内源性酒精溶解小麦提取物诊断 IgE 介导的小麦过敏的准确性。

Accuracy of in-house alcohol-dissolved wheat extract for diagnosing IgE-mediated wheat allergy.

机构信息

Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

ivision of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

出版信息

Asian Pac J Allergy Immunol. 2020 Jun;38(2):102-107. doi: 10.12932/AP-140218-0265.

DOI:10.12932/AP-140218-0265

PMID:30447656

Abstract

BACKGROUND

The standard method for diagnosing immediate wheat allergy is oral food challenge test (OFC). However, OFC can provoke anaphylaxis during the challenge process. Skin prick test (SPT) using commercial wheat extract yielded unsatisfactory result for diagnosis of wheat allergy. As a result, an in-house, alcohol-dissolved (Coca-10% EtOH) wheat extract was developed to improve accuracy of the SPT.

OBJECTIVE

To determine the accuracy of in-house, alcohol-dissolved wheat extract in children with immediate wheat allergy.

METHODS

This prospective cross-sectional study included children with history of immediate reaction after wheat ingestion. SPTs with commercial and in-house Coca-10% EtOH wheat extract were performed and wheat and omega-5 (ω-5) gliadin specific IgE (sIgE) were measured. Patients with no history of recent anaphylaxis after wheat ingestion underwent OFC with 31 grams of wheat flour.

RESULTS

Thirty children were recruited. Thirteen of those had history of anaphylaxis after wheat ingestion. Eleven of the remaining 17 children (64.7%) had a positive result for wheat challenge test. Wheal size of 3 mm for both in-house and commercial wheat extract yielded the best accuracy for the test. Using these cutoff parameters, in-house Coca-10% EtOH wheat extract yielded 91.7% sensitivity, 66.7% specificity, and 86.7% accuracy. Comparatively, the commercial extract yielded 70.8% sensitivity, 100% specificity, and 76.6% accuracy.

CONCLUSIONS

SPT using in-house Coca-10% EtOH wheat extract yielded better accuracy than commercial extract for diagnosing immediate type wheat allergy in children.

摘要

背景

诊断即刻型小麦过敏的标准方法是口服食物激发试验（OFT）。然而，OFT 在激发过程中可能引发过敏反应。使用商业小麦提取物进行皮肤点刺试验（SPT）对诊断小麦过敏的结果并不理想。因此，开发了一种内部的、酒精溶解的（Coca-10% EtOH）小麦提取物，以提高 SPT 的准确性。

目的

确定内部酒精溶解的小麦提取物在即刻型小麦过敏儿童中的准确性。

方法

这项前瞻性的横断面研究纳入了有小麦摄入后即刻反应史的儿童。进行了商业和内部 Coca-10% EtOH 小麦提取物的 SPT，并测量了小麦和ω-5（ω-5）麦醇溶蛋白特异性 IgE（sIgE）。没有近期小麦摄入后过敏反应史的患者进行了 31 克小麦粉的 OFT。

结果

共招募了 30 名儿童。其中 13 名儿童有小麦摄入后过敏反应史。在其余的 17 名儿童中，有 11 名（64.7%）的小麦激发试验呈阳性结果。内部和商业小麦提取物的风团直径为 3 毫米时，该试验的准确性最佳。使用这些截断参数，内部 Coca-10% EtOH 小麦提取物的敏感性为 91.7%，特异性为 66.7%，准确性为 86.7%。相比之下，商业提取物的敏感性为 70.8%，特异性为 100%，准确性为 76.6%。