University of Florida College of Medicine, Gainesville, FL, USA.
University of Florida College of Medicine, Gainesville, Fl, USA.
Am Fam Physician. 2018 Jul 1;98(1):34-39.
An estimated 10% to 30% of the global population has an allergic disease. Clinical presentations of allergic diseases, respiratory infections, and autoimmune conditions have similar features. Allergy and immunologic testing can help clarify the diagnosis and guide treatment. Immediate immunoglobulin E (IgE) and delayed T cell-mediated reactions are the main types of allergic responses. The allergens suspected in an immediate IgE-mediated response are identified through serum IgE-specific antibody or skin testing. For patients with an inhalant allergy, skin or IgE-specific antibody testing is preferred. In patients with food allergies, eliminating the suspected allergenic food from the diet is the initial treatment. If this is ineffective, IgE-specific antibody or skin testing can exclude allergens. An oral food challenge should be performed to confirm the diagnosis. Patients with an anaphylactic reaction to an insect sting should undergo IgE-specific antibody or skin testing. Skin testing for penicillin has a high negative predictive value and can help when penicillin administration is indicated and there are limited alternatives. Testing for other drug allergies has less well-determined sensitivity and specificity, but can guide the diagnosis. Patch testing can help identify the allergen responsible for contact dermatitis.
据估计，全球有 10%至 30%的人口患有过敏性疾病。过敏性疾病、呼吸道感染和自身免疫性疾病的临床表现具有相似的特征。过敏和免疫测试可以帮助明确诊断并指导治疗。速发型免疫球蛋白 E（IgE）和迟发型 T 细胞介导的反应是主要的过敏反应类型。通过血清 IgE 特异性抗体或皮肤试验来确定速发型 IgE 介导反应中可疑的过敏原。对于吸入性过敏的患者，皮肤或 IgE 特异性抗体检测是首选。对于食物过敏的患者，从饮食中消除可疑的致敏食物是初始治疗方法。如果这无效，可以进行 IgE 特异性抗体或皮肤试验来排除过敏原。口服食物挑战应进行以确认诊断。对昆虫叮咬有过敏反应的患者应进行 IgE 特异性抗体或皮肤试验。青霉素皮试具有较高的阴性预测值，在需要使用青霉素且替代药物有限时，有助于指导治疗。其他药物过敏的检测敏感性和特异性较差，但可以指导诊断。斑贴试验有助于确定引起接触性皮炎的过敏原。
