Johns Hopkins University School of Medicine, Johns Hopkins Asthma and Allergy Center, Baltimore, MD, USA.
Allergy and Asthma Consultants, Indianapolis, IN, USA.
J Asthma. 2024 Sep;61(9):1050-1057. doi: 10.1080/02770903.2024.2324839. Epub 2024 Mar 5.
Screening asthma patients for atopy facilitates management. Since 2010, the core biomarker for screening asthma subjects for atopic status has been the qualitative Phadiatop. multi-aeroallergen screen. A more quantitative macroarray, the Allergy Explorer (ALEX), shows promise as an alternative.
The study's goal was to examine the pros and cons of the use of ALEX in the screening of asthma patients for atopic status.
We evaluated the atopic (IgE-sensitization) status in asthmatic Amish and Hutterite farm children using the ImmunoCAP and ALEX assays in Phadiatop equivocal and positive subjects.
All 42 asthmatic children were analyzed by Phadiatop and total serum IgE. Of these, 22 had a negative Phadiatop (<0.1 kUa/L) and total IgE <100 kU/L which defined them as non-atopic and they were excluded from ALEX testing. Of six children with equivocal Phadiatops (0.1-0.2 kUa/L-Group 1) and three children with a negative Phadiatop but total IgE >100 kUa/L (group 3), 44% ( = 4) had detectable IgE antibody by ALEX to mite, tree pollen, and other allergens not detected by Phadiatop, but confirmed by allergen-specific ImmunoCAP testing. In 11 Phadiatop positive subjects (>0.2 kUa/L-group 2), all but one were positive by ALEX. IgE antibody specific for mold and rabbit aeroallergens matched their agricultural and pet exposure history. Three children were positive for IgE antibody to allergens in the profilin, nsLTP, or PR-10 cross-reactive protein families.
Judicious use of ALEX's enhanced specificity data not provided by the Phadiatop can aid in the interpretation of sensitization patterns and planning management of atopic asthmatics, but sensitization relevance must be confirmed by the patient's clinical history.
筛选哮喘患者的过敏状态有助于管理。自 2010 年以来，筛选过敏状态的哮喘患者的核心生物标志物一直是定性 Phadiatop。多过敏原筛查。一种更具定量性的宏阵列，即 Allergy Explorer（ALEX），作为替代方案显示出前景。
本研究旨在探讨在筛选过敏状态的哮喘患者时使用 ALEX 的优缺点。
我们使用 ImmunoCAP 和 ALEX 检测法在 Phadiatop 可疑和阳性的受试者中评估了阿米什和哈特派农场儿童哮喘患者的过敏（IgE 致敏）状态。
所有 42 例哮喘患儿均通过 Phadiatop 和总血清 IgE 进行分析。其中 22 例 Phadiatop 阴性（<0.1 kUa/L）且总 IgE<100 kU/L，定义为非过敏，排除在 ALEX 检测之外。6 例 Phadiatop 可疑（0.1-0.2 kUa/L-第 1 组）的儿童和 3 例 Phadiatop 阴性但总 IgE>100 kUa/L 的儿童（第 3 组）中，44%（=4）通过 ALEX 检测到可检测的针对尘螨、花粉和其他 Phadiatop 未检测到但通过过敏原特异性 ImmunoCAP 检测证实的过敏原的 IgE 抗体。在 11 例 Phadiatop 阳性的受试者（>0.2 kUa/L-第 2 组）中，除 1 例外，其余均为阳性。针对真菌和兔过敏原的 IgE 抗体与其农业和宠物接触史相匹配。有 3 名儿童对过敏原蛋白家族中的过敏原蛋白、nsLTP 或 PR-10 具有 IgE 抗体。
明智地使用 ALEX 提供的比 Phadiatop 更具特异性的数据可以帮助解释致敏模式并计划管理过敏的哮喘患者，但致敏相关性必须通过患者的临床病史来证实。
