Evaluation of skin prick test to screen dust mite sensitization in chronic respiratory diseases in Southern Vietnam

Ha Thi Chu; Isabelle Godin; Nguyễn Thanh Phương; Lan Huu Nguyen; Tran Thi Mong Hiep; Ngo Minh Xuan; Francis Corazza; Olivier Michel

doi:10.5415/apallergy.2018.8.e39

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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

Original Article

Asia Pac Allergy 2018;8(4):e39.

Published online: 4 October 2018

DOI: https://doi.org/10.5415/apallergy.2018.8.e39

Evaluation of skin prick test to screen dust mite sensitization in chronic respiratory diseases in Southern Vietnam

Ha Thi Chu¹, Isabelle Godin², Nguyễn Thanh Phương¹, Lan Huu Nguyen¹, Tran Thi Mong Hiep³, Ngo Minh Xuan³, Francis Corazza⁴, Olivier Michel^5,^*

¹Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam

²School of Public Health, Université Libre de Bruxelles – ULB, Brussels, Belgium

³Department of Paediatrics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam

⁴Clinic of Immuno-allergology, CHU Brugmann – ULB, Brussels, Belgium

⁵Laboratory of Immunology, Université Libre de Bruxelles – ULB, Brussels, Belgium

^*Correspondence to Olivier Michel Laboratory of Immunology, Université Libre de Bruxelles – ULB, 4 Place A Van Gehuchten, B-1020 Brussels, Belgium. Tel: + 322477 3664 Fax: + 322477 2276 E-mail: omichel@ulb.ac.be

Received 19 December 2017 Accepted 19 October 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Skin test, Immunoglobulin E, Allergen, Chronic respiratory diseases, 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.

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
sIgE	No.	≥0.35 kU_A/L				≥0.70 kU_A/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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