Beutner Caroline, Wrobel Christian, Dombrowski Tobias, Beutner Dirk, Forkel Susann, Buhl Timo
Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany.
Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Göttingen, Göttingen, Germany.
Int Arch Allergy Immunol. 2023;184(9):841-848. doi: 10.1159/000530201. Epub 2023 Jun 2.
Skin prick tests (SPTs) are the gold standard for diagnosis of allergic rhinitis (AR). A decrease in the number of allergens included in standard SPT panels has recently been debated - particularly regarding the cross-reacting homologous pollen from birch, alder, and hazel trees - but has not yet been implemented in clinical guidelines.
A subgroup of patients with AR (n = 69) who showed inconsistent SPT results among birch, alder, and hazel was investigated in detail. Beyond SPT, patient workup included assessment of clinical relevance and various serological parameters (total IgE, and specific IgE to birch, alder, and hazel and to Bet v 1, Bet v 2, and Bet v 4).
More than half the study group had negative SPT results for birch but positive results for alder and/or hazel, and 87% of the study group was polysensitized, showing at least one more positive SPT result for other plants. Whereas 30.4% of patients showed serological sensitization to birch pollen extract, only 18.8% displayed positive specific IgE to Bet v 1. Clinical assessment revealed that most patients with AR were polysensitized and had perennial symptoms or symptoms also occurring during times other than tree flowering times. If the SPT panel is limited to testing birch only, 52.2% of patients in this subgroup would have been overlooked.
Inconsistent SPT results in the birch homologous group may result from cross-reacting allergens or technical errors. If patients report convincing clinical symptoms despite negative results from a reduced SPT panel or inconsistent results for homologous allergens, SPT should be repeated, and molecular markers should be added to achieve a correct diagnosis.
皮肤点刺试验（SPT）是诊断变应性鼻炎（AR）的金标准。近期，关于标准SPT检测板中变应原数量的减少存在争议——特别是关于桦树、桤木和榛树的交叉反应同源花粉——但尚未在临床指南中实施。
对一组AR患者（n = 69）进行了详细研究，这些患者在桦树、桤木和榛树的SPT结果不一致。除SPT外，患者检查还包括临床相关性评估和各种血清学参数（总IgE，以及针对桦树、桤木、榛树、Bet v 1、Bet v 2和Bet v 4的特异性IgE）。
超过一半的研究组患者桦树SPT结果为阴性，但桤木和/或榛树结果为阳性，并且87%的研究组患者为多敏状态，对其他植物的SPT结果至少还有一项为阳性。虽然30.4%的患者对桦树花粉提取物呈现血清学致敏，但只有18.8%的患者对Bet v 1显示特异性IgE阳性。临床评估显示，大多数AR患者为多敏状态，有常年性症状或在树木开花时间以外的其他时间也出现症状。如果SPT检测板仅限于检测桦树，该亚组中52.2%的患者将会被漏诊。
桦树同源组中SPT结果不一致可能是由于交叉反应变应原或技术误差导致。如果患者尽管SPT检测板结果减少或同源变应原结果不一致但仍报告有令人信服的临床症状，应重复进行SPT检测，并添加分子标志物以实现正确诊断。
