Allergy Screening Research Articles

Cost-effective allergy screening: a retrospective observational study.

Background. Allergies represent a substantial health concern affecting individuals across all age groups. Diagnostic screenings, such as phadiatop and phadiatop infant, are employed to identify specific IgE antibodies associated with allergic reactions. This study delves into the relationship between total IgE levels and screening test outcomes, with the objective of establishing a total IgE threshold capable of predicting the likelihood of negative results in these screenings. Methods. This retrospective observational study included adults and children under 15 years old who underwent total IgE tests in addition to phadiatop and phadiatop infant screenings from January 2018 to December 2022. Exclusion criteria were applied to patients with insufficient serum samples or those whose IgE determinations or screening tests had been invalidated according to standard laboratory protocols. Results. Data analysis uncovered a robust correlation between total IgE levels and screening test outcomes. Additionally, thresholds of 20 UI/mL and 28 UI/mL were pinpointed for total IgE levels, below which the likelihood of obtaining a positive result in phadiatop or phadiatop infant, respectively, significantly decreased. Conclusions. These findings present cost-effective strategies for healthcare practitioners by recommending the initial use of total IgE testing. Subsequently, reflex testing with phadiatop or phadiatop infant, depending on the IgE value, could be considered.

Impact of ovalbumin allergy on oral and gut microbiome dynamics in 6-week-old BALB/c mice.

The gut microbiota is known to have a significant impact on the development of food allergy, and several recent studies have suggested that both oral microbiota, which first come into contact with allergenic foods, may have a profound influence on the development of food allergy. In this study, we have established an ovalbumin-sensitive mice model by utilizing ovalbumin as a sensitizing agent. Subsequently, we performed a comprehensive analysis of the gut and oral microbiota in ovalbumin-sensitive mice and the control mice using full-length 16S rRNA sequencing analysis. Interestingly, both the gut and oral microbiota of ovalbumin-sensitized mice exhibited significant dysbiosis. The relative abundance of s__Lactobacillus_intestinalis in the gut microbiota of ovalbumin-sensitive mice exhibited a significant decrease, whereas the abundance of s__Agrobacterium_radiobacter and s__Acinetobacter_sp__CIP_56_2 displayed a significant increase. Furthermore, the relative abundance of s__unclassified_g__Staphylococcus, s__Streptococcus_hyointestinalis, and s__unclassified_g__Dechloromonas in the oral microbiota of ovalbumin-sensitive mice revealed a significant decrease. In contrast, the abundance of 63 other species, including s__Proteiniclasticum_ruminis, s__Guggenheimella_bovis, and s__Romboutsia_timonensis, demonstrated a significant increase. The random forest classifier achieved the best accuracy in predicting the outcome of food allergy using three gut and three oral biomarkers, with accuracies of 94.12 and 100%, respectively. Based on the predictions of the PICRUSt2 analysis, the only consistent finding observed across multiple samples from both the groups of mice was a significant up-regulation of the nucleotide-binding oligomerization domain (NOD)-like receptor signaling pathway in the ovalbumin-sensitized mice. Our study demonstrates that ovalbumin-sensitized mice experience substantial alterations in both gut and oral microbial composition and structure, and specific strains identified in this study may serve as potential biomarkers for food allergy screening. Moreover, our findings highlight that the oral environment, under the same experimental conditions, exhibited greater precision in detecting a larger number of species. Additionally, it is worth noting that the NOD-like receptor signaling pathway plays a vital role in the pathogenesis of OVA (ovalbumin)-induced allergy. These findings will generate novel concepts and strategies in the realm of food allergy prevention and treatment.

Tree nut testing and diagnosis in infants undergoing screening for peanut allergy

Tree nut testing and diagnosis in infants undergoing screening for peanut allergy

The impact of allergies on patient-reported outcomes after total hip and knee arthroplasty: a systematic review and meta-analysis.

