Pollen Allergy Screening with Allergen-Specific and TotalImmunoglobulin E Titers

IgE antibody in the serum--detection and diagnostic significance.

Introduction:Allergies are defined as an immune response to non-microbial environmental antigens (allergens) that involve TH2 cells, mast cells, eosinophils and immunoglobulin E (IgE). Atopic disorders such as urticaria, asthma, hay fever, and eczema exhibit a strong familial predisposition and specific IgE-mediated reaction after exposure to the allergens. Aeroallergens involved in the hypersensitivity reactions include pollens, animal dander, fungal spores and house dust mite. Frequency and type of aeroallergens vary in different countries based on climate, vegetation and geographic areas.Aim:Due to increased prevalence of allergic diseases, in vitro diagnostic tests are commonly utilized in our area. The aim of our study is to evaluate the association between total and specific IgE and to study frequency of different aeroallergens in the population.Methods:The study was conducted in a time period between 1/12/2017 and 15/11/2018 at King Hussein Medical Center, Amman, Jordan. A total of 80 patients with symptoms of allergic disorders were included, ages of individual’s ranged between 1 year and 77 years, 58.8 % (n=47) of which male and 41.2 % (n=33) female. Blood samples from all patients were collected into a 10 ml gel separator (with clot activator) tubes and tested for total IgE and specific IgE.Results:A total of 80 patients aged 1-77 years were divided into 4 groups depending on the normal value of total IgE as follow: 1-5 years, 6-9 years, 10-15 years, and adult. A total of 43(53.75%) patients exhibited elevated total IgE level, and 37(46.25%) had normal level. 41(51.2%) patients had elevated total IgE and positive specific IgE. The sensitivity and specificity of total IgE when using specific IgE as standard test was 77.4% and 92.5% respectively. The accuracy rate of the total IgE test was 82.5%. The most common aeroallergens were dermatophagoides pteronyssinus (13.6%), followed by grass mix (12.8).Conclusion:Testing of specific IgE is an essential procedure that helps to detect the cause of allergy. Although negative specific IgE could not exclude allergen sensitization due to limitations of detection method and allergen selection, and positive total and specific IgE indicate probability of sensitization.

In this study we aimed to assess whether the association between asthma (defined by symptoms and bronchial responsiveness) and total immunoglobulin E (IgE) levels was independent of specific IgE levels to common aeroallergens. A general population-based sample, supplemented with symptomatic individuals, comprising 1,916 young adults, aged 20-44 years, from five areas of Spain, performed a face-to-face respiratory questionnaire, and spirometry, and had total and specific serum IgE levels to mites, pets and moulds recorded. In 1,626 of the subjects, a dose-response methacholine challenge test was completed. Subjects reporting current attacks of asthma showed an association with total IgE (odds ratio (OR) for IgE > 100 kU.L-1 = 4.73, 95% confidence intervals (95% CI) = 2.01-11.12, adjusted for specific IgE, sex, age, smoking, forced expiratory volume in one second (FEV1), and area), which did not vary by bronchial responsiveness. The association between total IgE and asthma also occurred among those with negative specific IgE antibodies (OR 18.0; 95% CI 13.9-120). Individuals with current wheezing and bronchial responsiveness without attacks of asthma also showed an adjusted association with total IgE (OR 4.96; 95% CI 2.32-10.6), which remained for persons without specific IgE (OR 5.86; 95% CI 2.18-1.7). These findings reinforce previous evidence that asthma is associated with increased levels of total IgE, even in subjects negative for specific IgE to common aeroallergens.

