目的 比较过敏原特异性IgE(sIgE)和过敏原组分检测,探讨过敏原组分检测在食物过敏诊断中的应用价值。方法 纳入2017年10月—2019年3月就诊于复旦大学附属儿科医院、哈尔滨市儿童医院、北京大学第三医院、湖北省妇幼保健院和重庆医科大学附属儿童医院的有过敏原及组分sIgE两种检测病史的儿童242例。分别采用ImmunoCAP系统和酶联免疫印迹法检测血清鸡蛋、牛奶、花生sIgE和相应的过敏原组分。结果 1)242例IgE介导的食物过敏儿童中,鸡蛋过敏162例、牛奶过敏152例和花生过敏72例,50例健康儿童作为对照。鸡蛋过敏儿童中,卵白蛋白的sIgE检测阳性率最高,其次是伴清蛋白和卵类粘蛋白,分别为96.3%(156/162)、92.6%(150/162)和83.9%(136/162);牛奶过敏儿童中,α-乳白蛋白的sIgE检测阳性率最高,其次是β-乳球蛋白、酪蛋白和牛血清白蛋白,分别为82.9%(126/152)、81.6%(124/152)、80.3%(122/152)和75.0%(114/152);花生各过敏原组分在花生过敏儿童中的sIgE检测阳性占比0%~13.8%。70%以上鸡蛋、牛奶过敏儿童同时对3种及以上过敏原组分致敏;鸡蛋过敏儿童的过敏原sIgE水平越高,致敏的过敏原组分种类越多(r=0.212,P=0.002)。2)鸡蛋、牛奶和花生过敏原组分检测的灵敏度分别为0.975、0.993和0.208,特异度分别为0.660、0.920和0.980,阳性预测值分别为0.903、0.974和0.938,阴性预测值分别为0.892、0.979和0.462,受试者工作特征曲线下面积及95%CI分别为0.818(95%CI:0.735~0.900)、0.957(95%CI:0.912~1.000)和0.594(95%CI:0.494~0.694)。结论 食物过敏原组分检测可与过敏原sIgE检测同时作为诊断IgE介导的食物过敏的辅助检测手段,明确其致敏蛋白组分,更好地指导临床个体化管理食物过敏儿童。
Abstract
Objective To compare allergen specific immunoglobulin E (sIgE) with allergen component test in diagnosing food allergy, in order to explore the application value of allergen component test in diagnosing food allergy. Methods Children with history of allergen sIgE and allergen component test were enrolled in this study, from Children's Hospital of Fudan University, Harbin Children's Hospital, Peking University Third Hospital, Hubei Maternal and Child Health Hospital and Children's Hospital of Chongqing Medical University from October 2017 to March 2019. ImmunoCAP system and enzyme-linked immunoblotting were used to detect eggs, milk, peanuts sIgE and corresponding allergen components respectively. Results 1) Among 242 children with food allergy, 162 had egg allergies, 152 had milk allergies and 72 had peanut allergies, with 50 healthy children as controls. Among children with egg allergy, the highest rate of positive sIgE testing was for ovalbumin (96.3%,156/162), followed by ovotransferrin(92.6%,150/162) and ovomucoid(83.9%, 136/162). Among children with milk allergy, the highest rate of positive sIgE testing was for α-lactalbumin (82.9%, 126/152), followed by β-lactoglobulin (81.6%, 124/152), casein (80.3%, 122/152) and bovine serum albumin (75.0%, 114/152). The sIgE positivity for peanut allergen components in children with peanut allergy ranged from 0% to 13.8%. More than 70% of egg or milk allergies were sensitized to three or more allergen components concomitantly. The higher the level of allergen sIgE in children with egg allergy, the greater the variety of allergen components that cause allergy (r=0.212, P=0.002). 2) The sensitivity of the egg, milk and peanut allergen component test for diagnosing food allergy were 0.975, 0.993 and 0.208, respectively, with specificities of 0.660, 0.920 and 0.980, positive predictive values of 0.903, 0.974 and 0.938 and negative predictive values of 0.892, 0.979 and 0.462, respectively, and the area under the receiver operative characteristic curve were 0.818 (95%CI: 0.735 - 0.900), 0.957 (95%CI: 0.912 - 1.000) and 0.594 (95%CI: 0.494 - 0.694), respectively. Conclusion Food allergen component testing can be used in conjunction with allergen sIgE testing as an adjunct to the diagnosis of IgE-mediated food allergy, to identify the allergenic protein fraction and to better guide the individual clinical management of children with food allergy.
关键词
食物过敏 /
过敏原组分检测 /
过敏原特异性IgE /
儿童
Key words
food allergy /
allergen component testing /
allergen specific IgE /
children
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基金
国家重点研发计划(2021YFC2701802):上海市卫生健康学科带头人(2022XD024);儿科医院登峰计划(EK112520180202)。
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