Murray A B, Milner R A
Department of Paediatrics, University of British Columbia, Vancouver, Canada.
J Allergy Clin Immunol. 1995 Nov;96(5 Pt 1):588-96. doi: 10.1016/s0091-6749(95)70256-3.
The clinical history is given considerable weight when one decides which allergens are responsible for a patient's symptoms, and in research studies the clinical history has been used as the "gold standard" with which different tests for allergy are compared.
To determine whether standardized questions accurately predict replies to detailed questions asked by an experienced allergist, and to assess the utility of certain standardized questions for predicting sensitization to individual allergen groups.
Trained interviewers put standardized questions to parents of 1160 children, aged 1 to 17 years, who had respiratory symptoms and had been newly referred to the allergy clinic of a children's hospital. For the first 151 of the subjects the answers were compared with those elicited by questions asked by a pediatric allergist. Skin prick tests and pollen counts were performed by a technologist.
The standardized questions had an accuracy for predicting the allergist's history of 93% to 97% for all questions except one. The standardized questions with the highest accuracy for predicting the skin test results to the appropriate allergens were the following: for mite, improvement in symptoms when outdoors (66.8%) and when in dry areas 69.4%), and aggravation during house cleaning (65.9%) and when bed making (70.6%); for dog, symptoms when with dogs (80.6%); for cat, symptoms when with cats (77.3%); for tree pollen, symptoms worse in April (70.8%) and when among trees in March and April (80.8%); and for grass pollen, exacerbation in June (69.2l%) and during lawn mowing (71.2%). Although specificity was generally above 80%, sensitivity was variable, ranging from 11% to 56%.
The standardized questions accurately predicted a detailed history obtained by an experienced allergist. Because standardized questions are reproducible they are the preferred method of history taking for research projects. Because several of the standardized questions have a high specificity they are useful for excluding sensitization to individual allergen groups, but because they have only a modest sensitivity, they are less helpful for detecting those who are sensitized to individual allergen groups.
在确定哪些过敏原导致患者症状时，临床病史具有相当重要的权重，并且在研究中，临床病史被用作比较不同过敏测试的“金标准”。
确定标准化问题能否准确预测经验丰富的过敏症专科医生提出的详细问题的回答，并评估某些标准化问题对预测对个体过敏原组致敏的效用。
经过培训的访谈者向1160名1至17岁有呼吸道症状且新转诊至儿童医院过敏诊所的儿童的家长提出标准化问题。对于前151名受试者，将答案与儿科过敏症专科医生提出的问题所引出的答案进行比较。由技术人员进行皮肤点刺试验和花粉计数。
除一个问题外，所有标准化问题预测过敏症专科医生问诊结果的准确率为93%至97%。预测对相应过敏原皮肤试验结果准确率最高的标准化问题如下：对于螨虫，在户外（66.8%）和干燥区域（69.4%）时症状改善，以及在房屋清洁期间（65.9%）和铺床时（70.6%）症状加重；对于狗，与狗在一起时出现症状（80.6%）；对于猫，与猫在一起时出现症状（77.3%）；对于树花粉，4月症状加重（70.8%）以及3月和4月在树林中时症状加重（80.8%）；对于草花粉，6月症状加剧（69.2%）以及割草时症状加剧（71.2%）。虽然特异性一般高于80%，但敏感性各不相同，范围为11%至56%。
标准化问题准确预测了经验丰富的过敏症专科医生获得的详细病史。由于标准化问题具有可重复性，它们是研究项目首选的病史采集方法。由于一些标准化问题具有较高的特异性，它们有助于排除对个体过敏原组的致敏，但由于它们的敏感性仅为中等程度，对于检测对个体过敏原组致敏的人帮助较小。
