Weill Cornell Medical College, New York, NY.
Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, NY.
Int Forum Allergy Rhinol. 2019 Jun;9(6):624-628. doi: 10.1002/alr.22302. Epub 2019 Feb 5.
Current diagnostic testing methods for peanut allergy, including serum specific immunoglobulin E (sIgE) and skin-prick testing (SPT), have low specificity, whereas oral food challenge (OFC) carries significant risk of provoking adverse events. Mucosal brush biopsy (MBB) from the oral cavity is currently being studied as a new diagnostic test for peanut allergy, but normative data is not yet available with which to begin measuring specificity and predictive value.
Twenty individuals with no history of adverse reactions from eating peanuts underwent oral MBB and serum testing for peanut sIgE. These data were then compared with previously published data from 10 individuals with a history of clinical peanut allergy, in order to generate receiver operating characteristic (ROC) curves and calculate the sensitivity, specificity, and positive and negative predictive values for both testing modalities.
The optimal cutoff levels for oral MBB and sIgE testing were 0.12 kU/L and 1.0 kU/L, respectively. At 0.12 kU/L, the sensitivity of oral MBB testing was 80% and the specificity was 85%, whereas at 1.0 kU/L, the sensitivity of sIgE testing was 50% and the specificity was 100%. From the ROC curves, the areas under the ROC curve (AUC) for oral MBB and sIgE were 0.91 (p < 0.001) and 0.74 (p = 0.007), respectively. Combination testing further increased both sensitivity and accuracy over oral MBB alone.
In this pilot study, oral MBB demonstrated high sensitivity and specificity for screening individuals with and without oral cavity clinical reactivity to peanuts and may represent a potentially useful testing method for the diagnosis of peanut allergy in the future.
目前用于诊断花生过敏的检测方法，包括血清特异性免疫球蛋白 E（sIgE）和皮肤点刺试验（SPT），特异性都较低，而口服食物激发试验（OFC）有引发不良事件的重大风险。口腔黏膜刷活检（MBB）目前正被研究作为一种新的花生过敏诊断检测方法，但尚未有可用于衡量其特异性和预测价值的规范数据。
20 名无食用花生不良反应史的个体接受了口腔 MBB 和血清花生 sIgE 检测。然后将这些数据与先前发表的 10 名有临床花生过敏史的个体的数据进行比较，以生成接受者操作特征（ROC）曲线，并计算两种检测方式的敏感性、特异性、阳性和阴性预测值。
口腔 MBB 和 sIgE 检测的最佳截断值分别为 0.12 kU/L 和 1.0 kU/L。在 0.12 kU/L 时，口腔 MBB 检测的敏感性为 80%，特异性为 85%，而在 1.0 kU/L 时，sIgE 检测的敏感性为 50%，特异性为 100%。从 ROC 曲线来看，口腔 MBB 和 sIgE 的 ROC 曲线下面积（AUC）分别为 0.91（p < 0.001）和 0.74（p = 0.007）。联合检测进一步提高了口腔 MBB 检测的敏感性和准确性。
在这项初步研究中，口腔 MBB 对筛查有无口腔腔临床花生反应的个体显示出较高的敏感性和特异性，可能代表一种未来用于诊断花生过敏的潜在有用检测方法。
