Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Occupational Medicine, Berlin, Germany.
Occupational, Social and Environmental Medicine, University Hospital Jena - Friedrich Schiller University Jena, Jena, Germany.
Occup Environ Med. 2019 Apr;76(4):269-278. doi: 10.1136/oemed-2018-105434. Epub 2019 Feb 25.
To determine the test performance parameters for the retrievable range of high-molecular-weight (HMW) and low-molecular-weight (LMW) occupational allergens and to evaluate the impact of allergenic components and the implementation of measures for test validation.
A protocol with predefined objectives and inclusion criteria was the basis of an electronic literature search of MEDLINE and EMBASE (time period 1967-2016). The specific inhalation challenge and serial peak flow measurements were the reference standards for the specific IgE (sIgE) test parameters. All of the review procedures were reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Seventy-one studies were selected, and 62 entered meta-analysis. Pooled pairs analysis indicated a sensitivity of 0.74(95% CI 0.66 to 0.80) and specificity of 0.71(95% CI 0.63 to 0.77) for HMW allergens and a sensitivity of 0.28(95% CI 0.18 to 0.40) and specificity of 0.89(95% CI 0.77 to 0.95) for LMW allergens. Component-specific analysis improved the test parameters for some allergens. Test validation was handled heterogeneously among studies.
sIgE test performance is rather satisfactory for a wide range of HMW allergens with the potential for component-specific approaches, whereas sensitivity for LMW allergens is considerably lower, indicating methodological complications and/or divergent pathomechanisms. A common standard for test validation is needed.
确定高分子量（HMW）和低分子量（LMW）职业过敏原可检出范围的检测性能参数，并评估过敏原成分的影响和检测验证措施的实施。
采用具有预设目标和纳入标准的方案，对 MEDLINE 和 EMBASE 进行电子文献检索（时间范围为 1967 年至 2016 年）。特异性吸入挑战和系列峰流速测量是特异性 IgE（sIgE）检测参数的参考标准。所有的综述程序均按照系统评价和荟萃分析的首选报告项目进行报告。
共选择了 71 项研究，其中 62 项进入荟萃分析。合并对分析表明，HMW 过敏原的敏感性为 0.74（95%置信区间 0.66 至 0.80），特异性为 0.71（95%置信区间 0.63 至 0.77），LMW 过敏原的敏感性为 0.28（95%置信区间 0.18 至 0.40），特异性为 0.89（95%置信区间 0.77 至 0.95）。特异性成分分析提高了某些过敏原的检测参数。研究之间的检测验证处理存在异质性。
对于广泛的 HMW 过敏原，sIgE 检测性能相当令人满意，具有潜在的成分特异性方法，而对于 LMW 过敏原，敏感性较低，表明存在方法学复杂性和/或不同的发病机制。需要一个共同的检测验证标准。