A new commercial immunochromatographic test (Allerwatch) has recently been developed for determining total immunoglobulin E (IgE). We previously reported on the use of this kit for analyzing tear fluid samples collected during the spring. In this study, we examined the relationship between the total IgE level in tears and the specific serum IgE levels in patients with autumnal allergic conjunctivitis. A prospective, nonrandomized cross-sectional study was conducted in 36 patients with autumnal allergic conjunctivitis (autumnal allergic group), in 32 age-matched and sex-matched healthy control subjects (control group), and in 10 patients with epidemic keratoconjunctivitis. Total tear IgE score was determined in all subjects using the Allerwatch test (0, 1, and 2), whereas the serum levels of total IgE and specific IgE for 12 inhaled allergens were measured using the Phadezym PRIST and CAP-RAST systems, respectively. Positivity rates for total tear IgE were significantly higher in the autumnal allergic group as compared with the control and epidemic keratoconjunctivitis groups (88.9% vs. 0.0% vs. 0.0%, P < 0.00001). In the autumnal allergic group, there was a significant correlation between the total tear IgE score and the log-transformed total serum IgE level (r = 0.84). Significant correlations were also seen with the IgE serum levels for Dermatophagoides pteronyssinus (r = 0.53), house dust (r = 0.51), acarus (r = 0.49), cedar pollen (r = 0.33), and mugwort (r = 0.33). Multivariate logistic regression analysis showed that the only significant predictor of the total tear IgE score was the log-transformed total serum IgE level (odds ratio = 2.76, P < 0.00001). The correlation between the Allerwatch total tear IgE score and the specific IgE serum levels against house dust mites suggests that house dust mite allergens might be the primary cause of allergic conjunctivitis during autumn in Japan. The Allerwatch methodology can provide rapid measurements of total IgE in the tear fluid, which makes it possible to easily diagnose allergic conjunctivitis in an outpatient setting.

The objective of this study was to investigate the correlation of symptoms in patients with presumed allergic rhinitis on the basis of their medical history and physical examination with the levels of total immunoglobulin E (IgE) and specific IgE, and to question the necessity of these tests in diagnosis. The records of 295 patients, who had at least two complaints of nasal itching, nasal obstruction, runny discharge and sneezing, and/or presumed as allergic rhinitis on physical examination findings were retrospectively screened. The correlation between the levels of IgE, specific inhalant IgE, and food-specific serum IgE were evaluated in these patients. A total of 70 cases (23.7%) were determined to have a total value of IgE under 20 U/ml, 113 cases (38.3%) with IgE values between 20 U/ml and 100 U/ml, and 100 cases with IgE values above 100 U/ml. Results of total IgE could not be obtained in 12 (4.06%) patients. Dermatophagoides farinae was the most common allergy in this group with 74 (68.5%) cases. The determination of IgE in allergic rhinitis is a supportive method. However, it cannot be recommended for routine use because of the time loss and high cost.

Sensitization of human airways: what is the role of immunoglobulin-E?

Allergic rhinitis is diagnosed by clinical parameters with no widely accepted screening test. Measurement of total serum immunoglobulin E (IgE) has limited use in the general population due to a low negative predictive value. The value of total IgE level in select populations undergoing in vitro allergy testing remains unknown. The aim of this study is to determine the utility of total serum IgE in the in vitro diagnosis of allergic rhinitis. A retrospective chart review of patients undergoing testing for allergic rhinitis was performed. Clinical parameters, total IgE level, and enzyme-linked immunosorbent assay (ELISA) for serum-specific IgE levels were analyzed with multivariate logistic regression. The positive and negative predictive values and a receiver operating characteristic (ROC) curve were used to assess the utility of total IgE in predicting serum-specific IgE test results. Records from 1073 patients were reviewed. ROC curve for total IgE >150 IU/mL (Σ 0.88) indicates good discrimination in identifying patients with sensitization by in vitro testing, whereas low total IgE level had strong negative predictive value (0.87, IgE <10) in identifying negative specific IgE testing. Multivariate logistic regression showed that differences in covariables did not significantly change the odds of a positive in vitro allergy test panel. Serum total IgE level is useful in the in vitro diagnosis of allergic rhinitis. In vitro testing for specific IgE may be unnecessary in patients with low serum total IgE, whereas high total IgE level suggests that in vitro testing would confirm specific sensitizations in patients with allergic rhinitis.

