Tonomura Kyoko, Fujimoto Rai, Okuda Yosuke, Iba Norihito, Sakamoto Sachiko, Kosugi Emi, Kishida Hiroko, Matsuo Hiroaki, Kataoka Yoko
Department of Dermatology, Graduate School of Medicine Osaka University.
Department of Dermatology, Osaka Habikino Medical Center.
Arerugi. 2019;68(1):48-53. doi: 10.15036/arerugi.68.48.
A 16-year-old male high-school student experienced generalized itchy wheal and dyspnea during physical exercise after lunch. Each food material of his lunch was examined using a prick-prick test, allergen-specific IgE test (ImmunoCAP), and provocation test. The prick-prick test was positive for black tiger shrimp (raw and heated) and white leg shrimp (heated). Allergen-specific IgE test (ImmunoCAP) showed absolutely negativity for all suspected foods. The food-exercise provocation test using heated black tiger shrimp with additional aspirin intake finally induced anaphylaxis.We studied the IgE-binding molecules from shrimp using a purification procedure and Western blotting, with sera from the patient and several controls. A 40-kDa protein, corresponding to FBA, was found to be the major IgE-binding allergen component in this patient. Currently, the precise history and the prick-prick test using both raw and heated shrimps are useful to diagnose shrimp-induced FDEIA. Because the allergen-specific IgE test is insufficient to diagnose the cause of the symptoms, a component allergen-specific IgE test after the identification of the causative allergenic protein, such as FBA, is required.
一名16岁的男性高中生在午餐后进行体育锻炼时出现全身性瘙痒性风团和呼吸困难。对他午餐中的每种食物原料都进行了点刺试验、过敏原特异性IgE检测（免疫捕获法）和激发试验。点刺试验显示，黑虎虾（生的和加热的）及白对虾（加热的）呈阳性。过敏原特异性IgE检测（免疫捕获法）对所有可疑食物均显示绝对阴性。使用加热的黑虎虾并额外摄入阿司匹林进行食物-运动激发试验最终诱发了过敏反应。我们采用纯化程序和蛋白质印迹法，利用该患者及若干对照者的血清，研究了虾中的IgE结合分子。发现一种与变应原肌动蛋白结合蛋白（FBA）相对应的40 kDa蛋白是该患者主要的IgE结合过敏原成分。目前，详细的病史以及对生的和加热的虾进行点刺试验有助于诊断虾诱发的食物依赖运动诱发的过敏反应（FDEIA）。由于过敏原特异性IgE检测不足以诊断症状的病因，因此在鉴定出如FBA等致病过敏原蛋白后，需要进行成分过敏原特异性IgE检测。
