Lack of Correlation between Severity of Clinical Symptoms, Skin Test Reactivity, and Radioallergosorbent Test Results in Venom-Allergic Patients
Tóm tắt
To retrospectively examine the relation between skin test reactivity, venom-specific immunoglobulin E (IgE) antibody levels, and severity of clinical reaction in patients with insect venom allergy. Thirty-six patients (including 15 females) who presented with a history of allergic reactions to insect stings were assessed. The mean age at the time of the reactions was 33.4 ± 15.1 years (range, 4-76 years), and patients were evaluated 43.6 ± 90 months (range, 1-300 months) after the reactions. Clinical reactions were scored according to severity, from 1 (cutaneous manifestations only) to 3 (anaphylaxis with shock). These scores were compared to scores for skin test reactivity (0 to 5, indicating the log increase in sensitivity from 1 μg/mL to 0.0001 μg/mL) and radioallergosorbent test (RAST) levels (0 to 4, indicating venom-specific IgE levels, from undetectable to >17.5 kilounits of antigen per litre [kUA/L]). No correlation was found between skin test reactivity (Spearman's coefficient = 0.15, p = .377) or RAST level (Spearman's coefficient = 0.32, p = .061) and the severity of reaction. Skin test and RAST scores both differed significantly from clinical severity (p < .05), but there was a significant correlation between skin test reactivity and RAST score (p = .042). There was no correlation between skin test reactivity and time since reaction (Spearman's coefficient = 0.18, p = .294) nor between RAST and time since reaction (r = 0.1353, p = .438). Elimination of patients tested more than 12 months after their reaction still produced no correlation between skin test reactivity (p = .681) or RAST score (p = .183) and the severity of the clinical reaction. In venom-allergic patients (in contrast to reported findings in cases of inhalant IgE-mediated allergy), there appears to be no significant correlation between the degree of skin test reactivity or levels of venom-specific IgE (determined by RAST) and the severity of the clinical reaction.
Tài liệu tham khảo
Souille B: Bronchial provocation tests in 59 asthmatic children. Comparison with skin tests and serum allergens. Rev Mal Respir. 1987, 4: 225-30.
Mosbech H: Insect allergy. Acomparative study including case histories and immunological parameters. Allergy. 1984, 39: 543-9. 10.1111/j.1398-9995.1984.tb00876.x.
Nittner-Marszala M: Evaluation of diagnostic value of skin test, venom specific IgE antibodies and basophil histamine release test in Hymenoptera allergy. Pneumonal Alergol Pol. 1993, 61: 346-51.
Rosario NA, Vilela MM: Quantitative skin prick tests and serum IgE antibodies in atopic asthmatics. J Investig Allergol Clin Immunol. 1997, 7: 40-5.
Clark AT, Ewan PW: Interpretation of tests for nut allergy in one thousand patients, in relation to allergy or tolerance. Clin Exp Allergy. 2003, 33: 1041-5. 10.1046/j.1365-2745.2003.01624.x.
Ring J: History and classification of anaphylaxis. Novartis Found Symp. 2004, 257: 6-16. full_text.
Patrizzi R: Comparison of skin tests and RAST for the diagnosis of bee-sting allergy. Allergy. 1979, 34: 249-56. 10.1111/j.1398-9995.1979.tb01705.x.
Hoffman DR: Comparison of the radioallergosorbent test to intradermal skin testing in the diagnosis of stinging insect venom allergy. Ann Allergy. 1979, 43: 211-3.
Egner W: The frequency and clinical significance of specific IgE to both wasp (Vespula) and honey-bee (Apis) venoms in the same patient. Clin Exp Allergy. 1998, 28: 26-34. 10.1046/j.1365-2222.1998.00176.x.
Linden van der PW: Insect-sting challenge in 324 subjects with a previous anaphylactic reaction: current criteria for insect venom hypersensitivity do not predict the occurrence and severity of anaphylaxis. J Allergy Clin Immunol. 1994, 94: 151-9.
van Halteren HK: Hymenoptera sting challenge of 348 patients: relation to subsequent field stings. J Allergy Clin Immunol. 1996, 97: 1058-63. 10.1016/S0091-6749(96)70258-0.
Pumphrey R: Anaphylaxis: can we tell who is at risk of a fatal reaction?. Curr Opin Allergy Clin Immunol. 2004, 4: 285-90. 10.1097/01.all.0000136762.89313.0b.