To evaluate whether the measurement of specific immunoglobulin E (IgE) antibodies to food and/or inhalant allergens in infants who are hospitalized for wheezing can be used to predict later asthma. Eighty-two children who were hospitalized for wheezing at <2 years of age were followed prospectively until early school age. The baseline data and the characteristics of infancy had been collected at enrollment. At school age, the children were evaluated for asthma and allergic manifestations, including skin prick tests to common inhalant allergens. Frozen serum samples obtained during the index episode of wheezing were available for 80 children for determination of food and inhalant allergen-specific serum IgE antibodies by fluoroenzyme-immunometric assay, UniCAP, applying the Phadiatop Combi allergen panel. Asthma was present in 32 (40%) children at school age. Food-specific IgE antibodies of >or=0.35 kU/L were found in 37 (46%) wheezing infants, but only specific IgE to wheat and to egg white at the level of >or=0.35 kU/L were significantly associated with later asthma. In regard to specific IgE to the mixture of food allergens, the cutoff level of >or=0.70 proved to be significant. Inhalant allergen-specific IgE of >or=0.35 kU/L was found only in 14 cases (18%), but when present, it was significantly predictive of asthma. Elevated levels of specific IgE antibodies to food or inhalant allergens were significantly associated with allergic rhinitis and skin-test reactivity at school age. When present in wheezing infants, specific IgE of >or=0.35 kU/L to wheat, egg white, or inhalant allergens are predictive of later childhood asthma. Consequently, detection of those specific IgE antibodies in wheezing infants may facilitate the early diagnosis of asthma, especially in cases with no clinically evident atopic manifestations.

Background: Studies have shown that serum total immunoglobulin E (IgE) levels are higher in asthmatics. However, the role of the serum total IgE level, independently from atopy, in adult asthma is not understood. We studied the associations between serum total IgE, the number of sensitizations and the sum of specific IgEs and new-onset asthma using longitudinal data from the European Community Respiratory Health Survey. Methods: Serum total and specific IgE to 4 common inhalant allergens were measured at baseline in 9,175 participants, with a follow-up of 9 years. Individuals with asthma history and/or asthma symptoms were excluded. Atopy was defined as the presence of at least one specific IgE ≥0.35 kU/l. Total and specific IgEs were regressed against new-onset asthma using multivariate logistic regression with a random intercept for the study centre. Results: Two hundred and ninety-seven participants had developed asthma during follow-up (incidence rate 5.7 per 1,000 person-years). A 10% higher level of total IgE was associated with a 12% increased risk of new-onset asthma (p = 0.005). However, after adjustment for the number of positive specific IgEs [odds ratio (OR) for multiple sensitization 1.74, 95% confidence interval (CI) 1.05–2.88] and the sum of allergen-specific IgEs (OR 1.18, 95% CI 1.00–1.40), the association between total IgE and asthma disappeared (OR 1.00, 95% CI 0.91–1.10). Seventeen percent of new-onset asthma cases could be attributed to atopy, and this estimate was not largely modified when the total IgE level was simultaneously taken into account. Conclusions: After taking into account the number and intensity of 4 specific IgEs, the serum total IgE level was not associated with new-onset asthma in adults.

