评价特应性斑贴试验，皮肤点刺试验以及总lgE和特异性IgE检测在牛奶过敏诊断中的应用
Ozlem Keskin
Ayfer Tuncer
Gonul Adalioglu
关于特应性斑贴试验（APT）在食物过敏诊断中的应用的信息源于对特应性皮炎患儿的研究。
目的
评估APT在牛奶过敏（CMA）诊断中的有效性，以及确定外周血单核细胞产生白细胞介素4和干扰素-γ的有效性。
方法
使用双盲安慰剂对照食物挑战（DBPCFCs）以及牛奶特异性IgE，皮肤刺破的表现评估了37名患有疑似CMA且患有多种器官系统症状的儿童（中位年龄，11个月）。测试（SPT）和APT确定。为了寻找诊断测试和TH1 / TH2免疫应答之间的可能关系，我们测量了外周血单核细胞培养物上清液中的干扰素-γ和白细胞介素4水平。
结果
具有阳性DBPCFC结果的17名儿童和具有过敏反应史的6名儿童被诊断为患有CMA。 APT和SPT的联合使用灵敏度为100％，阴性预测值为100％，但特异性为50％，阳性预测值为76％。向APT和SPT添加乳特异性IgE测定并未改善这些值。细胞因子分泌的模式与APT阳性或对DBPCFC的特异性反应无关。
结论
在特应性皮炎以外的过敏性表现的儿童中，特应性斑贴试验可能是SPT排除CMA的有用辅助手段。但是，在存在阳性测试结果的情况下，DBPCFC仍然是必需的。
以下原文：
Evaluation of the utility of atopy patch testing, skin prick testing, and total and specific IgE assays in the diagnosis of cow's milk allergy
Ozlem Keskin, MD, Ayfer Tuncer, MD, Gonul Adalioglu, MD, Bulent E. Sekerel, MD, Cansin Sackesen, MD, Omer Kalayci, MDcorrespondenceEmail the author MD Omer Kalayci
PlumX Metrics
https://doi.org/10.1016/S1081-1206(10)61133-7
Article Info click to expand contents
Background
Information on the utility of atopy patch testing (APT) in the diagnosis of food allergy is derived from studies of children with atopic dermatitis.
Objective
To evaluate the usefulness of APT in the diagnosis of cow's milk allergy (CMA) and to determine interleukin 4 and interferon-γ production by peripheral blood mononuclear cells.
Methods
Thirty-seven children (median age, 11 months) with suspected CMA who had a variety of symptoms that involved many organ systems were evaluated using double-blind placebo-controlled food challenges (DBPCFCs), and the performances of milk specific IgE, skin prick testing (SPT), and APT were determined. To search for a possible relationship between the diagnostic tests and the TH1/TH2 immune response, we measured interferon-γ and interleukin 4 levels in the supernatants of peripheral blood mononuclear cell cultures.
Results
Seventeen children with positive DBPCFC results and 6 with a history of anaphylaxis were diagnosed as having CMA. The combined use of APT and SPT had a sensitivity of 100% and a negative predictive value of 100% but a specificity of 50% and a positive predictive value of 76%. The addition of milk specific IgE assays to APT and SPT did not improve these values. Pattern of cytokine secretion was not associated with APT positivity or a specific response to DBPCFC.
Conclusions
Atopy patch testing may be a useful adjunct to SPT in excluding CMA in children who have allergic manifestations other than atopic dermatitis. However, DBPCFCs are still necessary in the presence of positive test results.
Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine and Ihsan Dogramaci Children's Hospital, Hacettepe, Ankara, Turkey. This study was funded by grant OOT06101002 from Hacettepe University.