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　　原标题：从症状到分子或从分子到症状的过敏诊断：一个临床比较研究
　　从“症状到分子” 的经典过敏诊断包括：1）临床病史，2）皮肤点刺试验，3）最近的新方法：分子学过敏诊断。我们的目的是检验“从分子到症状”这个新的替换方法的诊断的精确性，这个方法在一个回顾性的研究中得到欧洲过敏与临床免疫学会的推荐。
　　在应用“ISAC- first”方法【即先用免疫固相过敏原芯片112检测组份特异性IgE随后进行选择性的皮肤点刺试验（SPT）】或SPT-first”方法【即先进行皮肤点刺试验随后进行微阵列检测】的两处医疗机构中，抽取202例临床疑似过敏病人的档案。
　　在过敏的诊断中，ISAC-first程序中进行SPT的机率明显要少（平均4:14），ISAC-first组中19%，SPT-first组中34%的病人额外的吸入过敏原ISAC微阵列检测为阴性(p = 0.014)。ISAC-first 组中有18%的额外ISAC微阵列检测敏感性，而SPT-first组中有32%的额外ISAC微阵列检测敏感性(p = 0.016)。在两组中，食物过敏原13%和12%额外敏感性被微阵列而不是被皮肤点刺试验检测到(p = 0.800)。ISAC-first组中，没有额外食物过敏原被SPT发现，而在SPT- first组中一级阳性（+）病例的6%在微阵列中检测结果为阴性。
　　ISAC-first随后（很少）进行SPT的过敏诊断方法迎合病人特定的需求，因此能被认为相当于把皮肤点刺试验作为首选随后进行IgE检测的传统的过敏筛查方法。
　　对临床疑似过敏的诊断确认， 新理念“从分子到临床”在较短时间内提供了一个可靠的诊断方法。由于其需要点刺的病例较少，特别适用于幼儿和年长者，特应性病人以及皮试困难或结果不可靠的病人。


　　延伸阅读
World Allergy Organization journal
Allergy diagnosis from symptoms to molecules, or from molecules to symptoms: a comparative clinical study
DOI: doi.org/10.1186/s40413-018-0199-y
Abstract:
Abstract
Background
Classical allergy diagnostic workup “from symptoms to molecules” comprises 1) clinical investigation, 2) skin prick- and IgE- testing, and recently, 3) molecular allergy testing. We aimed to examine the diagnostic fidelity of the alternative approach “from molecules to symptoms”, which was recently suggested in the EAACI Molecular Allergology User’s Guide, in a retrospective clinical study.
Methods
Records from 202 patients with clinically suspected allergic sensitizations were extracted from files at two sites applying either the “ISAC-first” workup with IgE-testing by immuno-solid phase allergen chip ISAC112 followed by selected skin prick tests (SPT) or the “SPT-first” starting with SPT followed by the microarray test.
Results
In the ISAC-first procedure significantly less SPTs were performed during allergy diagnosis (median 4 vs. 14). By SPT in 19% of patients in the ISAC-first group and in 34% in the SPT-first group additional respiratory allergens (p = 0.014) were detected not positive in ISAC microarray. By ISAC microarray test 18% additional sensitizations were found in the ISAC-first, and 32% in SPT-first cohort (p = 0.016). For food allergens 13 and 12% additional sensitizations were detected by the microarray not detected by SPT in the two groups (p = 0.800). No additional food allergen was found by SPT in the ISAC-first group, while in 6% of the cases in the SPT-first group detected sensitizations were negative in the microarray.
Discussion
The ISAC-first approach followed by (fewer) SPTs meets the demands for a patient’s tailored diagnostic work-up and therefore can be considered equivalent to the conventional way using the skin prick test as first screening tool, followed by IgE diagnosis.
Conclusions
For the diagnostic verification of clinically suspected allergy, the novel concept “from molecules to clinic” offers a reliable diagnostic workup in shorter time. Due to lower skin test numbers it is especially applicable for young children and seniors, in atopic patients, and whenever skin tests get difficult or unreliable.
First Author:
N. Mothes-Luksch
Correspondence:
Jensen-Jarolim
All Authors:
N. Mothes-Luksch G. Jordakieva, L. Hinterhölzl , A. N. Jensen  P. K. Hallmann,  M. KundianE. Jensen-Jarolim
　　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。