Objective To investigate the distribution characteristics in the positive ratio distribution of serum allergen specific immunoglobulin E(sIgE) in atopic dermatitis children with multiple sensitization factors, which could help to assess the atopic condition and offer recommendation for the avoidance of allergens. Methods A total of 90 children with atopic dermatitis were enrolled(male 66, female 24, aged 0.3-16.1 years). All the patients were divided into 3 groups according to the patients' age: 0-3 years old group (48 patients), 4-7 years old group (31 patients), 8-16 years old group (11 patients). The serum sIgE levels of 29 kinds of food and inhalation allergens in each patient were detected by the UniCAP 250 quantified IgE measurement system. Results The positive ratio of each food allergen in all the patients were as follows: 55.6%(50/90 cases) for egg white, 42.2%(38/90 cases) for milk, 32.2%(29/90 cases) for egg yolk, 12.2%(11/90 cases) for shrimp, 11.1%(10/90 cases) for crab, 7.8%(7/90 cases) for chicken, 4.4%(4/90 cases) for fish, 54.4%(49/90 cases) for wheat, 37.8%(34/90 cases) for peanut, 34.4% (31/90 cases) for soybean, 33.3%(30/90 cases) for tomato and 28.9%(26/90 cases) for peach. The positive ratio of each inhalation allergen in all the patients were as follows: 51.1% (46/90 cases) for house dust, 45.6% (41/90 cases) for alternaria alternata, 41.1% (37/90 cases) for dermatophagoides pteronyssinus, 40% (36/90 cases) for dermatophagoides farinae, 33.3% (30/90 cases) for dog dander, 28.9% (26/90 cases) for cockroach, 27.8% (25/90 cases) for cat dander, 21.9% (19/90 cases) for blomia tropicalis, 36.7% (33/90 cases) for ambrosia elatior, 34.4% (31/90 cases) for white ash, 32.2% (29/90 cases) for london plane, 32.2% (29/90 cases) for artemisia vulgaris, 31.1% (28/90 cases) for common silver birch, 27.8% (25/90 cases) for willow, 25.6% (23/90 cases) for mountain juniper, 25.6% (23/90 cases) for humulus scandens and 25.6% (23/90 cases) for chenopodium album. The positive ratios of sIgE for egg white, milk, egg yolk of patients in the 0-3 years old group were higher than those in the 4-7 years old group and 8-16 years old group (χ2=29.27, 15.98, 18.58, all P<0.05). The positive ratios of sIgE for dermatophagoides pteronyssinus, dermatophagoides farinae, blomia tropicalis, cat dander, mountain juniper, humulus scandens of patients in the 8-16 years old group were higher than those in the 0-3 years old group and 4-7 years old group (χ2=12.94, 14.31, 7.77, 7.65, 9.41, 6.93, all P<0.05). The positive ratios of sIgE for food allergens and animal dander in the patients of diagnosed as atopic dermatitis alone were higher than those of diagnosed as atopic dermatitis combined with asthma or allergic rhinitis. The positive ratios of sIgE for common inhalation allergens in the patients diagnosed as atopic dermatitis alone were lower than those diagnosed as atopic dermatitis combined with asthma or allergic rhinitis . Conclusions Allergens such as animal protein, house dust, mites and molds are the main sensitization allergens for atopic dermatitis children with multiple sensitization factors. Atopic dermatitis children in 0-3 years old group often presented sensitive to food allergens, while those in 8-16 years old group are more commonly sensitive to inhalation allergens. Patients diagnosed as atopic dermatitis alone are often presented sensitive to food allergens and animal dander, while those diagnosed with asthma or allergic rhinitis are more commonly sensitive to inhalant allergens. Key words: Atopic dermatitis; Specific immunoglobulin E; Allergen

Allergic rhinitis (AR) is a common immunoglobulin E (IgE) dependent disease among allergic patients worldwide. At the same time, the determination of specific IgE in the blood serum allows characterizing the relevant sensitizing allergens. Despite the existence of conditional thresholds for normal and elevated levels of total and specific IgE, there is no consensus in the literature on which IgE value unequivocally confirms the presence of atopy and what is the relationship between these levels and the severity of clinical manifestations. Purpose - to evaluate the levels of serum total and specific IgE and their relationship with severity and age in children with persistent AR and combined with bronchial asthma (BA) during sensitization to house dust mite (HDM) allergens. Materials and methods. A clinical, anamnestic and laboratory examination of 259 children aged 5 to 17 years with AR and combined AR with BA, who were sensitized to HDM allergens, was conducted. Results. In AR in children with sensitization to HDM, there is a dependence of serum total IgE level on the severity of AR and age of children. With increasing severity of AR manifestations, a significant (p&lt;0.05) increase in total IgE levels was noted. It was found that the content of sIgE also increased with increasing severity of AR. Thus, statistically significantly (p&lt;0.05) higher levels of sIgE were determined in sensitization to the major HDM molecules Der f 1, Der p 1, Der p 2, Der p 23 in children with severe AR. Sensitization to the tropomyosin Der p10 molecule, which usually has no effect on the clinical manifestations of respiratory allergy but indicates cross-reactivity to seafood, was significantly more common (p&lt;0.05) in children aged 3-7 years compared to children aged 13-17 years. Conclusions. The data obtained partially define the pathogenetic features in the formation of sensitization to HDM and their individual molecules, confirming that this process begins at an early age, which may indicate the need to start allergen-specific immunotherapy in such children if clinically necessary. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Recently, a new commercial test for total tear immunoglobulin E (IgE), based on immunochromatography (Allerwatch), was developed. We examined the relation between the total IgE level in tears and specific serum IgE. A prospective, nonrandomized, cross-sectional study was conducted in 35 patients with allergic conjunctivitis (allergic group), 30 age- and sex-matched healthy control subjects (control group), and 8 patients with epidemic keratoconjunctivitis. In all subjects, the total tear IgE score was determined with the Allerwatch test (0, 1, and 2), and serum levels of total IgE and specific IgE for 12 inhaled allergens were measured with the Phadezym PRIST and CAP-RAST systems, respectively. The total tear IgE-positive rate was significantly higher in the allergic group than in the control and epidemic keratoconjunctivitis groups (100.0% vs. 0.0% vs. 0.0%; P < 0.00001). In the allergic group, the total tear IgE score was significantly correlated with the log-transformed total serum IgE level (r = 0.61) and with the serum levels of IgE for cedar pollen (r = 0.35), house dust (r = 0.46), Dermatophagoides pteronyssinus (r = 0.49), and acarus (r = 0.36). Multivariate logistic regression analysis showed that the log-transformed total serum IgE level was the only significant predictor of the total tear IgE score (odds ratio = 1.85, P = 0.00008). The total tear IgE score, determined with the Allerwatch test, was correlated with the total and specific serum IgE levels. This rapid test is easy to perform, sensitive, and highly specific for the detection of ocular allergy on an outpatient basis.

