探讨大麻过敏的诊断和特征。
Exploring the Diagnosis and Profile of Cannabis Allergy.
机构信息
Department of Immunology-Allergology-Rheumatology, University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium; Department of Pediatrics, University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium.
Department of Immunology-Allergology-Rheumatology, University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium.
出版信息
J Allergy Clin Immunol Pract. 2019 Mar;7(3):983-989.e5. doi: 10.1016/j.jaip.2018.09.017. Epub 2018 Sep 29.
BACKGROUND
Cannabis allergy (CA) has mainly been attributed to Can s 3, the nonspecific lipid transfer protein (nsLTP) of Cannabis sativa. Nevertheless, standardized diagnostic tests are lacking and research on CA is scarce.
OBJECTIVE
To explore the performance of 5 cannabis diagnostic tests and the phenotypic profile of CA.
METHODS
A total of 120 patients with CA were included and stratified according to the nature of their cannabis-related symptoms; 62 healthy and 189 atopic controls were included. Specific IgE (sIgE) hemp, sIgE and basophil activation test (BAT) with a recombinant Can s 3 protein from Cannabis sativa (rCan s 3), BAT with a crude cannabis extract, and a skin prick test (SPT) with an nCan s 3-rich cannabis extract were performed. Clinical information was based on patient history and a standardized questionnaire.
RESULTS
First, up to 72% of CA reporting likely-anaphylaxis (CA-A) are Can s 3 sensitized. Actually, the Can s 3-based diagnostic tests show the best combination of positive and negative predictive values, 80% and 60%, respectively. sIgE hemp displays 82% sensitivity but only 32% specificity. Secondly, Can s 3+CA reported significantly more cofactor-mediated reactions and displayed significantly more sensitizations to other nsLTPs than Can s 3-CA. Finally, the highest prevalence of systemic reactions to plant-derived foods was seen in CA-A, namely 72%.
CONCLUSIONS
The most effective and practical tests to confirm CA are the SPT with an nCan s 3-rich extract and the sIgE rCan s 3. Can s 3 sensitization entails a risk of systemic reactions to plant-derived foods and cofactor-mediated reactions. However, as Can s 3 sensitization is not absolute, other cannabis allergens probably play a role.
背景
大麻过敏（CA）主要归因于大麻的非特异性脂质转移蛋白（nsLTP）Can s 3。然而，缺乏标准化的诊断测试，且 CA 的研究较少。
目的
探讨 5 种大麻诊断测试的性能和 CA 的表型特征。
方法
共纳入 120 例 CA 患者，并根据其与大麻相关症状的性质进行分层；纳入 62 例健康对照和 189 例特应性对照。进行大麻特异性 IgE（sIgE）检测、sIgE 和重组大麻 Can s 3 蛋白的体外嗜碱性粒细胞激活试验（BAT）、粗大麻提取物的 BAT 以及富含 nCan s 3 的大麻提取物的皮肤点刺试验（SPT）。临床信息基于患者病史和标准化问卷。
结果
首先，高达 72%的 CA 报告中可能存在过敏反应（CA-A）是 Can s 3 致敏。实际上，基于 Can s 3 的诊断测试具有最佳的阳性和阴性预测值组合，分别为 80%和 60%。sIgE 大麻显示 82%的敏感性，但仅有 32%的特异性。其次，Can s 3+CA 报告显著更多的协同因子介导的反应，并显示出对其他 nsLTPs 的显著更高的致敏率，而非 Can s 3-CA。最后，CA-A 患者对植物源性食物的全身性反应发生率最高，为 72%。
结论
确认 CA 最有效和实用的测试是使用富含 nCan s 3 的提取物进行 SPT 和 rCan s 3 的 sIgE 检测。Can s 3 致敏会导致对植物源性食物和协同因子介导的反应的全身性反应的风险。然而，由于 Can s 3 致敏并非绝对，可能还有其他大麻过敏原发挥作用。
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