Bernstein D I, Bernstein I L, Gaines W G, Stauder T, Wilson E R
Department of Medicine, University of Cincinnati Medical Center, OH 45267.
J Allergy Clin Immunol. 1994 Sep;94(3 Pt 1):498-507. doi: 10.1016/0091-6749(94)90206-2.
We observed that a group of detergent enzyme workers with known exposure to the subtilisin enzyme, Alcalase (Novo Industries, Bagsvaerde, Denmark), exhibited percutaneous sensitivity to Savinase (Novo Industries), a microbial protease, to which there was no previous occupational exposure. This was attributed to either cross-reactivity between these enzymes or to foreign enzyme contaminants contained in the Savinase antigen. The aims of this study were to determine the range of concentrations eliciting percutaneous responses to Alcalase and to another enzyme, Rapidase (an alpha-amylase) (Gist Brocades, Belgie, Netherlands); to compare the sensitivity of RAST and skin prick testing; and to characterize the relationship between wheal size and antigen concentration. Prick testing was conducted over six log10 antigen dilutions of Alcalase and Rapidase in 30 workers with previous exposure and skin reactivity to enzymes (group 1) and compared to nonexposed control groups, which included 60 atopic subjects (group 2) and 30 nonatopic subjects (group 3). The RAST was performed with Alcalase and Rapidase antigens. The percutaneous threshold concentrations in group 1 subjects varied widely from 10(3) to 10(-3) micrograms of protein per milliliter. Of 19 group 1 workers with skin test reactivity to Alcalase, 84% had positive RAST results; 83% of 24 workers who were reactive to Rapidase had positive RAST results. It was concluded that skin prick testing is preferred over in vitro methods for longitudinal monitoring of human sensitization to workplace allergens. In addition, the data predicted that based on a known Alcalase level of 0.07% in Savinase, 26% of Alcalase-sensitized subjects could react to Savinase. An excellent correlation (r > 0.97) was found between log concentration of antigen and wheal size parameters, with the log diameter and log area performing equally as well (r > 0.98). Analysis of variance revealed that more than 60% of intragroup variation represented human variability in wheal parameters at each concentration tested, whereas at least 95% of intergroup variation was due to regression. The excellent correlations of both wheal diameter and area with antigen concentrations were attributed to the very small changes observed between test concentrations.
我们观察到，一组已知接触过枯草杆菌蛋白酶（丹麦 Bagsvaerde 的诺和诺德公司生产的碱性蛋白酶）的洗涤剂酶工人，对一种微生物蛋白酶 Savinase（诺和诺德公司生产）表现出经皮敏感性，而此前他们并未有过职业接触。这归因于这些酶之间的交叉反应或 Savinase 抗原中含有的外来酶污染物。本研究的目的是确定引起对碱性蛋白酶和另一种酶 Rapidase（一种α-淀粉酶，荷兰 Belgie 的吉斯特布罗卡德斯公司生产）经皮反应的浓度范围；比较放射变应原吸附试验（RAST）和皮肤点刺试验的敏感性；以及描述风团大小与抗原浓度之间的关系。在 30 名曾接触过酶且对酶有皮肤反应性的工人（第 1 组）中，对碱性蛋白酶和 Rapidase 的六种以 10 为底的对数稀释抗原进行点刺试验，并与未接触过的对照组进行比较，对照组包括 60 名特应性受试者（第 2 组）和 30 名非特应性受试者（第 3 组）。用碱性蛋白酶和 Rapidase 抗原进行 RAST。第 1 组受试者的经皮阈值浓度差异很大，从每毫升 10³到 10⁻³微克蛋白质不等。在 19 名对碱性蛋白酶皮肤试验有反应性的第 1 组工人中，84%的 RAST 结果为阳性；在 24 名对 Rapidase 有反应性的工人中，83%的 RAST 结果为阳性。得出的结论是，对于纵向监测人类对工作场所过敏原的致敏情况，皮肤点刺试验优于体外方法。此外，数据预测，基于 Savinase 中已知的碱性蛋白酶水平为 0.07%，26%对碱性蛋白酶致敏的受试者可能对 Savinase 有反应。在抗原的对数浓度与风团大小参数之间发现了极好的相关性（r > 0.97），对数直径和对数面积的相关性同样良好（r > 0.98）。方差分析显示，在每个测试浓度下，组内变异的 60%以上代表了风团参数的个体差异，而组间变异的至少 95%是由于回归所致。风团直径和面积与抗原浓度的极好相关性归因于测试浓度之间观察到的非常小的变化。
