Clinical Validation Of Chinese Criteria For Atopic Dermatitis And Evaluation Of IgE In AD Diagnostic Criteria

Objective:To verify the application of Chinese criteria in the clinical diagnosis of Atopic Dermatitis(AD),and to quantitatively evaluate the value of total IgE(tIgE)and specific IgE(sIgE)in the diagnosis of AD.Methods:From September 2019 to January 2022,a total of 249 patients with a course of≥2 months,age≥12 years old and clinically diagnosed as symmetrical eczema were enrolled in the dermatology department of our hospital.According to the actual situation of each patient,the clinician filled out the AD clinical questionnaire,and judged whether the patient was diagnosed with AD according to the Chinese standard,H&R and JDA standards respectively.The sensitivity,specificity,positive predictive value and negative predictive value of the Chinese standard and the other two diagnostic criteria were compared.At the same time,tIgE,sIgE and EOS were detected in all patients.The patients were divided into AD group and non-AD group according to Chinese standard.The personal and family history of the two groups were compared by chi-square test to explore the correlation between personal history,family history and AD diagnosis.A binary logistic regression model was constructed to analyze the role of tIgE and sIgE in the diagnosis of AD by receiver operating characteristic(ROC)curve and area under the curve(AUC).In addition,food avoidance test was performed on patients with single positive sIgE,and the SCORAD score and clinical recurrence rate of the avoidance group and the non-avoidance group were compared to verify the diagnostic value of sIgE for AD.Results:1.To verify the Chinese standard with H&R standard and JDA standard respectively,the sensitivity(90.5%)of Chinese standard is closer to H&R standard,and the specificity(91.1%)is closer to JDA standard.In the correlation between personal history and AD,food allergy history,allergic rhinitis history and asthma history were significantly correlated with AD(P=0.000).In the study of the correlation between family history and AD,the atopic history of first-degree relatives and second-degree relatives were significantly correlated with AD(P=0.000,P=0.01),but the atopic history of third-degree relatives was not correlated with AD diagnosis(P=0.17).2.Analyze the correlation between tIgE and AD diagnosis,AUC:0.825,P= 0.000,95%confidence interval:0.773-0.878,suggesting that tIgE value has a significant correlation with AD diagnosis.When tIgE>197.5IU/mL(Youden index=0.568),patients with symmetrical eczema are more likely to be diagnosed with AD.3.Analyze the correlation between sIgE and AD diagnosis,AUC:0.949,P=0.000,suggesting that sIgE value also has a significant correlation with AD diagnosis,95%confidence interval CI:0.921-0.976.When sIgE value>3.605IU/ml(Youden index=0.828),patients with symmetrical eczema are more likely to be diagnosed with AD.The area under the curve of sIgE and tIgE was further compared with MedCalc,sIgE>tIgE(P<0.0001),suggesting that the correlation between sIgE and AD was significantly higher than that of tIgE.4.In patients with single positive sIgE,the SCORAD scores of routine outpatient treatment in the avoidance group and the non-avoidance group were improved(P=0.001,P=0.012).The total effective rate of clinical recurrence rate in the avoidance group was better than that in the latter(P=0.027).Conclusion:The Chinese standard of atopic dermatitis has high sensitivity and specificity in clinical application,and tIgE and sIgE are significantly positively correlated with the diagnosis of AD.1.The sensitivity of Chinese standard is close to H&R,and the specificity is close to JDA.The history of food allergy,allergic rhinitis,asthma,atopic history of first-degree relatives and atopic history of second-degree relatives were significantly correlated with AD.The diagnostic value of first-degree and second-degree relatives was higher than that of third-degree relatives.2.The value of tIgE was significantly positively correlated with AD diagnosis;3.The value of sIgE was also positively correlated with the diagnosis of AD,and the correlation was higher than tIgE;4.Food avoidance test can improve the symptoms and relapse rate of sIgE single positive AD patients,sIgE positive has diagnostic significance for AD.