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Trafność diagnostyczna oznaczeń alergenowo swoistych przeciwciał IgE w zawodowej alergii dróg oddechowych na czynniki o dużej masie cząsteczkowej

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Zgorzelska-Kowalik J., Walusiak-Skorupa J., Nowakowska-Świrta E., Wiszniewska M.
Medycyna Pracy
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2017
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vol. 68
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issue 1
31-43
EN
Background The performance of specific inhalation challenge test (SICT) – reference method in diagnostics of occupational allergy – has some limitations due to health status of a particular patient. Therefore, it is extremely important to identify usefulness of other tests, and the evaluation of diagnostic accuracy of commercially available serum specific immunoglobulin E (sIgE) kits to the most common high molecular weight agents has been launched. Material and Methods The study group comprised 141 subjects – 110 bakers and 31 farmers – with suspicion of occupational airway allergy. All patients underwent evaluation of serum sIgE to occupational allergens with the use of Phadia and Allergopharma kits: in bakers to flour mix and α-amylase, in farmers to epithelium of cow, pig and feathers. Specific inhalation challenge test with workplace allergens performed in all subjects was a reference method for further analysis. Results Serum specific IgE to flour mix had the highest sensitivity (Phadia – 95.6%, Allergopharma – 88.3%), while its specificity was relatively low (Phadia – 47.8%, Allergopharma – 25%). There were numerous discrepancies between the results of sIgE estimation for particular single allergens (k87, e4, e83), as well as for their mixtures (fx901, fx20, ex71), performed with the kits of both companies (Phadia vs. Allergopharma). Conclusions Evaluation of serum specific IgE is characterized by inadequate sensitivity, specificity and predictive value to take the place of specific inhalation challenge test in diagnostics of occupational respiratory allergy. Med Pr 2017;68(1):31–43
PL
Wstęp Test swoistej prowokacji wziewnej – metoda referencyjna w diagnostyce alergii zawodowej – u niektórych chorych nie może być przeprowadzony z powodu przeciwwskazań zdrowotnych. Ponieważ ustalenie rzeczywistej przydatności innych testów jest niezwykle ważne, podjęto badanie, którego celem było określenie trafności i przydatności diagnostycznej dostępnych komercyjnie odczynników do oznaczania alergenowo swoistych przeciwciał immunoglobuliny E (asIgE) w surowicy w diagnostyce IgE-zależnej alergii dróg oddechowych na najczęstsze alergeny pochodzenia roślinnego. Materiał i metody Badaniem objęto grupę 141 pacjentów – 110 piekarzy i 31 rolników – z podejrzeniem zawodowej alergii dróg oddechowych. U wszystkich badanych oznaczono asIgE dla alergenów zawodowych w surowicy odczynnikami firm Phadia i Allergopharma: u piekarzy dla mieszaniny mąk i α-amylazy, u rolników dla alergenów naskórka krowy, naskórka świni i mieszaniny piór. Metodę referencyjną do oceny powyższych testów diagnostycznych stanowił wykonany u wszystkich badanych test swoistej prowokacji wziewnej z alergenami z miejsca pracy. Wyniki Najwyższą czułością charakteryzowały się oznaczenia asIgE dla alergenów mąk (Phadia – 95,6% i Allergopharma – 88,3%), przy stosunkowo niskiej swoistości (Phadia – 47,8% i Allergopharma – 25%). Rozbieżności między wynikami uzyskanymi przy użyciu zestawów Phadia vs Allergopharma dotyczyły oznaczeń asIgE zarówno dla pojedynczych alergenów (k87, e4, e83), jak i mieszanin alergenów (fx901, fx20, ex71). Wnioski Oznaczanie asIgE w surowicy nie charakteryzuje się wystarczającą czułością, swoistością i wartością predykcyjną, żeby zastąpić test swoistej prowokacji wziewnej w diagnostyce zawodowej alergii dróg oddechowych. Med. Pr. 2017;68(1):31–43
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Identification of cross-reactive carbohydrate determinants in subjects reporting work-related respiratory symptoms

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Wiszniewska M., Zgorzelska-Kowalik J., Nowakowska-Świrta E., Walusiak-Skorupa J.
International Journal of Occupational Medicine and Environmental Health
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2015
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vol. 28
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issue 1
90-101
EN
Introduction: The role of cross-reactive carbohydrate determinants (CCDs) in diagnostics of occupational allergy remains unclarified and its clinical relevance is still questioned. The aim of the study was to assess the frequency of positive response to CCDs in the subjects with suspected occupational allergy and the relationship between other diagnostic test results and final diagnosis. Material and methods: The study group included 201 patients. They underwent clinical examination, skin prick test (SPT) to common and occupational allergens, specific serum immunoglobulin (sIgE) determinations, spirometry and specific inhalation challenge test. Moreover, sIgE to CCDs from bromelain was assessed in all subjects. Results: Occupational respiratory allergy was recognized in 64.3% of CCD-positive and 52.4% of CCD-negative patients. Positive SPT results to common and occupational allergens were found in 64.3% and 35.7% of CCD-positive subjects, respectively. In all subjects with CCDs, the sIgE to grass pollens as well as to occupational allergens were detected. The total IgE level > 100 kU/l was significantly associated with the presence of sIgE to CCDs. Conclusions: sIgE to CCDs were found in 7% of subjects suspected to suffer from occupational respiratory allergy. The presence of CCDs is not significantly associated with occupational respiratory allergy. It is also not more frequent in subjects reporting work-related respiratory symptoms in whom occupational allergy was not confirmed. The elevated total IgE level was related with CCD positivity. In patients with suspected occupational allergy, the presence of sIgE to CCDs in serum did not indicate the irrelevance of positive sIgE to occupational allergens.
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