原標題：病例報告：用組份診斷重新評價一個之前診斷為榛子過敏病例
　　我們報道了過敏門診對一個11歲女孩進行的榛子過敏的重新評價。在嬰兒期，她成功地進行了對牛奶、雞蛋的脫敏。隨后，她在另一個過敏門診，根據(jù)皮膚點刺試驗和特異性IgE的含量，被建議嚴格規(guī)避花生和所有樹堅果的食用，盡管臨床病史并沒有提示有樹堅果的過敏。由于存在對樹堅果的嚴重反應的風險，她還被提供一個自動注射的腎上腺素注射劑，但是上述處置并沒有經(jīng)過食物挑戰(zhàn)試驗的確認。
　　第一次來我們過敏門診時，女孩的母親給我們看了一個ISAC (Immuno Solid-phase Allergen Chip)試驗，操作特異性IgE檢測的同事建議得到更清晰的變態(tài)反應結果。這次試驗結果顯示，對塵螨、榛子、樺樹和草花粉中度陽性，對Jugr3中度陽性，對Cora1只是輕度陽性。其它所有的花生和樹堅果過敏原均陰性。榛子花粉點刺（陽性，5mm）,榛子提取物點刺試驗結果陰性。因此，進行了榛子的食物激發(fā)試驗，沒有出現(xiàn)即刻反應。從此，食用榛子均無出現(xiàn)任何異常。
　　本案例突出了組份診斷在榛子過敏的診斷中的重要性。另外，我們強調(diào)了食物過敏診斷中正確診斷的重要性，正確的診斷不僅依賴于特異性IgE的高低或皮膚點刺試驗的結果，而必需經(jīng)食物激發(fā)試驗證實。
　　延伸閱讀
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
　　創(chuàng)建過敏性疾病的科研、科普知識交流平臺，為過敏患者提供專業(yè)診斷、治療、預防的共享平臺。