Journal List > Asia Pac Allergy > v.8(4) > 1108192

Chu, Godin, Phương, Nguyen, Hiep, Xuan, Corazza, and Michel: Evaluation of skin prick test to screen dust mite sensitization in chronic respiratory diseases in Southern Vietnam

Abstract

Background

In the view of the epidemic growth of sensitization to indoor allergens in Southern Vietnam, there is a requirement to screen large population.

Objective

To evaluate skin prick tests (SPTs) as predictors of positive specific IgE (sIgE) to dust allergens, among patients with chronic respiratory diseases (CRDs).

Methods

The sensitization to Blomia tropicalis (Blo t), Dermatophagoides pteronissinus (Der p), and Blattella germanica allergens (Bla g) were evaluated among 610 CRD, both SPT (≥4 mm) and sIgE by immuno-CAP (≥0.7 kU A/L).

Results

Based on sIgE, 45%, 32%, and 33% of patients with CRD were sensitized to Blo t, Der p, and Bla g, respectively, compared to 19%, 18%, and 13% by SPT. The association between SPT and sIgE was statistically significant, though the Kappa factor was fair (i.e., 0.39 to 0.23). While the specificity of SPT to detect sensitization (compared to sIgE) was >90% among the whole population, the sensitivity was only 34%, 41%, and 24% for Bo t, Der p, and Bla g, suggesting that SPT was not enough sensitive to screen the indoor allergen sensitization. Though, among the <10 pack-year (PY) smokers, the sensitivity was 43% for Blo t, 52% for Der p, and 61% for Blo t and/or Der p, compared to 27%, 30%, and 35% among the ≥10 PY smokers. The sensitivity/specificity was not associated with the diagnosis of asthma compared to chronic obstructive pulmonary disease.

Conclusion

In the present circumstance, SPT to dust mites allergens can be used to detect a sensitization among CRD population in Southern Vietnam.

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Fig. 1.
Prevalence of allergen sensitization. (A) Prevalence of positive skin prick test (SPT). (B) Prevalence of positive sIgE. The black bars indicate a cutoff of 0.35 kU A/L and the white bares show a cutoff of 0.70 kU A/L specific IgE (sIgE). Blo t, Blomia tropicalis; Der p, Dermatophagoides pteronyssinus; Bla g, Blattella germanica; Bla a, Blattella americana; Bla o, Blattella orientalis.
apa-8-e39f1.tif
Table 1.
Demographics and clinical characteristics of the whole population and their specific sensitization
Variable All Der p (+) Blo t (+) Bla g (+)
No. of patients 610 109 (17.9) 114 (18.7) 77 (12.6)
Sex
 Male 489 81 (16.6) 86 (17.6) 59 (12.1)
 Female 121 28 (23.1) 28 (23.1) 18 (14.9)
Age (yr) 54 ± 13 47 ± 13 50 ± 14 50 ± 14
Smoke habits   a    
 Nonsmoker 167 46 (27.5) 40 (24.0) 24 (14.4)
 Ex-smoker 232 31 (13.4) 37 (15.9) 20 (8.6)
 Current smoker 211 32 (15.2) 37 (17.5) 33 (15.6)
Cumulative smoke
 <10 PY 243 69 (28.4) 64 (26.3) 38 (15.6)
 ≥10 PY 367 40 (10.9)* 50 (13.6)* 39 (10.6)
Diagnosis
 COPD
  All 340 45 (13.2) 43 (12.7) 36 (10.6)
  <10 PY 103 24 (23.3) 19 (18.4) 13 (12.6)
  ≥10 PY 237 21 (8.9) 24 (10.1) 23 (9.7)
 Asthma
  All 186 42 (22.6) 51 (27.4) 30 (16.1)
  <10 PY 89 30 (33.7) 30 (33.7) 17 (19.1)
  ≥10 PY 97 12 (12.4) 21 (21.6)§ 13 (13.4)
Others, all 84 21 (25.0) 20 (23.8) 11 (13.1)

Values are presented as number (%) or mean ± standard deviation. (+), positive skin prick tests for Dermatophagoides pteronissinus (Der p), Blomia tropicalis (Blo t) or Blattella germanica (Bla g); PY, pack-year.

* p < 0.001 comparing smokers < and ≥ 10 PY.

p < 0.001 comparing COPD and asthmatics.

p < 0.01 comparing smokers < and ≥ 10 PY among asthmatics.

§ p < 0.05 comparing smokers < and ≥ 10 PY among asthmatics.

p < 0.01 comparing smokers < and ≥ 10 PY among COPD. a: p trend.

Table 2.
SPT as predictors of specific IgE
sIgE No. Sensitivity (%) Specificity (%) Kappa* p value Sensitivity (%) Specificity (%) Kappa* p value
≥0.35 kUA/L ≥0.70 kUA/L
Blo t, all 610 27 93 0.18 <0.001 34 94 0.29 <0.001
Der p, all 610 33 94 0.29 <0.001 41 94 0.39 <0.001
German cockroach, all 610 20 93 0.14 <0.001 24 93 0.20 <0.001
Oriental cockroach, all 608 22 92 0.17 <0.001 30 92 0.25 <0.001
American cockroach, all 610 21 93 0.16 <0.001 28 93 0.24 <0.001
Shrimp, all 519 5 97 0.02 NS 6 97 0.04 NS
Blo t and/or Der p, all 610 39 87 0.31 <0.001 46 88 0.35 <0.001
Blo t
 Asthma 186 34 86 0.05 <0.01 38 88 0.24 <0.001
 COPD 340 20 95 0.04 <0.001 26 95 0.25 <0.001
Der p
 Asthma 186 34 92 0.05 <0.001 37 91 0.28 <0.001
 COPD 340 29 96 0.05 <0.001 41 95 0.43 <0.001
Blo t and/or Der p
 Asthma 186 44 80 0.06 <0.01 48 83 0.27 <0.001
 COPD 340 31 90 0.04 <0.001 40 91 0.33 <0.001
Blo t
 Smoking <10 PA 243 39 89 0.05 <0.001 43 90 0.33 <0.001
 Smoking ≥10 PA 367 20 95 0.03 <0.001 27 96 0.24 <0.001
Der p
 Smoking <10 PA 243 47 89 0.06 <0.001 52 88 0.41 <0.001
 Smoking ≥10 PA 367 22 97 0.04 <0.001 30 97 0.33 <0.001
Blo T and/or Der p
 Smoking <10 PA 243 55 79 0.06 <0.001 61 81 0.42 <0.001
 Smoking ≥10 PA 367 28 92 0.04 <0.001 35 92 0.28 <0.001

SPT, skin prick test; sIgE, specific IgE; Der p, Dermatophagoides pteronissinus; Blo t, Blomia tropicalis; Bla g, Blattella germanica; NS, nonsignificant; COPD, chronic obstructive pulmonary disease; PY, pack-year.

* Kappa association between positive sIgE and SPT.

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