- 期刊
The Clinical Efficacy of in Vitro Allergen-Specific IgE Antibody Test in the Diagnosis of Allergic Children with Asthma
體外特異性IgE抗體檢出項目在過敏性氣喘病童之診斷價值
摘要
氣喘是台灣地區常見的呼吸道過敏疾病，並且患病的人數有年年加增的趨勢。造成氣喘病的原因中過敏原的接觸也是很重要的原因。臨床上診斷引發氣喘之過敏原，檢查血清中的過敏原時異性IgE抗體是一項重要的檢查項目，在許多種的方法中，Pharmacia CAP系統之IgE檢測功能能快速地提供較高的特異性檢測數據(Liappis, Paganelli)，並且與臨床的相關性很好，但檢測項數及檢測項目的選擇常是爭論的要點。本研究的目的，主要是測定氣喘病患血液中過敏原的特異性IgE抗體，並分析主要造成氣喘的過敏原，由此數據可以協助了解氣喘病患應該注意的過敏原及醫生在診斷上選擇過敏原檢測項目的參攷。我們使用Pharmacia CAP系統(Pharmacia, Uppsala, Sweden的吸入性過敏原系列)分析200位氣喘病兒童的血清。結果顯示家塵包括Der p(Dermatophagoides pteronyssinus), Der f (Dermatophagoides farinase)與Bt (Blomia Tropicalis)有最高之敏感度，分別是82.5%、82.0%與72%。 白色念珠菌則是黴菌類過敏原中敏感度最高者，數值爲14%，而花粉類敏感度最常見者則爲狗牙根，而花粉類的累積總數值(10%)，相對於黴菌類(21.5%)與家塵類(84%)過敏原之比例是較低的。對過敏原呈陰性反應的氣喘兒童(n=30)其血清之全部IgE平均值也明顯地比至少有一項過敏原陽性敏感的氣喘兒童(n=170)(377.9±123.6 vs 1117.8±235.7 I.U./ml, P＜0.05)來的低。全部IgE之數值明顯地與塵蹣特殊IgE抗體濃度相關，但與過敏原敏感的數目則不相關，實驗結果亦顯示最常見之四種過敏原(Der p, Der f, Dog dander 與 Cockroach)有84%的檢測率。這個結果也同樣地相對所有12項過敏原。從統計的數字上看來以四項一般類過敏原檢測即可達到最大檢出率，但是依環境不同，所接觸的過敏原種類或許不同，因此造成致敏的原因也可能不相同，因此依據環境因素，選擇以四到六項過敏原檢測爲合理選擇項數。
並列摘要
Asthma is a very common respiratory allergic disease in Taiwan. The aims of this study were to investigate the allergen-sensitized profile and its relationship with serum total IgE levels in allergic asthmatic children in Taiwan. Moreover the number of allergens to be tested for the most efficient and effective diagnosis of allergic diseases was also examined. Total IgE and IgE specific for a panel of common aeroallergens were assayed in 200 serum samples of asthmatic children using Pharmacia CAP system (Pharmacia, Uppsala, Sweden). House dust mites Der p (Dermatophagoides pteronyssinus), Derf (Dermatophagoides farinae), and Bt (Blomia Tropicalis) had the highest sensitized rates at 82.5%, 82.0%, and 72%, respectively. Candida albican (14.0%) and Bermuda grass (8.0%) were the most common sensitized fungus and pollen in our subjects, respectively. The accumulated sensitized rate (10%) for pollens was lower than those of fungus (21.5%) and house dust allergens (84%). The average serum total IgE of the allergen-negative asthmatic children (n=30) was significantly lower than that of children with at least one allergen sensitized asthma (n=170) (377.9±123.6 vs. 1117.8±235.7 IU/ml, p＜0.05). The level of total IgE was significantly correlated with the concentrations of mite-specific IgE antibodies, but not with the numbers of allergen sensitized. In addition, the detection rate was 84% when the 4 most common allergens (Der p, Der f Dog dander, and cockroach) were tested, similar to the result after testing for all 12.