Measurement of peptide-specific IgE as an additional tool in identifying patients with clinical reactivity to peanuts
Measurement of peptide-specific IgE as an additional tool in identifying patients with clinical reactivity to peanuts
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DOI：
10.1067/mai.2003.1621
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发表时间：
2003-07-01
影响因子：
14.2
通讯作者：
Sampson, HA
中科院分区：
文献类型：
--
作者：
Beyer, K;Ellman-Grunther, L;Sampson, HA
背景：花生过敏是最常见的食物过敏之一，常导致严重的反应。食物特异性IgE抗体浓度的诊断决定水平已经被描述。然而，许多患者仍然需要接受口服花生的挑战，因为他们的IgE水平是在非诊断level.Objective：本研究的目的是确定是否存在差异，在IgE结合表位识别之间的致敏儿童与无症状的花生allergy.Methods：8肽代表免疫显性顺序表位的阿糖胞苷h 1，2，和3合成SPOTs膜。对15例有症状的花生过敏患者和16例致敏但耐受的患者的血清进行个体患者标记。这16名患者中有10人“长大”他们的allergy.Results：无论他们的花生特异性IgE水平，大多数有症状的花生过敏患者表现出IgE结合的3个免疫显性表位的阿糖胞苷h 2。相比之下，这些表位中的每一个都被< 10%的耐受患者识别。此外，耐受患者不识别Ara h 1上的2个免疫显性表位.至少93%的有症状的患者，但只有12.5%的耐受患者，认识到这些“预测”表位Ara h 1或2。此外，与花生肽结合的累积IgE在花生过敏患者中显著高于耐受患者。与高达50%的花生特异性IgE水平低于诊断决策水平的患者仍然是临床反应，口服食物的挑战，可以避免在90%以上的这些患者通过测定肽特异性IgE.Conclusions：确定表位识别提供了一个额外的工具来诊断症状性花生过敏，特别是在儿童花生特异性IgE低于诊断决策水平。
Background: Peanut allergy is one of the most common food allergies, often resulting in severe reactions. Diagnostic decision levels of food-specific IgE antibody concentrations have been described. However, many patients still need to undergo oral peanut challenges because their IgE levels are in the non-diagnostic level.Objective: The aim of this study was to determine whether differences exist in IgE-binding epitope recognition between sensitized children with and without symptomatic peanut allergy.Methods: Eight peptides representing the immunodominant sequential epitopes on Ara h 1, 2, and 3 were synthesized on SPOTs membranes. Individual patient labeling was performed with sera from 15 patients with symptomatic peanut allergy and 16 patients who were sensitized but tolerant. Ten of these 16 patients had "outgrown" their allergy.Results: Regardless of their peanut-specific IgE levels, most patients with symptomatic peanut allergy showed IgE binding to the 3 immunodominant epitopes on Ara h 2. In contrast, each of these epitopes was recognized by < 10% of the tolerant patients. In addition, tolerant patients did not recognize 2 immunodominant epitopes on Ara h 1. At least 93% of symptomatic, but only 12.5% of tolerant patients, recognized 1 of these "predictive" epitopes on Ara h 1 or 2. Moreover, the cumulative IgE binding to the peanut peptides was significantly higher in patients with peanut allergy than in tolerant patients. With up to 50% of patients with peanut-specific IgE levels below diagnostic decision levels still being clinically reactive, oral food challenges could be avoided in ∼90% of these patients through determination of peptide-specific IgE.Conclusions: Determination of epitope recognition provides an additional tool to diagnose symptomatic peanut allergy, especially in children with peanut-specific IgE below diagnostic decision levels.