Tesis

Uji Diagnostik Imunoglobulin E Spesifik Serum Dibandingkan dengan Uji Tusuk Kulit dalam Mendiagnosis Sensitisasi Alergen Tungau Debu Rumah dan Kecoa pada Pasien Asma dan/atau Rinitis Alergi = Diagnostic study of Serum Specific IgE versus Skin Prick Test in Diagnosing Sensitization to House Dust Mites and Cockroach Allergens in Patients with Allergic Asthma and/or Rhinitis.

Latar Belakang: Pemeriksaan IgE spesifik serum baru diperkenalkan di Indonesia, tetapi belum ada data uji diagnostik mengenai akurasinya dalam mendeteksi alergen tungau debu rumah dan kecoa pada pasien asma dan atau rinitis alergi. Tujuan: Tujuan penelitian ini adalah untuk mendapatkan akurasi diagnosis pemeriksaan IgE spesifik serum dalam mendiagnosis sensitisasi alergen Dermatophagoides pteronyssinus (Der p), Dermatophagoides farinae (Der f), Blomia tropicalis (Blo t) dan Blatella germanica (Bla g) pada pasien asma dan atau rinitis alergi. Metode: Penelitian ini adalah studi potong lintang pada pasien alergi pernapasan dan merupakan bagian dari studi epidemiologi mengenai sensitisasi IgE spesifik di Divisi Alergi-Immunologi, RS Cipto Mangunkusumo, Jakarta, antara September dan Desember 2016. Pengukuran sensitisasi IgE spesifik dilakukan dengan metode imunoblot (Euroline ® , Euroimmun AG, Germany). Alergen yang diuji adalah Der p, Der f, Blo t, dan Bla g. Hasilnya dibandingkan dengan baku emas uji tusuk kulit. Uji diagnostik yang dilakukan meliputi sensitivitas, spesifisitas, positive predicitive value (PPV), negative predictive value (NPV), likelihood ratio positif dan negatif (LR+ and LR-). Hasil: Serbanyak 101 pasien dilibatkan dalam studi, 77 (76,2%) di antaranya adalah perempuan. Rerata usia pasien adalah 38,8 tahun. Berdasarkan uji tusuk kulit, sensitisasi tertinggi yang didapatkan adalah terhadap Blo t (76,2%), disusul oleh Der p (70,3%), Der f (69,3%), dan Bla g (41,6%). Sensitisasi IgE-spesifik tertinggi ditunjukkan oleh Der f (52,9%), diikuti oleh Der p (38,2%), Blo t (33,3%) dan Bla g (10,8%). Alergen Der p memiliki 50,7% sentivitas, 90% spesifisitas, 92,3% PPV, 43,5% NPV, 5,1 LR+ dan 0,1 LR-. Der f memperlihatkan 71,4% sensitivitas, 87,1% spesifisitas, 82,6% PPV, 57,4% NPV, 5,5 LR+ dan 0,3 LR-. Alergen Blo t menunjukkan 41,6% sensitivitas, 91,7% spesifisitas, 94,1% PPV, 32,8% NPV, 5,0 LR+, dan 0,6 LR-. Alergen Bla g menghasilkan 23,8% sensitivitas, 98,3% spesifisitas, 90,9% PPV, 64,4% NPV, 14,5 LR+ dan 0,8 LR-. Kesimpulan: Pemeriksaan IgE spesifik serum dalam mendiagnosis sensitisasi alergen Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis, dan Blatella germanica pada pasien asma dan atau rinitis alergi memperlihatkan sensitivitas rendah sampai sedang, tetapi spesifisitas dan PPV yang tinggi.
Kata kunci: alergi, alergen inhalan, IgE spesifik, uji diagnostik, uji tusuk kulit



Background: Serum specific IgE testing has recently been introduced in Indonesia, but diagnostic test has not been performed to know its performance to detect house dust mite and cockroach allergens in patients with allergic asthma and/or rhinitis. Objective: The objective of this study was to obtain diagnostic accuracy of serum specific IgE testing in diagnosing allergen sensitization to Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis, and Blatella germanica allergens in patients with allergic asthma and/or rhinitis. Method: This was a cross-sectional study among patients with respiratory allergy and was part of a larger epidemiology study on specific IgE-sensitization in the Division of Allergy-Immunology, Cipto Mangunkusumo Hospital, Jakarta between September and December 2016. Specific IgE sensitization was measured using immunoblot method (Euroline ® , EuroImmun AG, Germany). Allergens tested were Dermatophagoides pteronyssinus (Der p), Dermatophagoides farinae (Der f), Blomia tropicalis (Blo t), and Blatella germanica (Bla g). The results was compared to the standard skin prick test). Diagnostic test were performed and include sensitivity, specificity, positive predicitive value (PPV), negative predictive value (NPV), positive and negative likelihood ratio (LR+ and LR-). Results: A total of 101 patients were enrolled; 77 (76.2%) were women. Patients mean age was 38.8 years old. Based on SPT, sensitization was highest for Blo t (76.2%), followed by Der p (70.3%), Der f (69.3%), and Bla g (41.6%). Specific IgE-sensitization was highest for Der f (52.9%), followed by Der p (38.2%), Blo t (33.3%) and Bla g (10.8%). Der p allergen had 50.7% sentivity, 90% specificity, 92.3% PPV, 43.5% NPV, 5.1 LR+ and 0.1LR-. Der f showed 71.4% sensitivity, 87.1% specificity, 82.6% PPV, 57.4% NPV, 5.5 LR+ and 0.3 LR-. Blo t allergen had 41.6% sensitivity, 91.7% specificity, 94.1% PPV, 32.8% NPV, 5.0 LR+, and 0.6 LR-. Bla g allergen had 23.8% sensitivity, 98.3% specificity, 90.9% PPV, 64.4% NPV, 14.5 LR+ and 0.8 LR-. Conclusion: Serum specific IgE testing to Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis, and Blatella germanica allergens in patients with allergic asthma and/or rhinitis showed only low-to-moderate sensitivity, but high specificity and PPV.
Key words: allergy, diagnostic test, inhalant allergen, specific IgE, skin prick test