目的 我国苹果过敏的致敏情况研究非常缺乏.本研究拟分析苹果过敏原的组分蛋白的致敏情况,并对苹果过敏的护理干预效果进行研究.方法 40例可疑苹果过敏受试者纳入研究,分为苹果耐受组(n=19)和过敏组(n=21).所有受试者均接受ImmunoCAP过敏原sIgE检测,评估苹果及其主要致敏蛋白组分(Mal d 1和Mal d 3),以及Bet v 2的sIgE水平.分析不同组分在苹果过敏组和耐受组的差异,并对苹果过敏组进行护理干预.结果 苹果sIgE阳性率为70％,Mal d 1的阳性率为85％,Mal d 3为20％,Bet v 2的阳性率为35.0％.97.5％的患者至少1种苹果过敏原组分阳性.60％的患者仅对1种苹果过敏原组分过敏,35％对2种组分过敏,2.5％的患者对所有3种组分均过敏.其中50％对Mal d 1单一过敏,而10％对Bet v2单一过敏.Mal d 3与苹果过敏原sIgE呈正相关(r=0.944,P＜0.001).与耐受组相比,苹果过敏组中Mal d 1的sIgE水平显著升高(P＜0.001),Bet v2 sIgE水平显著降低(P=0.036).ROC分析显示,Mal d 1 sIgE水平在诊断苹果过敏时的曲线下面积(AUC)为 0.902,95％CI 0.789～1.000,P＜0.001,cut-off 值为 1.61kUA/L(灵敏度为 93.8％,特异性为75.0％).对苹果过敏组21例患者进行充分护理教育后,患者病情知晓率达100％,必要忌口联合对症治疗后症状控制率达到90.4％(19/21),目前所有患者在长期随访中.结论 Mald1是苹果过敏的主要组分,是诊断苹果过敏的最佳指标,苹果、Mald 3和Bet v 2的sIgE对诊断苹果过敏的价值并不显著.对苹果过敏患者进行有效的护理干预可以提高治疗效果.
A Study on the Sensitization Characteristics and Diagnostic Value of Apple Allergens Components and Its Nursing Intervention
Objective The profile of apple allergens in China is very limited.This study aims to analyze the sensitization of the components of apple allergens in China and to evaluate the diagnostic value of these components.Methods Forty subjects with suspected apple allergy were enrolled and divided into an apple tolerance group(n=19)and an allergy group(n=21).All subjects were tested by ImmunoCAP to evaluate the sIgE concentrations of apple and its main components(Mal d 1 and Mal d 3),as well as Bet v 2.The differences of different components were then analyzed.Nursing intervention was carried out for apple allergy group.Results The apple sIgE positivity rate was 70％,while the Mal d 1,Mal d 3,and Bet v 2 positivity rates were 85％,20％,and 35.0％respectively.A total of 97.5％of the patients exhibited positive reactions to at least one component of apple allergens.Among them,60％were exclusively allergic to a single component,while 35％showed sensitivities towards two components.Interestingly,a small proportion(2.5％)demonstrated allergic responses to all three components.Among them,50％of the patients were mono-allergic to Mal d 1,and 10％of the patients were mono-allergic to Bet v 2.Mal d 3 was positively correlated with apple allergen sIgE(r=0.944,P＜0.001).Compared with the tolerance group,the sIgE level of Mal d 1 in the allergy group was significantly increased(p＜0.001),and the sIgE level of Bet v 2 was significantly decreased(P=0.036).ROC curve showed that Mal d 1 sIgE level had a consistent AUC value in the diagnosis of apple allergy(AUC 0.902,95％CI 0.789-1.000,P＜0.001),and the cut-off value was 1.61 kUA/L(sensitivity:93.8％,specificity:75.0％).After providing comprehensive nursing education to the 21 patients with apple allergy,the patients'awareness rate of their condition reached 100％.The symptom control rate after necessary avoidance of certain foods combined with symptomatic treatment was 90.4％(19/21),and all patients are currently being followed up for a long period of time.Conclusion Mal d 1 sIgE is the main component of apple and the best indicator for the diagnosis of apple allergy,while the value of sIgE of apple,Mal d 3 and Bet v 2 in the diagnosis of apple allergy is not significant.Effective nursing interventions for patients with apple allergies can improve treatment outcomes.
Food allergyApple allergyAllergen componentMal d 1Mal d 3Nursing intervention
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