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2021 中国共识文件：过敏原诊断（英文）

作者：中华医学网发布时间：2026-01-20 20:01浏览：次

2021《China Consensus Document on Allergy Diagnostics》（AAIR，2021；DOI:10.4168/aair.2021.13.2.177）由中国多学会联合制定，是国内首部过敏性疾病病因诊断指南，聚焦 IgE 介导机制，规范体内外检测路径、组分诊断与临床决策，适配中国过敏原分布特征PubMed。以下为结构化英文要点解读。

一、Basic Principles & Diagnostic Algorithm

Core Purpose
- Standardize in vivo/in vitro testing, clarify cross-sensitization/co-sensitization interpretation, and integrate clinical history with test results for etiological diagnosisPubMed.
Diagnostic Workflow
1. Clinical assessment: History (symptom pattern, exposure triggers, comorbidities)+physical examination (mucosal edema, wheezing, skin rash).
2. Initial screening: Skin prick test (SPT) or serum specific IgE (sIgE) → positive = IgE-mediated allergy.
3. Local allergy evaluation: If SPT/sIgE negative, test local secretions (nasal/bronchial) sIgE → positive = local allergic rhinitis/asthma.
4. Definitive confirmation: Allergen provocation test or elimination-challenge if above negative but clinically suspected.

二、In Vivo Testing (Core In Vivo Methods)

Test	Indications	Procedure	Result Interpretation	Strengths/Limitations
SPT	Initial screening for inhalant/food allergens	20-30 min after pricking, measure wheal ≥3 mm vs. negative control	≥3 mm = positive; fresh food SPT for fruit/vegetable allergy	Fast, cost-effective; contraindicated in severe skin disease/antihistamine use
Intradermal test	Low SPT reactivity, drug allergy	0.01-0.02 mL allergen injected intradermally, read at 15-20 min	Wheal ≥5 mm = positive	High sensitivity; higher false-positive rate, risk of systemic reaction
Allergen provocation test (nasal/bronchial/oral)	Refractory cases, local allergy confirmation	Controlled exposure to allergen, monitor symptoms/signs	Positive if symptoms reproduce with objective markers	Gold standard for local allergy; requires experienced team, risk of severe reaction

三、In Vitro Testing (Key Laboratory Tools)

Assay	Target	Clinical Value	Cut-off/Interpretation	Notes
Serum sIgE	Allergen-specific IgE	Identify sensitization; predict reaction severity	Class 0: <0.35 kUA/L (negative); Class 1-6: ≥0.35 kUA/L (positive, higher class = higher reactivity)	Widely available; unaffected by antihistamines; cannot distinguish active allergy from sensitization
Component-resolved diagnosis (CRD)	Allergen components (e.g., Der p 1/Der p 2, Phl p 1/5)	Differentiate cross-sensitization (e.g., birch-pollen-food syndrome), predict severe reaction risk	Component sIgE positive indicates true sensitization vs. cross-reactivity	Critical for immunotherapy candidate selection; costlier, limited component availability
Basophil activation test (BAT)	CD63/CD203c expression on basophils	Diagnose drug allergy, severe anaphylaxis; monitor immunotherapy response	Activation rate ≥15% = positive	High specificity; requires fresh blood, technical expertise
Total IgE	Total serum IgE level	Screen atopy; not diagnostic alone	Normal range varies by age/laboratory	Elevated in atopy but non-specific

四、Allergen Spectrum & Regional Distribution (China-Specific)

Inhalant Allergens
- Northern China: Dust mites (Der p/f), Artemisia, Humulus japonicus, birch pollen.
- Southern China: Dust mites, mold (Aspergillus/Cladosporium), cockroach, ragweedPubMed.
Food Allergens
- Common: Cow’s milk, egg, peanut, shrimp, wheat.
- Regional: Mango (Southern), peach (Northern), buckwheat (some areas).
Cross-Sensitization Patterns
- Pollen-food syndrome: Birch pollen (Bet v 1) cross-reacts with apple/peach; mugwort (Art v 1) with celery/carrot.
- Dust mite-cockroach: Tropomyosin cross-reactivity.

五、Special Populations & Clinical Pearls

Children
- SPT preferred for ≥3 years; serum sIgE for <3 years or antihistamine use.
- CRD helps distinguish true food allergy from cross-sensitization.
Pregnancy/Lactation
- SPT/intradermal test avoided in first trimester; serum sIgE safe.
Elderly
- Consider polypharmacy (e.g., beta-blockers) affecting test results; lower skin reactivity may require intradermal test.
Common Pitfalls
- Over-reliance on sIgE class without clinical correlation (sensitization ≠ allergy).
- Neglecting local allergy (normal serum sIgE but positive local secretion sIgE).
- Misinterpreting cross-sensitization as true allergy (CRD essential).

六、Core Recommendations

Diagnosis
- Prioritize clinical history + SPT/serum sIgE as first-line screening.
- Use CRD for cross-sensitization differentiation and immunotherapy candidate selection.
- Allergen provocation test reserved for refractory/local allergy cases.
Testing Standardization
- SPT: Use standardized extracts, avoid antihistamines 3-7 days prior.
- Serum sIgE: Follow manufacturer cut-offs; results should be laboratory-commutable.
Result Interpretation
- Combine test results with symptoms, exposure history, and response to avoidance/medication.