Metal hypersensitivity has been associated with persistent symptoms after total hip arthroplasty (THA) and total knee arthroplasty (TKA), despite successful joint replacement. Allergies frequently co-occur and have been linked to psychiatric disturbances such as anxiety. There is a knowledge gap regarding the effect of allergies, including metal hypersensitivity, on patient-reported outcome measures (PROMs) after THA and TKA. This study aimed to evaluate the influence of allergies including metal hypersensitivity on PROMs in patients undergoing THA and TKA. A systematic search PROSPERO (CRD42023475972) was conducted using PubMed, EMBASE, Scopus, and Cochrane databases. Studies that compared allergic and non-allergic adults undergoing primary THA or TKA and reported PROMs were included. Methodological quality was assessed using the MINORS criteria. The mean differences (MD) and standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated. Eight studies, involving 33,808 patients, were included. For functional outcomes assessed using SF-12, SF-36, KOOS JR, and HOOS JR, allergic patients demonstrated significantly worse scores (SMD - 0.23, 95% CI -0.36 to -0.09). The WOMAC functional scale also demonstrated poorer results in allergic patients (MD 2.49, 95% CI 0.64 4.35). For pain assessed using the WOMAC pain scale, allergic patients reported significantly greater pain (MD 1.04, 95% CI 0.46 1.62). Changes in mental status assessed using the SF-12 and SF-36 did not show significant differences between the groups (MD -0.46, 95% CI -1.40 to 0.47). In subgroup analysis, patients in the THA subgroup showed significantly worse outcomes (MD -7.20, 95% CI -12.97 - -1.43). This meta-analysis found that patients with allergies, including metal hypersensitivity, generally had worse functional outcomes after THA and TKA than patients without allergies. Further research is required to confirm these findings. Preoperative allergy screening can identify individuals at risk of treatment optimization.

Point-of-Care Fluorescence Biosensing System for Rapid Multi-Allergen Screening.

With the steady increase in allergy prevalence worldwide, there is a strong need for novel diagnostic tools for precise, fast, and less invasive testing methods. Herein, a miniatured fluorescence-based biosensing system is developed for the rapid and quantitative detection of allergen-specific immunoglobulin-E. An antibody-based fluorescence assay in a microfluidic-patterned slide, combined with a custom-made portable fluorescence reader for image acquisition and user-friendly software for the data analysis, enables obtaining results for multiple allergens in just ~1 h with only 80 μL of blood serum. The multiplexed detection of common birch, timothy grass, cat epithelia, house dust mite, and dog epithelia shows quantitative IgE-mediated allergic responses to specific allergens in control serum samples with known total IgE concentration. The responses are verified with different control tests and measurements with a commercial fluorescence reader. These results open the door to point-of-care allergy screening for early diagnosis and broader access and for large-scale research in allergies.

Diagnostics of allergic rhinitis under dupilumab therapy

BackgroundAllergic rhinits is a prevalent condition, affecting a substantial proportion of the population. This study investigates the impact of ongoing biologic therapy, specifically with Dupilumab, on allergy diagnostics in patients with allergic rhinits.MethodsVarious tests, including the Skin Prick Test, serum IgE levels and Allergy Screening Panels, were examined for their effectiveness in detecting sensitizations during biologic treatment.ResultsThe results indicate a significant decline in total IgE levels following biologic therapy initiation, aligning with previous findings on Dupilumab's inhibitory effects on IL-4 and IL-13. However, the specific IgE to total IgE ratio for major allergens was not significantly reduced. Comparing diagnostic tools, the Skin Prick Test demonstrates an impressive retention rate of sensitizations (98%) during Dupilumab treatment, outperforming the Allergy Screening Panel, which shows a 75% detection rate. Notably, the panel displays limitations in capturing lower sensitization levels.ConclusionIn summary, this study underscores that, despite the influence of biologic therapy on certain markers, standard allergy tests remain viable while emphasizing the importance of considering specific IgE levels rather than relying solely on CAP classes. The Skin Prick Test in particular proves to be a reliable tool for identifying sensitizations during Dupilumab treatment. The results offer valuable guidance for the diagnostic management of Allergic rhinits in individuals subjected to Dupilumab treatment.

A literature review and expert consensus statement on diagnostics in suspected metal implant allergy.

