Povezanost in vivo i in vitro testova na nutritivne alergene kod dece

Abstract

Nutritivna alergija je nepovoljan imunološki odgovor na proteine hrane, a alergeni su podeljeni u dve klase: u prvoj klasi se senzibilizacija dešava per os i dovodi do alergijske reakcije; u drugoj klasi alergijska reakcija nastaje kao posledica senzibilizacije na inhalacione alergene, naročito polene koji imaju identične, homologe proteine, panalergene. Trenutna IgE posredovana reakcija na hranu često obuhvata dva ili više target organa kao što su koža, gastrointestinalni trak, pluća. Najčešći nutritivni alergeni kod dece su : proteini kravljeg mleka, jaje, riba, koštunjavo voće, kikiriki, pšenično brašno i soja. Dijagnoza nutritivne alergije je sinteza dobro uzete anamneze, pregleda, kožnog testiranja, određivanja specifičnog IgE, ali je zlatni standard za dijagnozu provokacioni test. Provokacioni test iziskuje mnogo vremena za izvođenje i nosi potencijalni rizik po pacijenta. Zato testiranje započinje kožnim testovima nutritivnim standardizovanim alergenima poznate koncentracije. Selektivniji test je kožni test sa upotrebom sveže namirnice. U kožnom testu se analizira veličina prečnika papule. In vitro test je određivanje vrednosti specifičnog IgE. Do sada nije dat primat samo jednom testu i u praksi je korisno uraditi in vivo i in vitro testove i potvrditi ili isključiti sumnju na nutritivnu alergiju. CILJEVI: Cilj studije je da se odredi povezanost in vitro i in vivo testova: upoređivanjem rezultata dobijenih izvođenjem skin prik testa komercijalnim ekstraktima i prick – prick testa svežim namirnicama, upoređivanjem rezultata dobijenih određivanjem vrednosti specifičnog IgE i skin prick testa komercijalnim ekstraktima, upoređivanjem rezultata dobijenih određivanjem specifičnog IgE i prik-prik testa svežom hranom. Takođe, određivali smo uticaj polisenzibilizacije na više nutritivnih alergena: jedan od glavnih koje smo pratili i pojedine nutritivne alergene iz šire palete koja je rađena paralelno, ali ciljano, sa glavnim alergenima...

Nutrition allergy is an unfavorable immune response to food proteins. These allergens are divided into two categories: in the first category sensitization happens per os and it results in an allergic reaction; in the second category an allergic reaction happens as the consequence of sensitization to inhaled allergens (especially pollen) which have identical homologous proteins, i.e. panallergens. Current IgE-mediated reaction to food often includes two or more target organs, like skin, gastrointestinal tract, lungs. The most common food allergens in children are cow’s milk proteins, eggs, fish, nuts, peanuts, wheat flour and soy. The nutrition allergy diagnosis is the synthesis of a well taken anamnesis, examination, skin testing and specific IgE measurement, but the gold standard for nutrition allergy diagnosis is a provocation test. However, a provocation test takes a lot of time to be done and there is a certain risk for the patient. Therefore the testing begins with the standard, known concentration, nutrition allergens skin prick testing. A more selective test is a skin prick test performed using a fresh food allergen. A skin prick test analyzes the size of wheal diameter, whereas an in vitro test measures the value of specific IgE. So far neither of these tests has had a priority, which means that it is most useful to do both in vivo and in vitro tests in practice and either confirm or exclude the suspicion of a nutrition allergy. OBJECTIVES: The objective of this study is to determine the concordance between in vitro and in vivo testing by: comparing the results of a skin prick test (SPT) performed using commercial extracts and a prick to prick test (PPT) using fresh food; comparing the results of measured specific IgE values and a skin prick test performed using commercial extracts; comparing the results of measured specific IgE values and a prick to prick test using fresh food. We have also determined the influence of polysensitization on multiple nutrition allergens: one of the major allergens we have observed and some of the food allergens from the wider scope of allergens, the targeted determination of which has been done simultaneously with the major allergens...