Witteman A M, Stapel S O, Perdok G J, Sjamsoedin D H, Jansen H M, Aalberse R C, van der Zee J S
Department of Pulmonology, University of Amsterdam, The Netherlands.
J Allergy Clin Immunol. 1996 Jan;97(1 Pt 1):16-25. doi: 10.1016/s0091-6749(96)70278-6.
Study of the relationship between skin test results and IgE antibody levels is seriously hampered by the use of conventional allergen extracts because the precise amount of relevant allergen for each patient is unknown.
This study was designed to investigate skin reactivity with purified major allergens and to assess the relation with serum levels of IgE antibodies and to determine which additional factors contribute to the skin test result.
We used five purified major allergens (Der p 1, Der p 2, Fel d 1, Lol p 1, and Lol p 5) in skin tests, RASTs, and histamine release tests in 43 multisensitized patients with asthma or rhinitis.
The differences in biologic activity of the five major allergens at a given level of specific IgE are within one order of magnitude. A significant residual variation remains in the correlation between skin test results and levels of IgE antibodies, which cannot be explained by imprecision of both tests (Pearson log skin test vs log specific IgE: r = 0.46-0.92). With similar levels of specific IgE, the amount of allergen that is required for a positive skin test result may differ by as much as a factor of 100 between patients. The amount of total IgE in serum contributes significantly to the skin test result. High values of total IgE are accompanied by a lower skin reactivity for allergen. Within individuals, allergens that cause skin test results that deviate from the prediction based on IgE antibody level often show a similar deviation in the histamine release test. This indicates that the type of IgE response (i.e., affinity or epitope recognition pattern) contributes significantly to the skin test result. Skin reactivity for histamine does not significantly influence the skin reactions expressed as allergen threshold. However, increased skin reactions with higher allergen dosages depend on histamine reactivity.
The major allergens tested show similar biologic activities. In addition to IgE antibody level, total serum IgE and type of IgE antibody response contribute significantly to the skin test threshold for allergens. Even in a system with purified allergens, IgE antibody levels and skin test results are not interchangeable as an indicator of the degree of allergic sensitization.
由于每位患者的相关变应原的精确含量未知，传统变应原提取物的使用严重阻碍了对皮肤试验结果与IgE抗体水平之间关系的研究。
本研究旨在调查对纯化主要变应原的皮肤反应性，评估其与IgE抗体血清水平的关系，并确定哪些其他因素影响皮肤试验结果。
我们对43例患有哮喘或鼻炎的多敏患者进行了5种纯化主要变应原（屋尘螨主要变应原1、屋尘螨主要变应原2、猫毛屑主要变应原1、黑麦草主要变应原1和黑麦草主要变应原5）的皮肤试验、放射性变应原吸附试验（RAST）和组胺释放试验。
在特定IgE水平下五种主要变应原的生物活性差异在一个数量级内。皮肤试验结果与IgE抗体水平之间的相关性仍存在显著的残余变异，这不能用两种试验的不精确性来解释（Pearson对数皮肤试验与对数特异性IgE：r = 0.46 - 0.92）。在特异性IgE水平相似的情况下，不同患者皮肤试验结果呈阳性所需变应原的量可能相差100倍。血清中总IgE的量对皮肤试验结果有显著影响。总IgE值高伴随着对变应原的皮肤反应性较低。在个体内部，导致皮肤试验结果偏离基于IgE抗体水平预测的变应原，在组胺释放试验中通常也表现出类似的偏差。这表明IgE反应的类型（即亲和力或表位识别模式）对皮肤试验结果有显著影响。对组胺的皮肤反应性对以变应原阈值表示的皮肤反应没有显著影响。然而，变应原剂量增加时皮肤反应增强取决于组胺反应性。
所检测的主要变应原显示出相似的生物活性。除了IgE抗体水平外，血清总IgE和IgE抗体反应类型对变应原的皮肤试验阈值有显著影响。即使在使用纯化变应原的系统中，IgE抗体水平和皮肤试验结果也不能作为过敏性致敏程度的指标相互替代。
