Wongsa Chamard, Phinyo Phichayut, Dharakul Tararaj, Sompornrattanaphan Mongkhon, Srisuwatchari Witchaya, Thongngarm Torpong
Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
World Allergy Organ J. 2023 Jun 27;16(6):100784. doi: 10.1016/j.waojou.2023.100784. eCollection 2023 Jun.
Patients with non-mast cell mediator-induced angioedema (NM-AE) usually experience a diagnostic delay. Therefore, a clinical tool for predicting NM-AE diagnosis is essential.
To identify clinical predictors related to a confirmed diagnosis of NM-AE.
Participants with a history of recurrent AE with unknown causes were enrolled. They were classified into mast cell mediator-induced AE (M-AE) and NM-AE according to the response to anti-mast cell mediator therapy. All participants were asked to rate their worst AE ever experienced (% Photomax) from 0 to 100% using a novel photo aid. Clinical characteristics were recorded and analyzed by univariable and multivariable analysis.
Thirty-five participants were included, 25 with NM-AE and 10 with M-AE. AE located at extremities, face, and genitalia and positive family history were significantly associated with NM-AE. The AE severity in the NM-AE group was significantly higher than in the M-AE group, with the mean % Photomax of 82.4 ± 20.3 vs 47.5 ± 25.6 (p < 0.001), respectively. Univariable analysis showed that the % Photomax (every 10% increase), feet AE and hands AE were predictive of being NM-AE with the area under the receiver operating characteristic curve (AuROC) of 0.87 (95% CI 0.75, 0.99), 0.85 (95% CI 0.72, 0.98), and 0.84 (0.69, 0.99), respectively. Multivariable analysis showed that the combination of hands AE and % Photomax enhanced diagnostic accuracy (AuROC 0.94, 95% CI 0.86, 1.0) and constituted the prototype formula for calculating the diagnostic probability.
Patient-rated angioedema severity using a novel photo aid combined with hands AE had a high probability of diagnosing NM-AE.
非肥大细胞介质诱导性血管性水肿（NM-AE）患者通常会经历诊断延迟。因此，一种预测NM-AE诊断的临床工具至关重要。
确定与确诊NM-AE相关的临床预测因素。
纳入有不明原因复发性血管性水肿病史的参与者。根据对抗肥大细胞介质治疗的反应，将他们分为肥大细胞介质诱导性血管性水肿（M-AE）和NM-AE。所有参与者均被要求使用一种新颖的照片辅助工具，将他们经历过的最严重血管性水肿（% Photomax）从0到100%进行评分。记录临床特征，并通过单变量和多变量分析进行分析。
共纳入35名参与者，其中25名患有NM-AE，10名患有M-AE。位于四肢、面部和生殖器的血管性水肿以及阳性家族史与NM-AE显著相关。NM-AE组的血管性水肿严重程度显著高于M-AE组，平均% Photomax分别为82.4±20.3和47.5±25.6（p<0.001）。单变量分析显示，% Photomax（每增加10%）、足部血管性水肿和手部血管性水肿可预测为NM-AE，受试者工作特征曲线下面积（AuROC）分别为0.87（95%CI 0.7,5 0.99）、0.85（95%CI 0.72,0.98）和0.84（0.69,0.99）。多变量分析显示，手部血管性水肿和% Photomax的组合提高了诊断准确性（AuROC 0.94，95%CI 0.86,1.0），并构成了计算诊断概率的原型公式。
使用新颖照片辅助工具结合手部血管性水肿进行患者自评血管性水肿严重程度，对NM-AE的诊断具有较高概率。