Extensive IgE serology in occupational or environmental health studies is often hampered by a lack of technical facilities and finance. The use in population studies of relatively simple and inexpensive enzyme immunoassays (EIAs) was therefore evaluated for the assessment of total serum immunoglobulin E (IgE), and of specific IgE reactions with various common (house dust mites, grass and birch pollen, and cat) or occupational (fungal alpha-amylase and rat urinary protein) allergens. Total IgE was measured with a sandwich EIA, calibrated with commercially available IgE standards. Reproducibility was studied by testing pooled normal human serum samples in each of a large series of test plates. A panel of 156 children's serum samples with known IgE values was used to compare the assay with other total IgE assays. A previously developed EIA for anti-yeast IgE was adapted for the measurement of IgE reacting with various common and occupational allergens. Binding of IgE to microwells coated with commercially available allergen extracts, or allergen preparations from our own laboratory, was measured with a monoclonal anti-human IgE antibody and subsequent incubations with biotinylated rabbit anti-mouse Ig and avidin-peroxidase. Panels of serum samples from school children (n = 116), bakery workers (n = 126), and laboratory animal workers (n = 52) were used to study sensitivity and specificity, with reference to skin prick tests as the standard, and to compare the EIAs with commercially available test kits. The detection limit of the EIA for total IgE was 0.5-1 kU/l for undiluted serum samples, and the coefficient of variation between assays was less than 15% at serum concentrations between 1 and 150 kU/l. Results obtained with the panel of 156 children's serum samples were strongly correlated (r2 = 0.86) with IgE concentrations measured previously by radioimmunoassay. The results of the EIA for various occupational allergens correlated very well, both qualitatively and quantitatively, with the results of commercial test kits. Sensitivity and specificity of the EIA results as a predictor of skin prick test reactivity towards common allergens (house dust mite, grass pollen, birch pollen, and cat) were remarkably high (> 80%-90%) in the series of 116 children's serum samples. In a population of bakery workers the specificity of the EIAs was also very high (> 90%). The sensitivity was notably lower (30%-70%) in this adult population, which is, however, in agreement with results reported for conventional IgE tests. As the costs were estimated to be at least five to 10-fold lower than those of commercial test kits, the EIAs for total and specific IgE may be very useful tools in epidemiological studies of atopic respiratory or other disorders.

