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　　原标题：病例报告：用组份诊断重新评价一个之前诊断为榛子过敏病例
　　我们报道了过敏门诊对一个11岁女孩进行的榛子过敏的重新评价。在婴儿期，她成功地进行了对牛奶、鸡蛋的脱敏。随后，她在另一个过敏门诊，根据皮肤点刺试验和特异性IgE的含量，被建议严格规避花生和所有树坚果的食用，尽管临床病史并没有提示有树坚果的过敏。由于存在对树坚果的严重反应的风险，她还被提供一个自动注射的肾上腺素注射剂，但是上述处置并没有经过食物挑战试验的确认。
　　第一次来我们过敏门诊时，女孩的母亲给我们看了一个ISAC (Immuno Solid-phase Allergen Chip)试验，操作特异性IgE检测的同事建议得到更清晰的变态反应结果。这次试验结果显示，对尘螨、榛子、桦树和草花粉中度阳性，对Jugr3中度阳性，对Cora1只是轻度阳性。其它所有的花生和树坚果过敏原均阴性。榛子花粉点刺（阳性，5mm）,榛子提取物点刺试验结果阴性。因此，进行了榛子的食物激发试验，没有出现即刻反应。从此，食用榛子均无出现任何异常。
　　本案例突出了组份诊断在榛子过敏的诊断中的重要性。另外，我们强调了食物过敏诊断中正确诊断的重要性，正确的诊断不仅依赖于特异性IgE的高低或皮肤点刺试验的结果，而必需经食物激发试验证实。
　　延伸阅读
Clinical and Translation alAllergy
Case Report: Revaluation of a previously diagnosed hazelnut allergy with component resolved diagnosis (CRD)
DOI:10.1186/2045-7022-4-S2-P39
Abstract:
Introduction
We report a case of an eleven years old girl who was referred to our Allergy Outpatient Clinic for the revaluation of a hazelnut allergy. During her infancy she was successfully desensitised to milk and egg. Afterward she had been followed by another Allergy Unit where, according to skin prick test and specific IgE dosage, it had been suggested to strictly avoid peanut and all treenuts, although clinical history was not suggestive of treenuts allergy. She was also provided with an auto-injectable adrenaline, due to the high risk of severe reactions to treenuts. No oral provocation test was performed to validate diagnosis and adrenaline prescription.
Methods and Results
At her first visit in our Allergy Outpatient Clinic, the girl's mother showed us an ISAC (Immuno Solid-phase Allergen Chip) test, suggested by the colleague who performed the specific IgE dosage to better clarify the allergological results. On this test, a moderate positivity to dust mites, hazel, birch and grass pollen, a moderate positivity to Jugr3 and only a mild positivity to Cora1 were identified. All other peanuts and treenuts allergens were negative. A prick test for hazel pollen (positive, 5 mm) was performed; hazelnut extract , hazelnut with prick-by-prick method all resulted negative. Therefore an oral provocation test was performed with hazelnut and no immediate reactions were observed. In the following days she ate hazelnut without any symptoms.
Conclusion
In this case-report we highlight the important role of CRD in the diagnosis of hazelnut allergy. Moreover, we underline the importance of a correct diagnosis of food allergy which has to rely not only on specific IgE dosage or skin prick test, but should be confirmed by an oral provocation test.
First Author:
Francesca Saretta
All Authors:
Francesca Saretta
Roberto Perini
Elio Tonutti
Daniela Visentini
　　创建过敏性疾病的科研、科普知识交流平台，为过敏患者提供专业诊断、治疗、预防的共享平台。