原標(biāo)題：從癥狀到分子或從分子到癥狀的過(guò)敏診斷：一個(gè)臨床比較研究
　　從“癥狀到分子” 的經(jīng)典過(guò)敏診斷包括：1）臨床病史，2）皮膚點(diǎn)刺試驗(yàn)，3）最近的新方法：分子學(xué)過(guò)敏診斷。我們的目的是檢驗(yàn)“從分子到癥狀”這個(gè)新的替換方法的診斷的精確性，這個(gè)方法在一個(gè)回顧性的研究中得到歐洲過(guò)敏與臨床免疫學(xué)會(huì)的推薦。
　　在應(yīng)用“ISAC- first”方法【即先用免疫固相過(guò)敏原芯片112檢測(cè)組份特異性IgE隨后進(jìn)行選擇性的皮膚點(diǎn)刺試驗(yàn)（SPT）】或SPT-first”方法【即先進(jìn)行皮膚點(diǎn)刺試驗(yàn)隨后進(jìn)行微陣列檢測(cè)】的兩處醫(yī)療機(jī)構(gòu)中，抽取202例臨床疑似過(guò)敏病人的檔案。
　　在過(guò)敏的診斷中，ISAC-first程序中進(jìn)行SPT的機(jī)率明顯要少（平均4:14），ISAC-first組中19%，SPT-first組中34%的病人額外的吸入過(guò)敏原ISAC微陣列檢測(cè)為陰性(p?=?0.014)。ISAC-first 組中有18%的額外ISAC微陣列檢測(cè)敏感性，而SPT-first組中有32%的額外ISAC微陣列檢測(cè)敏感性(p?=?0.016)。在兩組中，食物過(guò)敏原13%和12%額外敏感性被微陣列而不是被皮膚點(diǎn)刺試驗(yàn)檢測(cè)到(p?=?0.800)。ISAC-first組中，沒(méi)有額外食物過(guò)敏原被SPT發(fā)現(xiàn)，而在SPT- first組中一級(jí)陽(yáng)性（+）病例的6%在微陣列中檢測(cè)結(jié)果為陰性。
　　ISAC-first隨后（很少）進(jìn)行SPT的過(guò)敏診斷方法迎合病人特定的需求，因此能被認(rèn)為相當(dāng)于把皮膚點(diǎn)刺試驗(yàn)作為首選隨后進(jìn)行IgE檢測(cè)的傳統(tǒng)的過(guò)敏篩查方法。
　　對(duì)臨床疑似過(guò)敏的診斷確認(rèn)， 新理念“從分子到臨床”在較短時(shí)間內(nèi)提供了一個(gè)可靠的診斷方法。由于其需要點(diǎn)刺的病例較少，特別適用于幼兒和年長(zhǎng)者，特應(yīng)性病人以及皮試?yán)щy或結(jié)果不可靠的病人。


　　延伸閱讀
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. Hinterh?lzl , A. N. Jensen  P. K. Hallmann,  M. KundianE. Jensen-Jarolim
　　創(chuàng)建過(guò)敏性疾病的科研、科普知識(shí)交流平臺(tái)，為過(guò)敏患者提供專業(yè)診斷、治療、預(yù)防的共享平臺(tái)。