小麦相关蛋白特异性IgE检测在小麦依赖-运动诱发的严重过敏反应中的诊断价值  

Diagnostic value of wheat-associated protein-specific IgE assay in wheat-dependent exercise-induced anaphylaxis

作　　者：肖仔婧 朱奕锜 邵亦心 王朵勤 徐金华 唐慧 XIAO Zi-jing;ZHU Yi-qi;SHAO Yi-xin;WANG Duo-qin;XU Jin-hua;TANG Hui(Department of Dermatology,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院皮肤科,上海200040

出　　处：《中国临床医学》2022年第2期218-223,共6页Chinese Journal of Clinical Medicine

基　　金：国家自然科学基金青年科学基金(82003348)。

摘　　要：目的评估不同小麦相关蛋白过敏原在小麦依赖-运动诱发的过敏反应(wheat-dependent exercise-induced anaphylaxis,WDEIA)诊断中的临床价值,完善WDEIA的实验室诊断方法。方法收集31例疑似WDEIA患者,总结临床信息,检测小麦相关蛋白特异性IgE抗体,统计分析不同小麦相关蛋白特异性IgE抗体在WDEIA诊断中的灵敏度和特异度。结果31例患者均曾在运动时发生严重过敏反应,有13例随访期间过敏,可诊断为WDEIA。小麦相关蛋白特异性IgE检测显示,20例患者有阳性反应,其中阳性率最高的为3-磷酸甘油醛脱氢酶(GAPDH),其次为ω-5醇溶蛋白和小麦花粉提取物。上述3种蛋白诊断性分析的灵敏度分别为53.8%、53.8%、23.1%;特异度分别为66.7%、88.3%、88.9%。ω-5醇溶蛋白联合小麦花粉提取物的灵敏度(76.9%)和特异度(72.2%)均较高。结论WDEIA是一种罕见的严重过敏性疾病,以颜面水肿、全身性皮疹、呼吸困难、腹痛腹泻、冷汗和晕厥为主要表现。临床病史及随访对WDEIA的诊断至关重要,而小麦相关蛋白特异性IgE检测可为诊断WDEIA提供参考,其中ω-5醇溶蛋白和小麦花粉提取物联合检测具有最高的诊断价值。Objective To assess the clinical value of different wheat-related protein allergens in the diagnosis of wheat�dependent exercise-induced anaphylaxis(WDEIA)and to improve the laboratory diagnostic method of WDEIA.Methods 31 patients with suspected WDEIA were collected,and their medical history and clinical symptoms were statistically summarized.Wheat-associated protein-specific IgE antibodies were tested,and their sensitivity and specificity in the diagnosis of WDEIA were statistically analyzed.Results All 31 patients had anaphylaxis during exercise,and 13 patients were allergic during follow-up and could be diagnosed as WDEIA.20 patients had positive reactions to wheat-related protein-specific IgE testing,with the highest rate of positivity for 3-phosphoglyceraldehyde dehydrogenase(GAPDH),followed byω-5 gliadin and wheat pollen extract.The sensitivity of these three proteins in the diagnostic analysis was 53.8%,53.8%,and 23.1%,and the specificity was 66.7%,88.3%,and 88.9%,respectively.ω-5 gliadin combined with wheat pollen extract had higher sensitivity(76.9%)and specificity(72.2%).Conclusions WDEIA is a rare and severe allergic disease with facial edema,generalized rash,dyspnea,abdominal pain and diarrhea,cold sweats and syncope as the main manifestations.Clinical history and follow-up are essential for the diagnosis of WDEIA,and wheat-related protein-specific IgE assay also provides an important reference for the diagnosis of WDEIA,with the combination ofω-5 alcoholic protein and wheat pollen extract having the highest diagnostic value.

关 键 词：小麦依赖-运动诱发的严重过敏反应 小麦 诊断试验 小麦花粉提取物 ω-5醇溶蛋白 

分 类 号：R392.8[医药卫生—免疫学]