tests (SPT) have a low sensitivity. Investigation of alternate diagnostic methods is warranted.
To evaluate the utility of SPT and the basophil activation test (BAT) for SFA diagnosis.
Eighty-two patients with suspected SFA completed an open OFC to sesame or reported a recent confirmed reaction. Patients were administered skin prick tests (SPT) with commercial sesame seed extract (CSSE) and a high protein concentration sesame extract (HPSE) (100 mg/mL protein). Whole blood from 80 patients was stimulated with sesame seed extract (40-10 000 ng/mL protein) for BAT), assessing CD63 and CD203c as activation markers.
Sixty patients (73%) had IgE-mediated reactions to sesame, and 22 (27%) did not react. Receiver operating characteristic (ROC) curve analysis demonstrated an area under the curve (AUC) of 0.87 for HPSE-SPT and 0.66 for CSSE-SPT. At 1000 ng/mL of sesame protein, induction of CD63 and CD203c was weakly but significantly associated with OFC eliciting dose by rank (Spearman's rho = -.42 (P < .01) and -.35 (P < .05) for CD63 and CD203c, respectively). By ROC analysis, the AUC was 0.86 for CD63 and was 0.81 for CD203c sesame-induced basophil expression. Using HPSE-SPT as a first test to definitively diagnose (n = 24) or rule-out (n = 5) SFA and BAT as a second test to diagnose the remainder results in the correct classification of 73 of 80 (91%) patients, leaving one false negative and 4 false positive patients. Two BAT non-responders remain unclassified by this algorithm.
CONCLUSIONS & CLINICAL RELEVANCE: While prospective cohort validation is necessary, joint utilization of BAT and SPT with HPSE extract may obviate the need for OFC in most SFA patients.
近年来，芝麻食物过敏（SFA）的患病率有所增加，暴露后有发生过敏反应的潜在风险。口服食物挑战（OFC）仍然是诊断标准，但实施可能存在风险。商业皮肤点刺试验（SPT）的敏感性较低。因此有必要研究替代的诊断方法。
评估 SPT 和嗜碱性粒细胞活化试验（BAT）在 SFA 诊断中的作用。
82 名疑似 SFA 的患者完成了开放的芝麻食物挑战（OFC）或报告了最近确诊的过敏反应。对患者进行了商业芝麻种子提取物（CSSE）和高浓度芝麻蛋白提取物（HPSE）（100mg/mL 蛋白）的皮肤点刺试验（SPT）。从 80 名患者中抽取全血，用芝麻提取物（40-10000ng/mL 蛋白）刺激嗜碱性粒细胞，评估 CD63 和 CD203c 作为活化标志物。
60 名患者（73%）对芝麻有 IgE 介导的反应，22 名患者（27%）无反应。受试者工作特征（ROC）曲线分析显示，HPSE-SPT 的曲线下面积（AUC）为 0.87，CSSE-SPT 的 AUC 为 0.66。在 1000ng/mL 的芝麻蛋白浓度下，CD63 和 CD203c 的诱导与 OFC 激发剂量呈弱但显著的等级相关（Spearman 相关系数分别为 -.42（P<.01）和 -.35（P<.05））。通过 ROC 分析，CD63 的 AUC 为 0.86，CD203c 的 AUC 为 0.81。使用 HPSE-SPT 作为首次测试来明确诊断（n=24）或排除（n=5）SFA，以及 BAT 作为诊断其余患者的第二次测试，结果 80 名患者中的 73 名（91%）被正确分类，有 1 名假阴性和 4 名假阳性患者。根据该算法，还有 2 名 BAT 无反应者未分类。
虽然需要前瞻性队列验证，但联合使用 HPSE 提取物的 BAT 和 SPT 可能可以避免大多数 SFA 患者进行 OFC。
