既往病史数据预测屋尘螨致敏的临床相关性有多可靠？
How reliable is anamnestic data in predicting the clinical relevance of house dust mite sensitization?
机构信息
Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany.
出版信息
Eur Arch Otorhinolaryngol. 2022 Feb;279(2):801-810. doi: 10.1007/s00405-021-06862-x. Epub 2021 May 21.
PURPOSE
For perennial inhalant allergens such as house dust mite (HDM), the German guideline on allergen-specific immunotherapy explicitly recommends provocation testing. This procedure is time-consuming, expensive, and potentially dangerous for the patient. Recently it has been discussed whether provocation tests are really necessary for diagnosing allergy to Dermatophagoides species. Thus, our study aimed to analyze the concordance between nasal provocation tests with Dermatophagoides species and anamnestic data.
METHODS
We retrospectively analyzed the concordance between patients' histories including self-reported symptom scores and the results of provocation testing in 471 individuals with proven sensitization to Dermatophagoides species.
RESULTS
248 patients had a positive nasal provocation test (NPT) result to Dermatophagoides species and 223 individuals a negative NPT result. Patients allergic to HSM suffered significantly more often from atopic dermatitis (14% vs. 7%, p = 0.046) and more from asthma (20% vs. 19%, p = 0.851). Moreover, individuals with clinically silent sensitization complained less about nasal secretion (37% vs. 45%, p = 0.244) but significantly more about nasal dryness (46% vs. 34%, p = 0.046) whereas rates of nasal airway obstruction, ocular complaints and sleep quality were comparable in both groups. Allergic patients reported more often perennial (34% vs. 30%, p = 0.374) and location-dependent (39% vs. 31%, p = 0.090) symptoms. However, the discrepant prevalence of atopic dermatitis was the only statistically significant difference between both groups.
CONCLUSION
Despite slight differences between both patient groups, clinical data are not sufficient to distinguish between silent sensitization and clinically relevant allergic rhinitis to HDM. Therefore, nasal provocation testing remains the gold standard for assessing clinical relevance in patients sensitized to Dermatophagoides species.
目的
对于常年吸入性过敏原，如屋尘螨（HDM），德国过敏原特异性免疫治疗指南明确推荐激发试验。该程序既耗时又昂贵，且对患者有潜在危险。最近有人讨论是否真的需要进行激发试验来诊断对尘螨过敏。因此，我们的研究旨在分析尘螨致敏患者的鼻激发试验与病史数据的一致性。
方法
我们回顾性分析了 471 例尘螨致敏患者的病史，包括自我报告的症状评分，以及激发试验的结果。
结果
248 例患者对尘螨的鼻激发试验（NPT）结果阳性，223 例患者 NPT 结果阴性。对 HSM 过敏的患者更常患有特应性皮炎（14%比 7%，p=0.046）和哮喘（20%比 19%，p=0.851）。此外，有临床无症状致敏的个体抱怨鼻腔分泌物的情况较少（37%比 45%，p=0.244），但鼻腔干燥的情况明显更多（46%比 34%，p=0.046），而鼻气道阻塞、眼部症状和睡眠质量在两组之间相似。过敏患者更常报告常年（34%比 30%，p=0.374）和位置依赖（39%比 31%，p=0.090）的症状。然而，特应性皮炎的不一致患病率是两组之间唯一具有统计学意义的差异。
结论
尽管两组患者存在细微差异，但临床数据不足以区分无症状致敏和对 HDM 有临床意义的过敏性鼻炎。因此，鼻激发试验仍然是评估尘螨致敏患者临床相关性的金标准。
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