Gureczny Tobias, Heindl Benjamin, Klug Livia, Wantke Felix, Hemmer Wolfgang, Wöhrl Stefan
Floridsdorf Allergy Center (FAZ), Vienna, Wien, Austria.
Medical University of Vienna, Vienna, Wien, Austria.
Clin Transl Allergy. 2023 Feb;13(2):e12220. doi: 10.1002/clt2.12220.
As extract-based skin testing as well as in vitro tests for major allergens have their own advantages, both procedures are usually performed in routine settings. In times of shortages in medical staff and supplies, we asked ourselves, how many patients would be underdiagnosed, if only one test could be used.
In a retrospective analysis, we investigated a cohort of 2646 patients seen by a single physician in a large Austrian outpatient allergy clinic in 2018. Only patients with an allergen source-specific history and pairs of extract-based skin prick (SPT) and in vitro molecular allergy tests to major allergens were included.
For all tested allergen sources, sensitivity was higher for SPT than for sIgE-based molecular allergy testing. Concerning 1006 birch pollen-allergic patients, 791 (78.6%) had positive results with both tests, while 153 (15.2%) only with the SPT and 62 (6.2%) only with the sIgE to Bet v1. The other allergen sources showed similar results: For house dust mite 816/1120 (72.9%), grass pollen 1077/1416 (76.1%) and cat 433/622 (69.6%) remained test-positive with both procedures, whereas in 276 (24.6%), 224 (15.8%) and 173 (27.8%) times only the SPT and 28 (2.5%), 115 (8.1%) and 16 (2.6%) times only the sIgE to Der p1/2/23, Phl p1/5 and Fel d1 showed a positive result. Each comparison was statistically significant (each p < 0.0001, Chi-squared test).
Screening for allergy with major molecular allergens has lower sensitivity when compared with extract-based skin tests. A combination of both is required for an optimal sensitivity.
由于基于提取物的皮肤试验以及主要变应原的体外试验都有各自的优势，这两种检测方法通常都在常规环境中进行。在医护人员和物资短缺的时期，我们不禁思考，如果只能使用一种检测方法，会有多少患者被漏诊。
在一项回顾性分析中，我们调查了2018年在奥地利一家大型门诊过敏诊所由一位医生诊治的2646例患者。仅纳入具有变应原来源特异性病史且同时进行了基于提取物的皮肤点刺试验（SPT）和主要变应原的体外分子过敏试验的患者。
对于所有检测的变应原来源，SPT的敏感性高于基于特异性免疫球蛋白E（sIgE）的分子过敏检测。在1006例桦树花粉过敏患者中，791例（78.6%）两种检测均呈阳性，而153例（15.2%）仅SPT呈阳性，62例（6.2%）仅sIgE针对Bet v1呈阳性。其他变应原来源显示出类似结果：对于屋尘螨，816/1120例（72.9%）两种检测均呈阳性，对于草花粉，1077/1416例（76.1%），对于猫，433/622例（69.6%）；而分别有276例（24.6%）、224例（15.8%）和173例（27.8%）仅SPT呈阳性，28例（2.5%）、115例（8.1%）和16例（2.6%）仅sIgE针对Der p1/2/23、Phl p1/5和Fel d1呈阳性。每项比较均具有统计学意义（每项p<0.0001，卡方检验）。
与基于提取物的皮肤试验相比，用主要分子变应原进行过敏筛查的敏感性较低。为获得最佳敏感性，两种方法需要联合使用。
