Pastorello E A, Codecasa L R, Pravettoni V, Qualizza R, Incorvaia C, Ispano M, Stocchi L, Guidoboni A, Zanussi C
1st Department of Internal Medicine, University of Milan, School of Medicine, Italy.
Boll Ist Sieroter Milan. 1988;67(5-6):377-85.
To determine the diagnostic value and precision of the quantitative skin test (QST), RAST, specific nasal (NPT) and conjunctival (CPT) provocation tests, we studied 91 patients, suffering from allergic rhinoconjunctivitis with positive skin prick tests (SPT) to common allergens, among whom sixty-nine of them had symptoms related to the positive SPT, and 22 had no clinical correspondence. In these two groups, by comparing the threshold of positivity, we investigated whether there was any parallelism between responses to the tests considered. We also compared the level of specific IgE (RAST) to the wheal-areas evoked by preliminary SPT for the corresponding allergen in order to detect any quantitative relationship between these investigations. Increasing concentrations of standardized allergen extracts (from 10 to 100,000 BU/ml) were used in all in vivo tests. NPT was evaluated on the basis of multiple recordings of nasal resistances by anterior passive rhinomanometry. QST proved to correlate well with RAST and its easier method ensures it a major role in assessing the levels of allergic sensitization. SPT wheal-areas and RAST vales correlated well only for grass and birch, presumably because of better standardization of these allergen extracts. When provocation tests, especially NPT, were positive, patients were almost always symptomatic for the allergen tested (high positive predictive value). Likewise, 21 out of the 22 asymptomatic subjects had negative NPT (high specificity). These results suggested the utility of standardized provocation tests in order to restrict diagnosis to the truly causative allergens in patients with multiple positive SPT results.
为了确定定量皮肤试验（QST）、放射性变应原吸附试验（RAST）、特异性鼻激发试验（NPT）和结膜激发试验（CPT）的诊断价值和准确性，我们研究了91例对常见变应原皮肤点刺试验（SPT）呈阳性的变应性鼻结膜炎患者，其中69例有与阳性SPT相关的症状，22例无临床对应症状。在这两组中，通过比较阳性阈值，我们研究了所考虑的试验反应之间是否存在任何平行关系。我们还比较了特异性IgE（RAST）水平与相应变应原初步SPT诱发的风团面积，以检测这些检查之间的任何定量关系。所有体内试验均使用浓度递增的标准化变应原提取物（从10到100,000 BU/ml）。NPT通过前鼻被动测压法多次记录鼻阻力进行评估。QST被证明与RAST相关性良好，其更简便的方法确保了它在评估变应性致敏水平方面的重要作用。SPT风团面积和RAST值仅在草和桦树变应原方面相关性良好，可能是因为这些变应原提取物的标准化程度更高。当激发试验，尤其是NPT呈阳性时，患者几乎总是对所检测的变应原出现症状（高阳性预测值）。同样，22例无症状受试者中有21例NPT阴性（高特异性）。这些结果表明标准化激发试验有助于将诊断局限于SPT结果呈多个阳性的患者中真正致病的变应原。
