一台灣醫學中心兒童與成人的特異性E型免疫球蛋白致敏性

Specific Immunoglobulin E Sensitization of Children and Adults in a Taiwan Medical Center

特異性E型免疫球蛋白是臨床上常見的過敏原檢查。在台灣常因食物過敏原檢查結果陽性而被建議禁止食用，然而檢查結果陽性可能只代表致敏性（sensitizeation），臨床上並不一定會產生過敏症狀。尤其在多種過敏原陽性的病人，有可能是因為過敏原蛋白質的相似性，導致交叉反應而產生陽性結果。因此主要過敏原檢查（component-resolved diagnostics（CRD））有助於分辨真正的過敏或只是致敏性或交叉反應。我們回朔性分析新光醫院自2013年9月1日到2017年9月1日為止，241個孩童與2，680個成人的電子病歷。孩童和成人的主要致敏性吸入過敏原都是塵蟎。孩童的主要致敏性食物過敏原是蛋白，牛奶；成人則是以蝦子，和螃蟹為主。2歲以下兒童的致敏性食物過敏原則是以蛋白，牛奶和花生為主。此外花生和堅果；帶殼海鮮和魚類；奇異果、哈密瓜、香蕉、桃子和鳳梨會產生交叉反應，因此在解釋檢查結果時要注意交叉反應的可能性，有必要時需要做主要過敏原檢查或食物過敏負荷試驗來區分真正的過敏或是交叉反應。

In Taiwan, patients are usually advised to completely avoid the food according to the allergen-sIgE sensitization results. We aimed to investigate the allergen-sIgE sensitizations and evaluate the necessity of oral food challenges (OFCs). We retrospectively reviewed electronic medical records of 241 children and 2,680 adults from a medical center in Taipei. The mites Dermatophagoides pteronyssinus(Der p) and Dermatophagoides farinae(Der f) were the top two aeroallergen-sIgE sensitizations in children (57.7% and 56.0%). In adults, the mites Der p (33.1%), Der f (33.1%) and Blomia tropicalis(26.2%)were the major aeroallergen-sIgE sensitizations. The major food-sIgE sensitizations identified in children were egg white, cow’s milk. In adults, the top two rankings of food-sIgE sensitizations were shrimp and crab. A moderate to strong correlation of peanut and tree nuts, shellfish and fish, fruits among kiwi, melon, banana, peach and pineapple, was noted with the possibility of cross-reactivity. The percentages of patients who may not have to undergo OFCs for egg white, cow’s milk, peanut and wheat were 13.1% (≥2 y/o; 19.7% <2y/o), 3.8% (≥2 y/o; 7.7%<2y/o), 9.5%, and 8.7%, respectively, by using the cutoff value of allergen-sIgE. By using the component-resolved diagnostics (CRD), the percentages were 17.6%, 20.0% and 0%, respectively for ovomucoid, Ara h 2 and ω-5 gliadin, respectively. Conclusions: Most of our pediatric patients with sIgE sensitizations to food allergens have to undergo OFCs for the purpose of differentiating sensitization or allergy, cross-reactivity or true allergy.