Yamada K, Ohashi Y, Tanaka A, Kakinoki Y, Washio Y, Hayashi M, Kishimoto K, Nakai Y
Department of Otolaryngology, Osaka City University Medical School, Japan.
Acta Otolaryngol Suppl. 1998;538:169-77.
The detection of specific IgE is a critical prerequisite for both the definitive diagnosis and the therapeutic strategy of allergic rhinitis and other allergic disorders. The aim of the present study was thus to evaluate the clinical significance of the solid phase capture system (CAP) and the lumiward immunoassay system (LMD) in the diagnosis of allergic rhinitis due to Dermatophagoides farinae (D. farinae) and Japanese cedar (Cryptomeria japonica) pollens. The specificity of both the CAP and the LMD in the detection of D. farinae-specific IgE and Japanese cedar pollen-specific IgE was 100%. The sensitivity to detect D. farinae-specific IgE was 95.76% in the skin test, 86.53% in the CAP and 88.53% in the LMD, respectively. The combination of the nasal provocation test and the CAP substituted for the skin test resulted in correct diagnoses for 98.25% of the patients, and the combination of the nasal provocation test and the LMD substituted for the skin test resulted in correct diagnoses for 98.00% of the patients. Therefore, the diagnostic significance of the LMD for perennial allergic rhinitis is likely to be equal to that of the CAP. The sensitivity to detect Japanese cedar pollen-specific IgE was 94.50% in the skin test, 84.47% in the CAP, and 96.76% in the LMD, respectively. The sensitivity of the CAP in the detection of Japanese cedar pollen-specific IgE was inferior to that of the skin test, but the sensitivity of the LMD in the detection of pollen-specific IgE was somewhat superior to that of the skin test. In addition, the combination of the nasal provocation test and the CAP substituted for the skin test resulted in correct diagnoses for 98.38% of the patients, whereas the combination of the nasal provocation test and the LMD substituted for the skin test resulted in correct diagnoses for 100% of the patients. Therefore, the diagnostic significance of the LMD for seasonal allergic rhinitis due to Japanese cedar pollens is probably larger than that of the CAP. In conclusion, the LMD may be a better "gold standard" for the detection of Japanese cedar pollen-specific IgE than the skin test, and the combination of the nasal provocation test and the LMD is a better diagnostic tool for the detection of Japanese cedar pollen-induced seasonal allergic rhinitis than the combination of the nasal provocation test and the skin test or the CAP.
特异性IgE的检测是过敏性鼻炎及其他过敏性疾病明确诊断和治疗策略的关键前提。因此，本研究的目的是评估固相捕获系统（CAP）和发光免疫分析系统（LMD）在诊断粉尘螨和日本柳杉花粉引起的过敏性鼻炎中的临床意义。CAP和LMD检测粉尘螨特异性IgE和日本柳杉花粉特异性IgE的特异性均为100%。检测粉尘螨特异性IgE的敏感性在皮肤试验中为95.76%，在CAP中为86.53%，在LMD中为88.53%。鼻激发试验与CAP联合替代皮肤试验对98.25%的患者做出了正确诊断，鼻激发试验与LMD联合替代皮肤试验对98.00%的患者做出了正确诊断。因此，LMD对常年性过敏性鼻炎的诊断意义可能与CAP相当。检测日本柳杉花粉特异性IgE的敏感性在皮肤试验中为94.50%，在CAP中为84.47%，在LMD中为96.76%。CAP检测日本柳杉花粉特异性IgE的敏感性低于皮肤试验，但LMD检测花粉特异性IgE的敏感性略高于皮肤试验。此外，鼻激发试验与CAP联合替代皮肤试验对98.38%的患者做出了正确诊断，而鼻激发试验与LMD联合替代皮肤试验对100%的患者做出了正确诊断。因此，LMD对日本柳杉花粉引起的季节性过敏性鼻炎的诊断意义可能大于CAP。总之，对于检测日本柳杉花粉特异性IgE，LMD可能是比皮肤试验更好的“金标准”，鼻激发试验与LMD联合是比鼻激发试验与皮肤试验或CAP联合更好的诊断日本柳杉花粉引起的季节性过敏性鼻炎的工具。
