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Evaluation of skin prick test to screen dust mite sensitization in chronic respiratory diseases in Southern Vietnam.

ABSTRACT: Background:In the view of the epidemic growth of sensitization to indoor allergens in Southern Vietnam, there is a requirement to screen large population. Objective:To evaluate skin prick tests (SPTs) as predictors of positive specific IgE (sIgE) to dust allergens, among patients with chronic respiratory diseases (CRDs). Methods:The sensitization to Blomia tropicalis (Blo t), Dermatophagoides pteronissinus (Der p), and Blattella germanica allergens (Bla g) were evaluated among 610 CRD, both SPT (?4 mm) and sIgE by immuno-CAP (?0.7 kUA/L). Results:Based on sIgE, 45%, 32%, and 33% of patients with CRD were sensitized to Blo t, Der p, and Bla g, respectively, compared to 19%, 18%, and 13% by SPT. The association between SPT and sIgE was statistically significant, though the Kappa factor was fair (i.e., 0.39 to 0.23). While the specificity of SPT to detect sensitization (compared to sIgE) was >90% among the whole population, the sensitivity was only 34%, 41%, and 24% for Bo t, Der p, and Bla g, suggesting that SPT was not enough sensitive to screen the indoor allergen sensitization. Though, among the <10 pack-year (PY) smokers, the sensitivity was 43% for Blo t, 52% for Der p, and 61% for Blo t and/or Der p, compared to 27%, 30%, and 35% among the ?10 PY smokers. The sensitivity/specificity was not associated with the diagnosis of asthma compared to chronic obstructive pulmonary disease. Conclusion:In the present circumstance, SPT to dust mites allergens can be used to detect a sensitization among CRD population in Southern Vietnam.

SUBMITTER: Chu HT

PROVIDER: S-EPMC6209603 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Evaluation of skin prick test to screen dust mite sensitization in chronic respiratory diseases in Southern Vietnam.

Chu Ha Thi HT Godin Isabelle I Phương Nguyễn Thanh NT Nguyen Lan Huu LH Hiep Tran Thi Mong TTM Xuan Ngo Minh NM Corazza Francis F Michel Olivier O

Asia Pacific allergy 20181023 4

<h4>Background</h4>In the view of the epidemic growth of sensitization to indoor allergens in Southern Vietnam, there is a requirement to screen large population.<h4>Objective</h4>To evaluate skin prick tests (SPTs) as predictors of positive specific IgE (sIgE) to dust allergens, among patients with chronic respiratory diseases (CRDs).<h4>Methods</h4>The sensitization to <i>Blomia tropicalis</i> (Blo t), <i>Dermatophagoides pteronissinus</i> (Der p), and <i>Blattella germanica</i> allergens (Bla ...[more]

PMID: 30402406

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Project description:BackgroundSkin prick test (SPT) solutions and allergy vaccines (AVs) are crucial tools for diagnosis and therapy of allergies. It was the aim of this study to corroborate the content of products for diagnosis and treatment of dust mite allergies that are produced and sold in India.MethodsSDS-PAGE, immunoblots and high-resolution mass spectrometric analysis was performed with 16 house dust mite (HDM) SPT solutions and AVs from 3 Indian manufacturers. Authority-approved European SPT solutions and in-house extracts were used as references.ResultsFrom the 5 Indian Dermatophagoides pteronyssinus products, none contained proteins from this source. Instead, 1 sample contained Dermatophagoides farinae and human serum proteins, 4 products contained allergens from the storage mite Suidasia medanensis, allergens from the legume Cicer arietinum (chickpea), and proteins from baker's yeast. From 4 Indian D. farinae-labeled products, 2 contained human serum proteins and a limited number of D. farinae allergens. Two contained only Suidasia, Cicer, and yeast proteins. In contrast, the European authority-approved D. pteronyssinus and D. farinae SPT solutions that were used as reference in this study, contained exclusively proteins of the respective species and covered the expected allergen spectra. The Blomia tropicalis sample contained no Blomia allergens at all, but consisted exclusively of Suidasia, Cicer, and yeast proteins. All 6 HDM samples consisted of human serum proteins and limited amounts of D. farinae allergens.ConclusionsAll commercial Indian SPT solutions and AVs analyzed in this study are not suitable for dust mite allergy diagnosis and therapy, as they contain either no, or only a limited number of, HDM allergens. In addition, their use could lead to misdiagnosis since some of them contain allergens from other sources, including the storage mite Suidasia, chickpea, as well as baker's yeast. Further, their application might be harmful to patients, as some products contain large amounts of proteins of human origin. Analysis of European SPT solutions, on the other hand, confirmed their suitability for dust mite allergy diagnosis.

Project description:There are several methods to read skin prick test results in type-I allergy testing. A commonly used method is to characterize the wheal size by its 'average diameter'. A more accurate method is to scan the area of the wheal to calculate the actual size. In both methods, skin prick test (SPT) results can be corrected for histamine-sensitivity of the skin by dividing the results of the allergic reaction by the histamine control. The objectives of this study are to compare different techniques of quantifying SPT results, to determine a cut-off value for a positive SPT for histamine equivalent prick -index (HEP) area, and to study the accuracy of predicting cashew nut reactions in double-blind placebo-controlled food challenge (DBPCFC) tests with the different SPT methods.Data of 172 children with cashew nut sensitisation were used for the analysis. All patients underwent a DBPCFC with cashew nut. Per patient, the average diameter and scanned area of the wheal size were recorded. In addition, the same data for the histamine-induced wheal were collected for each patient. The accuracy in predicting the outcome of the DBPCFC using four different SPT readings (i.e. average diameter, area, HEP-index diameter, HEP-index area) were compared in a Receiver-Operating Characteristic (ROC) plot.Characterizing the wheal size by the average diameter method is inaccurate compared to scanning method. A wheal average diameter of 3 mm is generally considered as a positive SPT cut-off value and an equivalent HEP-index area cut-off value of 0.4 was calculated. The four SPT methods yielded a comparable area under the curve (AUC) of 0.84, 0.85, 0.83 and 0.83, respectively. The four methods showed comparable accuracy in predicting cashew nut reactions in a DBPCFC.The 'scanned area method' is theoretically more accurate in determining the wheal area than the 'average diameter method' and is recommended in academic research. A HEP-index area of 0.4 is determined as cut-off value for a positive SPT. However, in clinical practice, the 'average diameter method' is also useful, because this method provides similar accuracy in predicting cashew nut allergic reactions in the DBPCFC.Trial number NTR3572.

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Evaluation of skin prick test to screen dust mite sensitization in chronic respiratory diseases in Southern Vietnam.

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Evaluation of skin prick test to screen dust mite sensitization in chronic respiratory diseases in Southern Vietnam.

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