de Weck A L, Derer T
Institut für Immunbiologie Inselspital, Bern, Switzerland.
Arb Paul Ehrlich Inst Bundesamt Sera Impfstoffe Frankf A M. 1994(87):89-114; discussion 114-7.
In two groups of 8 and 40 allergic patients repeatedly skin-tested with various dilutions of timothy allergen and with histamine (10 mg/ml) intradermally and by prick test, the skin reactions were evaluated by wheal and erythema size at 20 minutes and kinetically followed over 60 minutes by infrared telethermography. The latter technique permits to define further reaction parameters, such as thermographic area and Thermographic Units based on the average elevation of temperature in the reaction site. These studies have led to several conclusions. First, the skin area really involved in skin reactions to allergens or to histamine are much larger than assessed visually. There is more to it than meets the eye. Second, among all parameters studied in terms of reproducibility upon repeated testing, erythema and thermographic areas are the most stable, while wheal area shows considerably larger variations. Third, there is no good correlation between reactions to allergen dilutions and reactions to histamine, either individually or as groups of patients. In addition, the ratio of thermographic area (as true indication of allergic inflammation) to erythema area and the kinetics of the reaction are very different between allergen-induced and histamine-induced reactions. There is therefore no real advantage in relating reactions to allergen to reactions to histamine, in terms of biological standardization. Fourth, the intradermal technique, in terms of reactions to histamine, definitely shows better reproducibility than the prick test technique in skilled hands. A method such as the HEP standardization technique, combining prick testing, evaluation of skin reactions by wheal area and reference to a histamine standard is therefore the worst of possible alternatives. The US method, based on intradermal injection of various dilutions of allergen and evaluation of erythema, seems to us more adequate and reproducible for quantitative biological standardization of allergen extracts by skin testing. This statement does not mean that prick testing could not nevertheless be considered as a method of choice for diagnostic skin testing.
两组分别有8名和40名过敏患者，对他们进行了多种梯牧草过敏原稀释液的反复皮肤试验，并进行了组胺（10毫克/毫升）皮内注射和点刺试验，通过20分钟时的风团和红斑大小评估皮肤反应，并在60分钟内通过红外热成像技术动态跟踪。后一种技术能够确定更多反应参数，如热成像面积和基于反应部位温度平均升高的热成像单位。这些研究得出了几个结论。首先，真正参与对过敏原或组胺皮肤反应的皮肤面积比肉眼评估的要大得多。事实远不止所见。其次，在反复测试的可重复性方面研究的所有参数中，红斑和热成像面积最稳定，而风团面积变化大得多。第三，无论是个体还是作为患者群体，对过敏原稀释液反应和对组胺反应之间没有良好的相关性。此外，过敏原诱导反应和组胺诱导反应之间，热成像面积（作为过敏炎症的真实指标）与红斑面积的比率以及反应动力学非常不同。因此，就生物学标准化而言，将对过敏原的反应与对组胺的反应联系起来并没有实际优势。第四，就对组胺反应而言，皮内技术在熟练人员手中肯定比点刺试验技术具有更好的可重复性。因此，像HEP标准化技术这样的方法，结合点刺试验、通过风团面积评估皮肤反应并参考组胺标准，是所有可能选择中最差的。我们认为，基于皮内注射各种稀释过敏原并评估红斑的美国方法，对于通过皮肤试验对过敏原提取物进行定量生物学标准化更合适且可重复。这一说法并不意味着点刺试验不能被视为诊断性皮肤试验的首选方法。