Objective To evaluate the distribution characteristics of the positive ratio of serum allergen speci-fic IgE(sIgE) in asthmatic and allergic rhinitis children with multiple sensitization factors, which may be beneficial for recommendations on the avoidance of allergen and assessment of atopic disease. Methods A total of 128 children with asthma and allergic rhinitis were enrolled(93 male, 35 female, aged from 1.5 to 16.1 years old, and the average age was 7 years and 8 months). All of the patients were presented as positive allergic screening test results for 2 or more kinds of allergen when evaluated.Eighty-seven patients were diagnosed as asthma combined with allergic rhinitis, while 38 cases with allergic rhinitis and 3 cases with asthma.The serum sIgE levels to 29 kinds of inhalant allergens and food allergens for each patients were detected by the UniCAP250 quantified IgE measurement system. Results The positive ra-tios of each inhalant allergen for all the patients were as follows: 67% for House dust, 61% for Dermatophagoides pteronyssinus, 59% for Dermatophagoides farinae, 50% for Alternaria alternata, 42% for Blomia tropicalis, 29% for Cat dander, 23% for Dog dander, 11% for Cockroach, 32% for Artemisia vulgaris, 29% for Humulus scandens, 28% for White ash, 26% for Ambrosia elatior, 24% for Willow, 24% for Mountain juniper, 24% for London plane, 24% for Humulus scandens, 22% for Chenopodium album and 20% for Common silver birch; the positive ratios of each food allergen were as follows: 25% for Milk, 25% for Egg white, 7% for Shrimp, 6% for Crab, 6% for Egg yolk, 4% for Chicken, 2% for Fish, 31% for Wheat, 20% for Peanut, 17% for Soybean, 27% for Peach and 21% for Tomato.Sixty-five patients with positive results to food allergens were divided into food allergen sensitization group while the other 53 patients for food allergen non-sensitization group.The positive ratios of different inhalant allergens such as Dog dander, Alternaria alternate, Common silver birch, Mountain juniper, London plane, Willow, White ash, Ambrosia elatior, Artemisia vulgaris, Chenopodium album, Humulus scandens of children in the food allergen sensitization group were 35.4%, 60.0%, 39.7%, 41.5%, 43.1%, 43.1%, 46.2%, 43.1%, 55.4%, 40.0%, 44.6%, which were higher than those in the food allergen non-sensitization group(11.1%, 39.7%, 1.6%, 6.3%, 4.8%, 4.8%, 9.5%, 7.9%, 7.9%, 3.2%, 3.2%, respectively, all P<0.05). The positive ratios of Dermatophagoides pteronyssinus, Dermatophagoides farinae and House dust in the food allergen non-sensitization group were 69.8%, 69.8%, 76.2%, respectively, which were higher than those in the food allergen sensitization group (52.3%, 49.2%, 58.5%, respectively, all P<0.05). Eighty-two point eight percent of the children with asthma combined with allergic rhinitis and 73.7% of the children with allergic rhinitis were sensitive to 3 or more kinds of inhalant allergens. Conclusions Inhalant allergens such as house dust, mites and molds were the main sensitization allergen for asthmatic and allergic rhinitis children with multiple sensitization factors.The asthmatic and allergic rhinitis children with food allergens sensitization often presented sensitive to animal dander, molds and outdoor inhalant allergens, while those without food allergens sensitization were more commonly sensitive to indoor allergens. Key words: Asthma; Allergic rhinitis; Specific immunoglobulin E; Allergen

Rhinosinusitis is highly prevalent in patients with common variable immunodeficiency (CVID), and probably allergic rhinitis (AR) may be masked by a history of repeated respiratory infections. The diagnosis of AR is based on the patient's symptoms and detection of specific immunoglobulin E (IgE) to aeroallergens. This study was designed to identify rhinitis of probable allergic cause in patients with CVID. This study included 72 adult CVID patients. The patients were divided into three groups according to their history: suggestive of AR, nonallergic rhinitis, and without rhinitis. They were tested for total and specific IgE (in vivo and in vitro). The patients' mean age was 38.2 years. A history of chronic rhinitis was observed in 59 (81.9%) of the cases, 31 of which (43%) had a history suggestive of AR. Patients with a history of rhinitis (whether allergic or nonallergic) presented an earlier onset of symptoms and diagnosis of CVID. Total IgE was undetectable in 86.1% of patients. AR was confirmed by detection of specific IgE to aeroallergens in only 5.6% of the patients. In CVID patients, chronic rhinitis may be allergic, because many have personal and family histories suggestive of atopy. However, in this study, allergy was confirmed by specific IgE detection in only 5.6% of cases. CVID patients with a history suggestive of AR commonly present negative results on traditional testing, so additional experiments may be necessary. One suggestion for the investigation of AR in CVID patients would be nasal provocation with the most prevalent allergens.