Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-Universität München, Munich, Germany,
Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-Universität München, Munich, Germany.
Int Arch Allergy Immunol. 2021;182(2):120-130. doi: 10.1159/000510285. Epub 2020 Sep 17.
Sensitization to Aspergillus fumigatus is a risk factor for severe asthma. However, little is known about its presence, appearance, and impact on allergic rhinitis. Herein, we investigated the usefulness of component resolved diagnostics in patients sensitized to Aspergillus fumigatus protein extract.
Seventy-eight patients with suspected allergic rhinitis and elevated IgE levels toward Aspergillus fumigatus protein extract were retrospectively evaluated regarding their total and Aspergillus-specific IgE levels and their skin prick test. Furthermore, they were tested for specific IgE antibodies against Asp f 1, 2, 3, 4, and 6.
Skin prick test missed 6 patients (7.7%) with elevated IgE toward Aspergillus fumigatus protein extract. Fifty percent of patients (n = 39) were sensitized to at least one component. Even though monosensitization affected all components, all patients with positivity toward more than one component were sensitized to Asp f 1. There was a statistically significant increase of Aspergillus-specific IgE with increasing number of components affected by sensitization. Many patients were oligo- (34.6%) or polysensitized (51.3%). There was a high prevalence of sinusitis (61.8%).
Component resolved diagnostic testing toward the major allergen Asp f 1 was less sensitive than skin prick test and serology to Aspergillus fumigatus protein extract. However, sensitivity of component resolved diagnostics might be underestimated. Diagnostics of the species-specific allergens Asp f 1, 2, and 4 might allow to differentiate between genuine and cross-reactive sensitization. In the clinical routine, skin prick test and serology to crude extract remain the methods of choice.
对烟曲霉的致敏是严重哮喘的一个危险因素。然而，人们对其存在、表现及其对过敏性鼻炎的影响知之甚少。在此，我们研究了对烟曲霉蛋白提取物致敏的患者中成分分辨诊断的有用性。
回顾性评估了 78 例疑似过敏性鼻炎且对烟曲霉蛋白提取物 IgE 水平升高的患者，评估其总 IgE 和烟曲霉特异性 IgE 水平及其皮肤点刺试验。此外，他们还接受了针对 Asp f 1、2、3、4 和 6 的特异性 IgE 抗体检测。
皮肤点刺试验漏诊了 6 例（7.7%）对烟曲霉蛋白提取物 IgE 升高的患者。50%的患者（n=39）至少对一种成分过敏。尽管单致敏影响了所有成分，但所有对一种以上成分呈阳性的患者均对 Asp f 1 致敏。随着致敏所涉及的成分数量的增加，烟曲霉特异性 IgE 呈统计学显著增加。许多患者呈寡敏（34.6%）或多敏（51.3%）。鼻窦炎的患病率很高（61.8%）。
与烟曲霉蛋白提取物的皮肤点刺试验和血清学相比，针对主要过敏原 Asp f 1 的成分分辨诊断检测的敏感性较低。然而，成分分辨诊断的敏感性可能被低估了。对物种特异性过敏原 Asp f 1、2 和 4 的诊断可能有助于区分真正的和交叉反应性致敏。在临床常规中，粗提物的皮肤点刺试验和血清学仍然是首选方法。
