Quelle valeur clinique accorder aux résultats chiffrés des dosages d'IgE spécifiques ?
Les explorations in vitro en allergie ont recours principalement aux dosages des IgE « spécifiques » (IgE-S). Ces tests sont souvent dénommés RASTs et leurs résultats exprimés à la fois en unités semi-quantitatives, les classes et en valeurs chiffrées, les kU l –1. Ce double système a-t-il obscurci...
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| Vydáno v: | Immuno-analyse & biologie spécialisée Ročník 18; číslo 3; s. 144 - 151 |
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| Médium: | Journal Article |
| Jazyk: | francouzština |
| Vydáno: |
Paris
Elsevier SAS
2003
Elsevier |
| Témata: | |
| ISSN: | 0923-2532, 1878-1365 |
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| Abstract | Les explorations in vitro en allergie ont recours principalement aux dosages des IgE « spécifiques » (IgE-S). Ces tests sont souvent dénommés RASTs et leurs résultats exprimés à la fois en unités semi-quantitatives, les classes et en valeurs chiffrées, les kU l
–1. Ce double système a-t-il obscurci la valeur et donc l’utilité clinique des résultats chiffrés des tests in vitro ? Les dosages sanguins sont-ils en soi suffisants pour poser un diagnostic d’allergie ou pour prédire une future allergie ? Les courbes de risque récemment proposées et fondées sur des études de populations peuvent-elles améliorer l’efficacité des tests in vitro de ce point de vue ? Cet article analyse ces questions sur la base d’arguments théoriques et expérimentaux. Il en ressort que les résultats chiffrés des dosages d'IgE-S ne traduisent pas fidèlement l'expression clinique du patient et ne doivent donc être interprétés qu'avec le reste du dossier du patient. Les courbes de risque ne sont pas une meilleure solution car elles ajoutent à ces limitations des IgE-S un autre problème : ces courbes sont fortement dépendantes des caractéristiques des cohortes de sujets qui ont servi à les calculer (âge, environnement etc.). Aussi, l'intérêt de ces courbes pour un patient donné est très limité en pratique quotidienne.
In vitro allergy testing is mainly based on the measurement of so-called specific IgEs in serum. These assays are commonly referred to as RASTs. Their results are expressed both in semi-quantitative and quantitative units, i.e. classes and kU l
–1, respectively. Has this double system been detrimental to correctly appraise and use quantitative RAST results? Are the serum blood tests self-sufficient to establish a diagnosis of allergy or to predict the development of a future allergy? And, in this respect, can population–based risk curves, as those recently suggested, improve the efficiency of in vitro allergy testing? This article discusses these different aspects on theoretical arguments as well as on reviewing experimental data. It is concluded that quantitative RAST results must not be interpreted indepedently of clinical information because they do not properly parallel patient reactions. Risk curves add another drawback to quantitative RAST result shortcomings: they largely depend on the subjects recruited to calculate them (eg. age or allergenic environment). So these curves are of limited value for a given patient in daily practice. |
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| AbstractList | Les explorations in vitro en allergie ont recours principalement aux dosages des IgE « spécifiques » (IgE-S). Ces tests sont souvent dénommés RASTs et leurs résultats exprimés à la fois en unités semi-quantitatives, les classes et en valeurs chiffrées, les kU l
–1. Ce double système a-t-il obscurci la valeur et donc l’utilité clinique des résultats chiffrés des tests in vitro ? Les dosages sanguins sont-ils en soi suffisants pour poser un diagnostic d’allergie ou pour prédire une future allergie ? Les courbes de risque récemment proposées et fondées sur des études de populations peuvent-elles améliorer l’efficacité des tests in vitro de ce point de vue ? Cet article analyse ces questions sur la base d’arguments théoriques et expérimentaux. Il en ressort que les résultats chiffrés des dosages d'IgE-S ne traduisent pas fidèlement l'expression clinique du patient et ne doivent donc être interprétés qu'avec le reste du dossier du patient. Les courbes de risque ne sont pas une meilleure solution car elles ajoutent à ces limitations des IgE-S un autre problème : ces courbes sont fortement dépendantes des caractéristiques des cohortes de sujets qui ont servi à les calculer (âge, environnement etc.). Aussi, l'intérêt de ces courbes pour un patient donné est très limité en pratique quotidienne.
In vitro allergy testing is mainly based on the measurement of so-called specific IgEs in serum. These assays are commonly referred to as RASTs. Their results are expressed both in semi-quantitative and quantitative units, i.e. classes and kU l
–1, respectively. Has this double system been detrimental to correctly appraise and use quantitative RAST results? Are the serum blood tests self-sufficient to establish a diagnosis of allergy or to predict the development of a future allergy? And, in this respect, can population–based risk curves, as those recently suggested, improve the efficiency of in vitro allergy testing? This article discusses these different aspects on theoretical arguments as well as on reviewing experimental data. It is concluded that quantitative RAST results must not be interpreted indepedently of clinical information because they do not properly parallel patient reactions. Risk curves add another drawback to quantitative RAST result shortcomings: they largely depend on the subjects recruited to calculate them (eg. age or allergenic environment). So these curves are of limited value for a given patient in daily practice. |
| Author | Malandain, H |
| Author_xml | – sequence: 1 givenname: H surname: Malandain fullname: Malandain, H email: henri.malandain@ch-bretagne-atlantique.fr organization: Laboratoire de biochimie, centre hospitalier Chubert, 56000 Vannes, France |
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| Keywords | Result interpretation Allergy Courbes de risque Specific IgE Allergie IgE spécifiques Diagnostic Diagnosis Risk curves Interprétation des résultats Immunopathologie Homme Interprétation Analyse quantitative IgE spécifique Pronostic Facteur risque |
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| Title | Quelle valeur clinique accorder aux résultats chiffrés des dosages d'IgE spécifiques ? |
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