한국 소아에서 알레르기 질환의 선별검사로서 Phadiatop®Infant 검사법의 임상적 유용성
The Usefulness of an Phadiatop®Infant as a Allergic Screening Test in Korean Children
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목 적 : 아토피(IgE sensitization)는 IgE-매개성 알레르기질환 발생의 위험인자일 뿐 아니라 향후 예후에 대한 가장 중요한 인자이다. Phadiatop® Infant는 소아에서 감작률이 높은 항원으로 구성된 복합항원으로 ImmunoCAP을 측정하며 결과는 양성 및 음성으로 보고되어 IgE-매개성 알레르기 질환이 의심되는 소아에서 사용할 수 있는 선별검사이다. 본 연구에서는 한국 소아에서 흔한 식품 및 흡입항원에 대한 특이 IgE 유무를 검출하데 있어 PhadiatopInfant 검사법의 유용성을 알아보고자 하였다. 방 법 : 2008년 1월부터 2008년 7월까지 아토피피부염 혹은 반복천명을 주소로 서울아산병원 소아천식 아토피센터를 방문한 소아들을 대상으로 Phadiatop Infant 검사를 시행하고 동시에 6가지 흡입항원 (D.p, D.f, cat, dong, cockroach, alternaria) 및 6가지 식품항원 (egg, milk, soybean, wheat, fish, peanut)에 대한 특이 IgE 항체를 측정하여 두 가지 검사법에 대한 일치율 및 IgE-매개성 알레르기 질환의 진단에 있어 Phadiatop® Infant 검사법의 유용성을 조사하였다. 결 과 : 총 93명의 소아가 본 연구에 참여하였으며 이중 남자는 54명 여자는 39명이었다. 평균나이는 32.4(±20.4)개월이었다. 특이항원 측정에 의한 흡입항원에 감작률은 38.7%, 식품항원에 감작률은 53.8%, 12가지 항원 중 하나이상의 감작률은 71%였다. Phadiatop®Infant에 의한 양성률은 66.9%였다. 적어도 하나 이상의 특이항원에 대한 감작유무와 Phadiatop®Infant 검사의 일치도는 0.768 (Kappa value)이었다. Phadiatop®Infant에 양성이나 특이항원이 검출되지 않은 경우가 4례, Phadiatop®Infant에 음성이나 특이항원이 검출된 경우는 5례이었으며 후자에서는 모두 집먼지진드기 특이항원이 검출되었으며 전자에서는 1례를 제외하고 연령이 36개월 이상이었다. 나이별에 따른 일치율은 나이가 적을수록 높은 경향을 보였다. κ= 0.933(0-24개월), 0.692(25-48개월), 0.619(49개월이상) 결 론 : Phadiatop®Infant 검사는 한국 소아에서 IgE-매개성 질환을 진단하는데 유용하며 특히 나이가 어릴수록 유용할 것으로 생각된다. 이는 어릴수록 식품항원에 대한 감작이 높으며 연령이 높아질수록 흡입항원에 대한 감작이 증가하기 때문으로 사료된다.
Abstract
Purpose : Atopy is a prerequisite for IgE-mediated allergic disease and also a significant prognostic factor. Phadiatop®Infant (phadia AB, uppsala, sweden) is a new blood test designed for the detecting the presence of IgE sensitization in young children. This study aims to investigate the usefulness of Phadiatop®Infant test in Korea. Methods : Among the patients who visited Childhood Asthma Atopy Center, Asan Medical Center between January 2008 and August 2008, young children under 6 years of age who had eczema or wheezing were enrolled. Ninety-three patients were tested using specific IgE antibody tests with 6 aeroallergen including Dermatophagoides pteronyssinus (D.p), Dermatophagoides farinae (D.f), cat, dog, cockroach and alternaria, and 6 food allergen including egg, milk, soybean, wheat, fish and peanut as well as Phadiatop®Infant test. Results : The study group was consisted of 54 males and 39 females, with a mean age of 32.4±20.4 months. By specific IgE antibody test, 38.7% were sensitized to aeroallergen, 53.8% to food allergen, 71% to at least one allergen. Positive rate of Phadiatop®Infant was 66.9 %. There were 9 discrepant cases: 4 cases with positive Phadiatop®Infant but negative specific IgE antibody test and 5 cases with negative Phadiatop®Infant but positive specific IgE antibody test. The former cases except one were older than 36 months and all the latter cases were sensitized to house dust mite. The kappa value between Phadiatop®Infant and specific IgE antibody test was 0.768. When the age was considered, the younger children showed the better agreement rate [kappa value=0.933 (<24 months), 0.692 (24-48 months) and 0.619 (>48 months)]. Conclusion : Phadiatop®Infant may be a useful screening test for atopy in Korean children, especially in younger children. It is presumed that the rates of sensitization to local inhalant allergen become higher with increasing age.
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