过敏原皮肤点刺试验的专家共识  

Expert consensus on allergen skin prick test

作　　者：王洪田 马琳[4] 王成硕[8] 申昆玲[5] 何焱玲[9] 马迎民[10] 王宁宇[7,11] 王向东 王俊阁[13] 方秋红[12] 尹金淑[2] 石海云[1] 史飞[14] 邢志敏 向莉 孙劲旅[16] 吴静[19] 谷庆隆 张亚梅[1] 陈晓巍[17] 赵京 晋红中[18] 谢志强[22] 马婷婷[1] 王晓艳[1] 郭淼颖 王良录 张罗 王学艳 无[23] Wang Hongtian;Ma Lin;Wang Chengshuo;Shen Kunling;He Yanling;Ma Yingmin;Wang Ningyu;Wang Xiangdong;Wang Junge;Fang Qiuhong;Yin Jinshu;Shi Haiyun;Shi Fei;Xing Zhimin;Xiang Li;Sun Jinlyu;Wu Jing;Gu Qinglong;Zhang Yamei;Chen Xiaowei;Zhao Jing;Jin Hongzhong;Xie Zhiqiang;Ma Tingting;Wang Xiaoyan;Guo Miaoying;Wang Lianglu;Zhang Luo;Wang Xueyan;无(Department of Allergy,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Allergy branch of Beijing Medical Association)

机构地区：[1]首都医科大学附属北京世纪坛医院变态(过敏)反应科,100038 [2]首都医科大学附属北京世纪坛医院耳鼻咽喉头颈外科,100038 [3]解放军总医院第一医学中心耳鼻咽喉头颈外科 [4]首都医科大学附属北京儿童医院皮肤科,100038 [5]首都医科大学附属北京儿童医院呼吸科,100038 [6]首都医科大学附属北京儿童医院过敏反应科,100038 [7]首都医科大学附属北京儿童医院耳鼻咽喉头颈外科,100038 [8]首都医科大学附属北京同仁医院鼻变态反应科,100038 [9]首都医科大学附属北京朝阳医院皮肤科,100038 [10]首都医科大学附属北京朝阳医院西院呼吸科,100038 [11]首都医科大学附属北京朝阳医院耳鼻咽喉头颈外科,100038 [12]首都医科大学附属北京朝阳医院呼吸科,100038 [13]首都医科大学附属北京中医医院耳鼻咽喉科,100038 [14]解放军空军特色医疗中心皮肤科 [15]北京大学人民医院耳鼻咽喉头颈外科 [16]中国医学科学院北京协和医院变态(过敏)反应科 [17]中国医学科学院北京协和医院耳鼻咽喉头颈外科 [18]中国医学科学院北京协和医院皮肤科 [19]首都医科大学附属北京友谊医院消化科,1000338 [20]首都儿科研究所附属儿童医院耳鼻咽喉科 [21]首都儿科研究所附属儿童医院变态反应科 [22]北京大学第三医院皮肤科 [23]北京医学会过敏变态反应学分会

出　　处：《北京医学》2020年第10期966-985,共20页Beijing Medical Journal

基　　金：国家自然科学基金(81371074,81670901);北京市医院管理局临床医学发展专项——“扬帆”计划(ZYLX201826)。

摘　　要：皮肤点刺试验(skin prick test,SPT)因简单方便、快速灵敏、价格便宜,已成为临床上最常用的过敏原检测方法,至今国内外没有统一的、标准化的SPT操作流程。为此,制定标准化的SPT非常必要。SPT通常在单侧或双侧前臂进行,可分2 d或多天实施,也可在背部进行;抗组胺药物等对SPT有影响,进行SPT之前必须停用3~7 d;如果不能确定药物是否影响SPT结果,可采用组胺阳性对照来验证;组胺阳性对照的最佳浓度是10 mg/ml,也可用两种浓度的组胺验证SPT阳性反应是否成比例;金属单头点刺针的SPT结果非常可靠,塑料多头点刺针对儿童可能有较好的意义;风团>3 mm是SPT阳性反应的标准,红晕可做为参考;随时观察SPT后15~20 min内的反应,少数人也可出现迟发反应,应随时就医;SPT严重不良反应很少见,但应做好预防和急救;最常见的8种吸入过敏原可涵盖95%~99%的过敏患者,11种食物过敏原可以涵盖95%的过敏患者;吸入性过敏原SPT结果的特异度较食物过敏原更高;可用SPT评价抗组胺药的疗效;老年人SPT灵敏度和特异度低于儿童和青壮年;SPT不能作为过敏原特异性免疫治疗(allergen immuotherapy,AIT)的疗效指标,但可采用SPT进行终点滴定法确定AIT中断治疗后再次开始治疗的起始浓度,或在不同AIT产品间进行转换;如果SPT阴性,则建议查血清特异性IgE(specific IgE,sIgE)甚至局部sIgE或激发试验;SPT点刺液、结果解读、新鲜过敏原点刺液、药物过敏原点刺液、SPT操作的标准化非常重要,SPT操作人员应接受岗前培训,获得资质后持证上岗,严格掌握SPT适应证和禁忌证,在皮肤划痕症阳性患者容易出现假阳性,严重过敏期间不宜进行SPT,以免发生严重不良反应;SPT仍有许多方面需要深入研究。Skin prick test(SPT)has become the most commonly used allergen detection method in clinic because of its simplicity,quickness,sensitivity and low price.The seemingly simple SPT actually has many problems.Up to now,there is no unified and standardized operation process of SPT in the whole world and the comparability of SPT results is very poor.Therefore,it is necessary to develop standardized SPT.SPT is usually carried out in one or two forearms in patients with allergic diseases,which can be carried out in two or more days,or in the back skin of patients.Antihistamines and other drugs have an impact on SPT,which must be stopped at least 3-7 d before SPT.If it can not be determined whether the drugs affect the results of SPT,it can be verified by histamine positive control.The best concentration of histamine positive control is10 mg/ml,and it can also be tested by two different concentrations of histamine.The results of SPT with metal single point prick are very reliable,while plastic multiple point prick may have better significance for children.It is generally considered as the standard of SPT positive reaction that the wheal size diameter is more than 3 mm,and the red blush can be used as a reference,but the subjective symptoms of the patients after SPT should not be ignored.The reactions within 20 min after SPT should be observed carefully at any time,and the delayed reactions can occur in a few hours after SPT.The serious adverse reaction of SPT is rare,but prevention and first aid should be prepared well.The most common eight kinds of aeroallergens can cover 95%-99%of allergic patients,11 kinds of food allergens can cover 95%of allergic patients.The SPT results of food allergens are not as reliable as those of aeroallergens.The efficacy of antihistamines can be evaluated by SPT.The sensitivity and specificity of SPT in the elderly are not as good as those of children and young adults.SPT can not be used as the efficacy index of allergen immunotherapy(AIT),but the initial concentration of the starting point a

关 键 词：过敏原 皮肤点刺试验 适应证 禁忌证 专家共识 标准化 

分 类 号：R593.1[医药卫生—内科学]