Tesis

Akurasi Pemeriksaan IgE Spesifik Serum Dengan Metode ELISA dalam Mendiagnosis Sensitisasi Alergen Hirup pada pasien Asma dan/atau Rinitis Alergi = Accuracy of Serum Specific IgE Test Using ELISA Method in diagnosing Inhalant Allergen Sensitization in Asthma and/or Allergic rhinitis patients.

Latar Belakang : Skin prick test (SPT) merupakan baku emas mendiagnosis sensitisasi alergen, namun memiliki keterbatasan. Pemeriksaan IgE spesifik merupakan pemeriksaan in vitro, nyaman dan tidak ada risiko anafilaksis. Tujuan: Mendapatkan akurasi pemeriksaan IgE spesifik serum metode ELISA dalam mendiagnosis sensitisasi alergen hirup pada pasien asma dan/atau rinitis alergi. Metode: Merupakan uji diagnostik dengan desain cross sectional pada pasien asma dan rinitis alergi di poliklinik Alergi-Imunologi FKUI-RSCM. Seratus pasien diperiksa IgE spesifik serum tungau debu rumah (D.pterossinus, D.farinae, B.tropicalis), kulit anjing, kulit kucing dan kecoak dengan metode ELISA serta SPT sebagai baku emas mendiagnosis sensitisasi alergen tersebut. Sensitivitas, spesifisitas, nilai duga, dan rasio kemungkinan dari IgE spesifik serum dinilai untuk masing-masing alergen. Hasil: Sensitivitas IgE spesifik serum dalam mendiagnosis sensitisasi alergen tungau debu rumah berkisar 48-77%, dengan sensitivitas tertinggi 77% (IK 95% 66-86%) pada D.farinae. Spesifisitas berkisar 64-95%, dengan spesifitas tertinggi 95% (IK 95% 76-99) pada B.tropicalis, serta nilai RK+ antara 2,1-11, dengan tertinggi untuk B.tropicalis. Sensitivitas mendiagnosis sensitisasi kecoak 12% (IK 95% 4,5-27), namun spesifisitas 100% (IK 95% 92-100), dengan RK+ ~. Spesifisitas mendiagnosis sensitisasi kulit anjing 89% (IK 95% 79-95), namun senstitivitas 3% (IK 95% 1,5-17), dengan RK+ hanya 0,29 (IK 95% 0,03-2,26). IgE spesifik serum memiliki spesifitas 88% (IK 95% 77-95) dalam mendiagnosis sensitisasi kulit kucing, namun sensitivitas 10% (IK 95% 3,5-26) dan RK+ 0,9 (IK 95% 0,3-3,1). Kesimpuan: Pemeriksaan IgE spesifik serum metode ELISA memiliki akurasi diagnostik yang sedang dalam mendiagnosis sensitisasi terhadap tungau debu rumah dan kecoak, namun akurasi rendah untuk kulit anjing dan kucing.
Kata Kunci: Skin prick test¸ IgE spesifik serum, Akurasi, Alergen hirup


Background: Skin prick test (SPT) is the gold standard to diagnose allergen sensitization, but has some limitations. Serum specific IgE (SSIgE) is in vitro test, comfortable and has no anaphylaxis risk. Aim: To get the accuracy of SSIgE test using ELISA method in diagnosing inhalant allergens sensitization in asthma and/or allergic rhinitis patients. Method: This is diagnostic study with subjects were asthma and/or allergic rhinitis patients. One hundreds patients had SSIgE test for house dust mites (D.pterossinus, D.farinae, B.tropicalis), dog dander, cat dander and cockroach allergens and SPT as gold standard to diagnose allergen sensitization. Sensitivity, specificity, predictive value, and likelihood ratio of SSIgE were evaluated. Result: To diagnose house dust mites sensitization SSIgE has 48-77% sensitivity, with the highest is for D.farinae 77% (95% CI 66-86), while specificity is 6495%, with the highest is for B.tropicalis 95% (95% CI 76-99) and LR+ around 2,1-11, with the highest is for B.tropicalis. Sensitivity of SSIgE to diagnose cockroach sensitization is 12% (95% CI 4.5-27), but has high specificity 100% (95% CI 92-100), and high LR+. SSIgE has high specificity 89% (95% CI 79-95) in diagnosing dog dander sensitization, but low sensitivity 3% (95% CI 1.5-17) and low LR+ 0.29 (95% CI 0.03-2.26). To diagnose cat dander sensitization SSIgE has 88% (95%CI 77-95) specificity, but low sensitivity 10% (95% CI 3.526) and low LR+ 0.9 (95% CI 0.3-3.1) Conclusion: SSIgE test using ELISA method has moderate accuracy in diagnosing house dust mites and cockroach sensitization, but low accuracy for dog and cat dander sensitization.
Keywords: Skin prick test, Serum specific IgE, Accuracy, Inhalant Allergens