Day J H, Buckeridge D L, Welsh A C
Queen's University, Kingston, Ontario, Canada.
J Allergy Clin Immunol. 1994 Apr;93(4):691-705. doi: 10.1016/0091-6749(94)90249-6.
We evaluated the diagnostic parameters (sting rate, venom-specific RAST IgE, venom-specific RAST IgG, venom-specific IgG4, venom-specific skin test) of 224 individuals at risk of honeybee sting, assigned them a level of risk on the basis of a hypothetical risk model, and then sting challenged each subject with a live honeybee. Of the 70 subjects at the lowest risk level, only three (4.3%) experienced equivocal or mild systemic reactions, whereas eight (72.7%) of the 11 at the highest risk level experienced systemic reactions, of which five (45.5%) were severe. Increase in risk level was associated with an increased proportion of systemic reactions (p < 0.001). Of the individual diagnostic parameters, venom-specific RAST IgE was the best single predictor of reactivity (likelihood ratio = 0.759, p < 0.01). Venom-specific skin testing at a concentration of 0.1 microgram/ml was a better discriminator than a concentration of 1.0 microgram/ml but did not predict one severe systemic reaction. Three methods of prediction of risk and severity of reaction were examined; the one that assessed risk in the most clinically useful manner was similar to the hypothetical risk model. This model compared well with classical methods of risk assessment and may be used to assess high-risk individuals exposed to honeybees when management could include prophylactic immunotherapy.
我们评估了224名有蜜蜂蜇伤风险个体的诊断参数（蜇伤率、毒液特异性RAST IgE、毒液特异性RAST IgG、毒液特异性IgG4、毒液特异性皮肤试验），根据一个假设的风险模型为他们划分风险等级，然后用活蜜蜂对每个受试者进行蜇刺激发试验。在风险等级最低的70名受试者中，只有3名（4.3%）出现了不明确或轻度的全身反应，而在风险等级最高的11名受试者中，有8名（72.7%）出现了全身反应，其中5名（45.5%）为严重反应。风险等级的增加与全身反应比例的增加相关（p<0.001）。在各个诊断参数中，毒液特异性RAST IgE是反应性的最佳单一预测指标（似然比=0.759，p<0.01）。浓度为0.1微克/毫升的毒液特异性皮肤试验比浓度为1.0微克/毫升的试验具有更好的鉴别能力，但无法预测1例严重的全身反应。研究了三种预测反应风险和严重程度的方法；其中以最具临床实用性的方式评估风险的方法与假设风险模型相似。该模型与经典的风险评估方法相比效果良好，当管理措施可能包括预防性免疫治疗时，可用于评估接触蜜蜂的高风险个体。
