Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong.
Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
J Allergy Clin Immunol Pract. 2021 Jan;9(1):236-244.e9. doi: 10.1016/j.jaip.2020.08.057. Epub 2020 Sep 12.
The diagnosis of shellfish allergy currently relies on patient history, skin prick test (SPT), and serum specific IgE (sIgE) quantification. These methods lack sufficient diagnostic accuracy, whereas the gold standard of oral food challenges is risky and burdensome. Markers of reactivity and severity of allergic reactions to shellfish will improve clinical care of these patients.
This study compared the diagnostic performance of SPT, sIgE, basophil activation test (BAT), and IgE crosslinking-induced luciferase expression (EXiLE) test for shrimp allergy.
Thirty-five subjects with documented history of shrimp allergic reactions were recruited and grouped according to results of double-blind, placebo-controlled food challenge (DBPCFC). In addition to routine diagnostics, BAT (Flow CAST) and EXiLE test with shrimp extract and tropomyosin were performed.
Of 35 subjects, 15 were shrimp allergic with pruritus, urticaria, and itchy mouth on DBPCFC, whereas 20 were tolerant to shrimp. Tropomyosin only accounted for 53.3% of sensitization among subjects with challenge-proven shrimp allergy. BAT using shrimp extract as stimulant showed the highest area under curve value (0.88), Youden Index (0.81), likelihood ratio (14.73), odds ratio (104), and variable importance (4.27) when compared with other assays and tropomyosin diagnosis. Results of BAT significantly correlated with those of EXiLE (r = 0.664, P < .0001).
BAT is a more accurate diagnostic marker for shrimp allergy than SPT and shrimp sIgE, whereas the EXiLE test based on an IgE crosslinking assay is a good alternative to BAT. Tropomyosin may not be the most important shrimp allergen in Chinese, which warrants further investigation to search for other major allergens and diagnostic markers.
贝类过敏的诊断目前依赖于患者病史、皮肤点刺试验（SPT）和血清特异性 IgE（sIgE）定量。这些方法缺乏足够的诊断准确性，而口服食物挑战的金标准既危险又繁琐。贝类过敏反应的反应性和严重程度标志物将改善对这些患者的临床护理。
本研究比较了 SPT、sIgE、嗜碱性粒细胞活化试验（BAT）和 IgE 交联诱导荧光素酶表达（EXiLE）试验在虾过敏诊断中的表现。
招募了 35 名有虾过敏反应病史的患者，并根据双盲、安慰剂对照食物挑战（DBPCFC）的结果进行分组。除了常规诊断外，还进行了 BAT（Flow CAST）和 EXiLE 试验，使用虾提取物和肌球蛋白。
在 35 名受试者中，15 名对虾过敏，在 DBPCFC 时有瘙痒、荨麻疹和口腔瘙痒，而 20 名对虾耐受。在经证实的虾过敏患者中，肌球蛋白仅占致敏的 53.3%。用虾提取物作为刺激物的 BAT 显示出最高的曲线下面积值（0.88）、约登指数（0.81）、似然比（14.73）、比值比（104）和变量重要性（4.27），与其他检测方法和肌球蛋白诊断相比。BAT 的结果与 EXiLE 的结果显著相关（r=0.664，P<0.0001）。
BAT 是虾过敏比 SPT 和虾 sIgE 更准确的诊断标志物，而基于 IgE 交联的 EXiLE 试验是 BAT 的良好替代方法。肌球蛋白可能不是中国人中最重要的虾过敏原，这需要进一步调查以寻找其他主要过敏原和诊断标志物。
