집먼지 천식환자의 피부반응, 기관지 수축유발검사 및 RAST간의 비교관찰

Abstract

[한글]

알레르기 질환에 있어서 기인알레르겐을 찾아내는 것은 무엇보다 중요한데, 이를 위하여서는 환자의 병력이 가장 중요하며 그밖에 체내검사로서 피부시험과 각종 유발검사등이, 체외검사로서 백혈구 히스타민 유발검사나 RAST등이 시행되고 있다.

국내에서도 이미 알레르기성 호흡기질환 환자들의 기인성 알레르겐의 검색방법으로 흡입성 알레르겐에 대한 피부반응검사가 널리 보급되어서 시행되고 있으며 더 확실한 기인성 항원규명을 위하여 RAST와 기관지 수축유발검사등이 시행되고 있다.

저자는 기관지 천식진단에 사용되는 여러검사간의 상관성을 조사하기 위해 집먼지가 기인알케르겐으로 작용되었다고 짐작되는 기관지 천식환자 51예를 대상으로 말초혈액 총 호산구수 및 혈청 총 IgE, 알레르겐 피부반응검사, methacholine 및 집먼지 알레르겐 기관

지 수축유발검사, RAST등을 시행하여 다음과 같은 성적을 얻었다.

전체적으로 피부반응검사와 RAST사이에는 80.4%, 피부반응검사와 집먼지 알레르겐 기관지 수축유발검사사이에는 72.5%, 그리고 RAST와 집먼지 알레르겐 기관지 수축유발검사 사이에는 74.5%의 일치율이 있었다.

피부단자시험 결과가 강양성일수록, 피내검사 역치가 높을수록 집먼지 알레르겐 기관지 수축유발검사의 양성율이 높았으며 저등도 및 중등도 methacholine역치군의 기관지 수축유발검사 양성율이 고등도 methacholine역치군에 비해서 유의하게 높았고, 기관지 수축유

발검사 이중 반응군의 혈청 총 IgE와 총 호산구수, PC2O methacholine은 조기나 후기반응군에 비해서 높았다(P<0.01).

피부반응검사, 기관지 수축유발검사, 그리고 RAST 각각의 음성군과 양성군사이에서 혈청 총 IgE는 유의한 차이를 보였다(P<0.05).

양성 기관지 수축유발검사군에서 피부반응정도와 RAST사이에 유의한 상관관계가 있었으나(r= 0.81) 피부반응 홍반이나 팽진의 크기와 PC2O methacholine사이에는 유의한 상관관제가 없었다(P>0.1).

Correlation of allergen skin test, bronchoprovocation test, and RAST in house dust

asthmatics

Ki Baik Hahm, M.D.

Department of Medical Science, The Graduate School, Yonsei University

(Directed by Prof. Ki Ho Kim, M.D.)

Several different laboratory tests have been proposed to screen for respiratory

allergen and to search for provoking allergen, which are the most important one in

allergic disease.

Skin test remaines useful in finding the relationship between offending allergen

and bronchial asthma because of its ease of performance, high degree of

reproducibility and good correlation with in vitro measurements of specific IgE.

But skin tests ale superficial in the aspects of sensitivity and specificity,

though frequent and informative.

It is generally believed that provocation tests when done properly give the most

reliable infomation about different allergens inducing asthma. However, these in

vivo methods are tome consuming and Include a rusk of anaphylactic reaction.

Recently the introduction of in vitro tests for measurements of total and

specific serum IgE has permitted correlation to be made between clinical history,

skin test and provocation test.

We evaluate the correlation between allergen skin test, house dust

bronchoprovocation test, and RAST for revealing the sensitivity of skin test and

RAST with limitness of RAST and for helping to search for provoking allergen in

house dust asthmatics.

The following results were obtained:

1. There was overall 80.4% agreement between skin test and RAST, 72.5% agreement

between skin test and HD-BPT, and 74.5% agreement between HD-BPT and RAST.

2. A positive RAST (class 1 to 4) was found with a positive HD-BPT in 28/33

(84.8%) of cases, and if RAST was O, HD-BPT was negative in 10/18 (55.6%) of cases.

3. Of RAST positive cases, 33/33 (100%) of skin test was postive and of RAST

nesative cases, 8/18 (44.4) of cases was negative skin test.

4. A positive skin test was found with a positive HD-BPT in 33/44 (75.0%) of

cases, and if skin test was negative, the HD-BPT was negative in 4/7 (57.1%) of

cases.

5. A significant correlation was found between the result of skin test and that

of RAST in the early HD-BPT response group, but not in the late and dual HD-BPT

response group.

6. A definite overall correlation existed between serum IgE and skin test

reactivity. Also, there were significant correlations between serum IgE and HD-BPT

and serum IgE and RAST.

7. The greater the size of the prick test, the greater the likelihood of a

positive HD-BPT.

8. There was no significant correlation betweem serum IgE and total eosinophile

count.

9. There was no significant correlation between wheal and erythema size of skin

test and PC^^2O methacholine.

10. Serum IgE, total eosinophile counts In the dual response group of HD-BPT were

significantly higher than those in the early and late response group of HD-BPT.

[영문]

Several different laboratory tests have been proposed to screen for respiratory allergen and to search for provoking allergen, which are the most important one in allergic disease.

Skin test remaines useful in finding the relationship between offending allergen and bronchial asthma because of its ease of performance, high degree of reproducibility and good correlation with in vitro measurements of specific IgE.

But skin tests ale superficial in the aspects of sensitivity and specificity, though frequent and informative.

It is generally believed that provocation tests when done properly give the most reliable infomation about different allergens inducing asthma. However, these in vivo methods are tome consuming and Include a rusk of anaphylactic reaction.

Recently the introduction of in vitro tests for measurements of total and specific serum IgE has permitted correlation to be made between clinical history, skin test and provocation test.

We evaluate the correlation between allergen skin test, house dust bronchoprovocation test, and RAST for revealing the sensitivity of skin test and RAST with limitness of RAST and for helping to search for provoking allergen in house dust asthmatics.

The following results were obtained:

1. There was overall 80.4% agreement between skin test and RAST, 72.5% agreement between skin test and HD-BPT, and 74.5% agreement between HD-BPT and RAST.

2. A positive RAST (class 1 to 4) was found with a positive HD-BPT in 28/33 (84.8%) of cases, and if RAST was O, HD-BPT was negative in 10/18 (55.6%) of cases.

3. Of RAST positive cases, 33/33 (100%) of skin test was postive and of RAST nesative cases, 8/18 (44.4) of cases was negative skin test.

4. A positive skin test was found with a positive HD-BPT in 33/44 (75.0%) of cases, and if skin test was negative, the HD-BPT was negative in 4/7 (57.1%) of cases.

5. A significant correlation was found between the result of skin test and that of RAST in the early HD-BPT response group, but not in the late and dual HD-BPT response group.

6. A definite overall correlation existed between serum IgE and skin test reactivity. Also, there were significant correlations between serum IgE and HD-BPT and serum IgE and RAST.

7. The greater the size of the prick test, the greater the likelihood of a positive HD-BPT.

8. There was no significant correlation betweem serum IgE and total eosinophile count.

9. There was no significant correlation between wheal and erythema size of skin test and PC^^2O methacholine.

10. Serum IgE, total eosinophile counts In the dual response group of HD-BPT were significantly higher than those in the early and late response group of HD-BPT.