①对小麦面粉的敏感性在面包师哮喘的进展和诊断中扮演重要的角色。②我们对面包师过敏症的致敏物（小麦过敏原组份）进行了评估，并考虑了与草花粉的交叉反应。③以101名面粉过敏面包师(40名德国面包师、37名荷兰面包师、24名西班牙面包师)和29名花粉敏感的对照受试者（小麦特异性IgE阳性但无职业暴露）为研究对象，采用CAP-FEIA法测定了血清19种重组小麦粉蛋白和2种交叉反应碳水化合物特异性IgE的含量。用小麦粉、黑麦粉和草花粉抑制IgE与单组分的结合。单组份过敏原和混合过敏原IgE检测的诊断效率是通过基于ROC分析的识别面包师过敏症患者和对照受试者的能力来评估的。④ 80%的面包师的特异性IgE水平为0.35 kUA/L或更高，91%的面包师的特异性IgE水平为0.1 kUA/L或更高，而且至少对21种过敏原中的一种敏感。硫醇还原酶(Tri a 27)和小麦二聚α-定粉酶抑制剂0.19(Tri a 28)被发现是IgE结合频率最高的组份。9个组分表现出与草花粉存在交叉反应，18个组分与黑麦粉存在交叉反应。Tri a 27、Tri a 28,四聚物α-定粉酶抑制剂CM2(Tri a 29.02),丝氨酸蛋白酶抑制剂样过敏原(Tri 39),和1-半胱氨酸-类过氧化物酶(Tri a 28),这 5个组份的IgE联合检测, 在ROC分析中,产生最大曲线下面积(AUC = 0.84)，但这仍低于小麦-黑麦面粉-特异性 IgE的AUC值 (分别是0.89或0.88,)。⑤组分诊断有助于区分血清小麦特异性IgE阳性是由职业性面粉暴露引起的还是由于与草花粉存在的交叉反应引起的。然而，对面包师过敏症的常规诊断，使用全麦和黑麦面粉提取物进行过敏原特异性IgE检测仍然是必需的，因为其诊断敏感性更高。
Component-resolved diagnosis of baker's allergy based on specific IgE to recombinant wheat flour proteins∗
Sensitization to wheat flour plays an important role in the development and diagnosis of baker's asthma.
We evaluated wheat allergen components as sensitizers for bakers with work-related complaints, with consideration of cross-reactivity to grass pollen.
Nineteen recombinant wheat flour proteins and 2 cross-reactive carbohydrate determinants were tested by using CAP-FEIA in sera of 101 bakers with wheat flour allergy (40 German, 37 Dutch, and 24 Spanish) and 29 pollen-sensitized control subjects with wheat-specific IgE but without occupational exposure. IgE binding to the single components was inhibited with wheat flour, rye flour, and grass pollen. The diagnostic efficiencies of IgE tests with single allergens and combinations were evaluated by assessing their ability to discriminate between patients with baker's allergy and control subjects based on receiver operating characteristic analyses.
Eighty percent of bakers had specific IgE levels of 0.35 kUA/L or greater and 91% had specific IgE levels of 0.1 kUA/L or greater to at least one of the 21 allergens. The highest frequencies of IgE binding were found for thiol reductase (Tri a 27) and the wheat dimeric α-amylase inhibitor 0.19 (Tri a 28). Cross-reactivity to grass pollen was proved for 9 components, and cross-reactivity to rye flour was proved for 18 components. A combination of IgE tests to 5 components, Tri a 27, Tri a 28, tetrameric α-amylase inhibitor CM2 (Tri a 29.02), serine protease inhibitor–like allergen (Tri a 39), and 1-cys-peroxiredoxin (Tri a 32), produced the maximal area under the curve (AUC = 0.84) in receiver operating characteristic analyses, but this was still lower than the AUC for wheat- or rye flour–specific IgE (AUC = 0.89 or 0.88, respectively).
Component-resolved diagnostics help to distinguish between sensitization caused by occupational flour exposure and wheat seropositivity based on cross-reactivity to grass pollen. For routine diagnosis of baker's allergy, however, allergen-specific IgE tests with whole wheat and rye flour extracts remain mandatory because of superior diagnostic sensitivity.