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A new framework for the interpretation of IgE sensitization tests

机译：解释IgE致敏性测试的新框架

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IgE sensitization tests, such as skin prick testing and serum-specific IgE, have been used to diagnose IgE-mediated clinical allergy for many years. Their prime drawback is that they detect sensitization which is only loosely related to clinical allergy. Many patients therefore require provocation tests to make a definitive diagnosis; these are often expensive and potentially associated with severe reactions. The likelihood of clinical allergy can be semi-quantified from an IgE sensitization test results. This relationship varies though according to the patients' age, ethnicity, nature of the putative allergic reaction and coexisting clinical diseases such as eczema. The likelihood of clinical allergy can be more precisely estimated from an IgE sensitization test result, by taking into account the patient's presenting features (pretest probability). The presence of each of these patient-specific factors may mean that a patient is more or less likely to have clinical allergy with a given test result (post-test probability). We present two approaches to include pretest probabilities in the interpretation of results. These approaches are currently limited by a lack of data to allow us to derive pretest probabilities for diverse setting, regions and allergens. Also, cofactors, such as exercise, may be necessary for exposure to an allergen to result in an allergic reaction in specific IgE-positive patients. The diagnosis of IgE-mediated allergy is now being aided by the introduction of allergen component testing which may identify clinically relevant sensitization. Other approaches are in development with basophil activation testing being closest to clinical application.
机译：多年来，IgE致敏性测试（例如皮肤点刺测试和血清特异性IgE）已被用于诊断IgE介导的临床过敏。它们的主要缺点是它们检测到的致敏性与临床变态反应松散相关。因此，许多患者需要进行激发试验才能做出明确的诊断。这些通常很昂贵，并且可能与严重的反应有关。临床过敏的可能性可以从IgE致敏测试结果中进行半定量。虽然这种关系随患者的年龄，种族，假定的过敏反应的性质以及并存的临床疾病（如湿疹）而有所不同。通过考虑患者的表现特征（预测试概率），可以从IgE致敏测试结果中更精确地估计出临床过敏的可能性。这些患者特定因素中的每一个因素的存在可能意味着，在给定的测试结果（测试后概率）下，患者或多或少地具有临床过敏的可能性。我们提出了两种在结果解释中包括预测试概率的方法。目前，这些方法受到数据缺乏的限制，无法让我们得出各种环境，地区和过敏原的预测试概率。同样，辅助因子（例如运动）可能是暴露于过敏原以导致特定IgE阳性患者发生过敏反应的必要条件。 IgE介导的变态反应的诊断现在可以通过引入变应原成分测试来辅助，该测试可以识别临床上相关的致敏作用。正在开发其他方法，其中嗜碱性粒细胞活化测试最接近临床应用。

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