Institute Education and Clinical Research, Karolinska Institutet and Sachs' Children and Youth Hospital, Stockholm, Sweden.
Thermo Fisher Scientific, Uppsala, Sweden.
Pediatr Allergy Immunol. 2020 Feb;31(2):186-196. doi: 10.1111/pai.13110. Epub 2020 Jan 1.
Hazelnut-specific IgE antibodies (sIgEs) in serum support the diagnosis of hazelnut allergy, but extract-based tests have low diagnostic specificity, commonly leading to over-diagnosis. Measuring sensitization to individual allergen components may enhance the diagnosis of hazelnut allergy. We systematically examined data on diagnostic accuracy of sIgE to commercially available hazelnut components to compare their individual contributions in diagnosing hazelnut allergy.
Seven databases were searched for diagnostic studies on patients suspected of having hazelnut allergy. Studies employing component-specific IgE testing on patients whose final diagnosis was determined by oral food challenges were included in the meta-analysis. Study quality was assessed as recommended by Cochrane.
Seven cross-sectional studies and one case-control study were identified, seven presenting data on children (N = 635), and one on a mixed age population. Overall, the diagnostic accuracies of sIgE to both Cor a 9 and Cor a 14 were significantly higher than for Cor a 1-sIgE (P < .05). In children, the specificity of Cor a 14-sIgE at 0.35 kU /L cutoff was 81.7% (95% CI 77.1, 85.6), and 67.3% (60.3, 73.6) for Cor a 9-sIgE. The specificities for Cor a 1-sIgE and hazelnut-sIgE were 22.5% (7.4, 51.2) and 10.8% (3.4, 29.8), respectively. The sensitivity of Cor a 1-sIgE (60.2% [46.9, 72.2]) was lower than for hazelnut extract-sIgE (95.7% [88.7, 98.5]), while their specificities did not differ significantly.
sIgE to Cor a 14 and Cor a 9 hazelnut storage proteins increases diagnostic specificity in assessing hazelnut allergy in children. The combined use of hazelnut extract and hazelnut storage proteins may improve diagnostic value.
血清中榛果特异性 IgE 抗体（sIgE）支持榛果过敏的诊断，但基于提取物的检测具有较低的诊断特异性，通常导致过度诊断。测量对单个过敏原成分的致敏作用可能会增强榛果过敏的诊断。我们系统地检查了商业上可获得的榛果成分的 sIgE 的诊断准确性数据，以比较它们在诊断榛果过敏中的个体贡献。
在七个数据库中搜索了疑似榛果过敏患者的诊断研究。纳入了采用特定于成分的 IgE 检测的研究，这些研究的最终诊断是通过口服食物挑战确定的。研究质量按照 Cochrane 的建议进行评估。
共确定了 7 项横断面研究和 1 项病例对照研究，其中 7 项研究涉及儿童（N=635），1 项研究涉及混合年龄人群。总体而言，sIgE 对 Cor a 9 和 Cor a 14 的诊断准确性明显高于 Cor a 1-sIgE（P<0.05）。在儿童中，Cor a 14-sIgE 截取值为 0.35 kU /L 时的特异性为 81.7%（95%CI 77.1, 85.6），Cor a 9-sIgE 为 67.3%（60.3, 73.6）。Cor a 1-sIgE 和榛果-sIgE 的特异性分别为 22.5%（7.4, 51.2）和 10.8%（3.4, 29.8）。Cor a 1-sIgE 的敏感性（60.2%[46.9, 72.2%]）低于榛果提取物-sIgE（95.7%[88.7, 98.5%]），但其特异性差异无统计学意义。
在评估儿童榛果过敏时，sIgE 对 Cor a 14 和 Cor a 9 榛果储存蛋白可提高诊断特异性。榛果提取物和榛果储存蛋白的联合使用可能会提高诊断价值。
