Graham François, Caubet Jean Christoph, Ramadan Salim, Spoerl David, Eigenmann Philippe A
Pediatric Allergy Unit, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland,
Department of Allergy and Immunology, Centre Hospitalier Universitaire Sainte-Justine and Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada,
Int Arch Allergy Immunol. 2020;181(4):296-300. doi: 10.1159/000505728. Epub 2020 Feb 18.
Wheat IgE-mediated food allergy in children is one of the most frequent food allergies in westernized countries, affecting between 0.4 and 1% of children. Although 95% predictive decision points have been determined for major allergens such as peanut, egg, and milk, the diagnostic performances of wheat-specific IgE (sIgE) and wheat component testing are not well established.
The aim of this study was to determine sIgE decision point cutoffs in children with IgE-mediated wheat allergy and provide a review of the literature.
A retrospective review of wheat oral food challenges was performed at the pediatric allergy unit of the University Hospitals of Geneva between 2004 and 2019. Performance characteristics for wheat and ω-5 gliadin sIgE were calculated and positive and negative OFC data were compared using the Mann-Whitney U test.
A wheat sIgE cutoff of 2.88 kUA/L had a sensitivity of 95% (negative decision point), whereas a cutoff of 78.1 kUA/L had a specificity of 95% (positive decision point). When giving equal weight to sensitivity and specificity, the optimal cutoff point for wheat sIgE was 12 kUA/L, which gave a specificity of 70% and a sensitivity of 66.67%.
These findings suggest a high positive decision point for wheat sIgE (78.1 kUA/L). This reinforces the importance of considering OFC in children with IgE-mediated wheat allergy to confirm diagnosis even in patients with relatively high wheat sIgE values, as there is a risk of falsely mislabeling these patients as allergic.
小麦IgE介导的儿童食物过敏是西方国家最常见的食物过敏之一，影响0.4%至1%的儿童。尽管已经确定了花生、鸡蛋和牛奶等主要过敏原的95%预测决定点，但小麦特异性IgE（sIgE）和小麦成分检测的诊断性能尚未完全确立。
本研究的目的是确定IgE介导的小麦过敏儿童的sIgE决定点临界值，并对文献进行综述。
对2004年至2019年期间日内瓦大学医院儿科过敏科进行的小麦口服食物激发试验进行回顾性分析。计算小麦和ω-5醇溶蛋白sIgE的性能特征，并使用曼-惠特尼U检验比较阳性和阴性口服食物激发试验数据。
小麦sIgE临界值为2.88 kUA/L时，敏感性为95%（阴性决定点），而临界值为78.1 kUA/L时，特异性为95%（阳性决定点）。当对敏感性和特异性给予同等权重时，小麦sIgE的最佳临界值为12 kUA/L，特异性为70%，敏感性为66.67%。
这些发现表明小麦sIgE的阳性决定点较高（78.1 kUA/L）。这强化了在IgE介导的小麦过敏儿童中考虑口服食物激发试验以确诊的重要性，即使是小麦sIgE值相对较高的患者，因为存在将这些患者错误标记为过敏的风险。
