背景:已知芹菜根会在对艾草花粉敏感的患者中引起严重的过敏反应。
目的:通过全面的芹菜过敏原组进行IgE测试,以研究具有临床特征的芹菜过敏患者,以解开“芹菜-艾草综合征”的分子基础。
方法:对怀疑芹菜食物过敏的患者进行标准化访谈。主要纳入标准是芹菜的积极食物挑战或严重过敏反应的明确病史。芹菜过敏原的IgE(rApig1.01,rApig1.02,rApig2,rApig4,nApig5,rApig6,rApig7),和艾草过敏原(rArtv1,rArtv3,rArtv4)通过ImmunoCAP测定。IgE水平≥0.35kUA/L为阳性。
结果:纳入79例芹菜过敏患者。30名患者患有轻度口腔或鼻结膜症状,49名患者患有全身反应。68%的人对芹菜提取物有IgE,80%为桦树花粉,77%为艾草花粉。Apig1.01、1.02、4、5和7的组合将芹菜过敏的诊断敏感性提高至92%。LTPsApig2和Apig6在我们的芹菜过敏人群中不相关。IgE到Apig7,在52%的患者中检测到,艾草花粉与艺术v1密切相关(r=0.86)。对Apig7单敏的12例患者中有11例对芹菜提取物为IgE阴性。Apig7致敏与Apig7非致敏受试者发生严重过敏反应而不仅仅是轻度口腔症状的比值比约高6倍(比值比5.87;95%CI1.08-32.0,p=0.0410)。
结论:迫切需要常规诊断测试来评估对Apig7的敏感性,不仅是为了提高测试灵敏度,还要识别芹菜过敏患者对芹菜有严重过敏反应的风险。
BACKGROUND: Celery root is known to cause severe allergic reactions in patients sensitized to mugwort pollen.
OBJECTIVE: We studied clinically well-characterized patients with celery allergy by IgE testing with a comprehensive panel of celery allergens to disentangle the molecular basis of what is known as the celery-mugwort syndrome.
METHODS: Patients with suspected food allergy to celery underwent a standardized interview. Main inclusion criteria were a positive food challenge with celery or an unambiguous case history of severe anaphylaxis. IgE to celery allergens (rApi g 1.01, rApi g 1.02, rApi g 2, rApi g 4, nApi g 5, rApi g 6, rApi g 7) and to mugwort allergens (rArt v 1, rArt v 3, rArt v 4) were determined. IgE levels ≥0.35 kUA/L were regarded positive.
RESULTS: Seventy-nine patients with allergy to celery were included. Thirty patients had mild oral or rhinoconjunctival symptoms, and 49 had systemic reactions. Sixty-eight percent had IgE to celery extract, 80% to birch pollen, and 77% to mugwort pollen. A combination of Api g 1.01, 1.02, 4, 5, and 7 increased the diagnostic sensitivity for celery allergy to 92%. The lipid transfer proteins Api g 2 and Api g 6 were not relevant in our celery-allergic population. IgE to Api g 7, detected in 52% of patients, correlated closely (r = 0.86) to Art v 1 from mugwort pollen. Eleven of 12 patients with monosensitization to Api g 7 were IgE negative to celery extract. The odds ratio for developing a severe anaphylactic reaction rather than only mild oral symptoms was about 6 times greater (odds ratio, 5.87; 95% confidence interval, 1.08-32.0; P = .0410) for Api g 7-sensitized versus -nonsensitized subjects.
CONCLUSIONS: There is an urgent need for routine diagnostic tests to assess sensitization to Api g 7, not only to increase test sensitivity but also to identify patients at risk of a severe allergic reaction to celery.