Although rare, allergic reactions to metal implants represent a diagnostic challenge in view of missing guidelines. To develop an European expert consensus on characteristics of metal allergy reactions and the utility of various diagnostic tools in suspected metal implant allergy. A nominal group technique (NGT) was applied to develop consensus statements. Initially an online literature database was created on a secure server to enable a comprehensive information. Twenty-three statements were formulated on potential aspects of metal implant allergy with a focus on diagnostics and grouped into five domains. For the consensus development, the panel of 12 experts initially did refine and reformulate those statements that were ambiguous or had unclear wording. By face-to-face (9/12) or virtual participation (3/12), an anonymous online voting was performed. Consensus (≥80% of agreement) was reached in 20/23 statements. The panel agreed that implant allergy despite being rare should be considered in case of persistent unexplained symptoms. It was, however, recommended to allow adequate time for resolution of symptoms associated with healing and integration of an implant. Obtaining questionnaire-aided standardized medical history and standardized scoring of patient outcomes was also considered an important step by all experts There was broad consensus regarding the utility/performance of patch testing with additional late reading. It was recognized that the lymphocyte transformation test (LTT) has to many limitations to be generally recommended. Prior to orthopaedic implant, allergy screening of patients without a history of potential allergy to implant components was not recommended. Using an expert consensus process, statements concerning allergy diagnostics in suspected metal implant allergy were created. Areas of nonconsensus were identified, stressing uncertainty among the experts around topics such as preoperative testing in assumed allergy, histological correlate of periimplant allergy and invitro testing, which underscores the need for further research.

Asthma and allergy screening in elite soccer athletes: Is it worth it?

Asthma and allergy screening in elite soccer athletes: Is it worth it?

Immunoglobulin E-Mediated Food Sensitization in a Moroccan Pediatric Population with Celiac Disease

Introduction: Celiac disease is a chronic autoimmune disorder that occurs following the ingestion of gluten, in genetically predisposed individuals. Patients with celiac disease, especially children, are likely prone to develop allergic reactions to different food allergens. However, the relationship between food allergy and celiac disease remains not elucidated. The aim of this pioneering study was to evaluate the prevalence of allergic food sensitization in children with celiac disease in Morocco. Methods: A total of 57 children with confirmed celiac disease, including 25 males and 32 females with a mean age of 8.6 ± 4.4 years, underwent a food allergen-specific immunoglobulin E (IgE) screening. This screening was conducted using a multiparametric immunodot assay (Euroline Food “Maghreb,” Euroimmun). Statistical analysis was performed using R software. Results: Among the 57 cases tested, the overall rate of IgE-mediated sensitization to food allergens was found to be 48% (27/57), dominated by chicken, with 51.9% (14/27), followed by almond, 40.7% (11/27), sesame, 40.7% (11/27), potato 33.3% (9/27), and apple 18.5% (5/27). Of the s-IgE positive cases, 74% were sensitized at least to one allergen, 37% (10/27) were sensitized to both chicken and almond allergens. A significant correlation was observed between almond, sesame, chicken, and potato. Conclusion: The current study highlighted a high prevalence of food allergen sensitization in children with celiac disease. This underlines the potential benefit in screening for food allergy in celiac patients.

IgE mediated food allergy and celiac disease: An updated review

Celiac disease is a chronic autoimmune disorder that affects the small intestine. It is triggered in genetically predisposed individuals by consumption of gluten, a protein found in wheat, barley and rye. Celiac disease typically manifests in young pediatric patients as malabsorption of nutrients, gastrointestinal symptoms, and other health complications, which is associated with partial or total villous atrophy of the proximal small intestine. Food allergy, on the other hand, is an abnormal immune response to a specific food protein that causes inflammation and a range of symptoms, from mild hives to life-threatening anaphylaxis.
 Although the mechanisms behind celiac disease and food allergy are different, both conditions involve an immune response to food proteins. The current study revealed the possibility of IgE-A coexistence in celiac disease and food allergy screening should be considered for people with celiac disease, especially when symptoms persist even after implementing a gluten-free. However, the relationship between celiac disease and food allergy is not fully understood, and more research is needed to explore this link.
 This review aims to examine the available literature for the occurrence of food allergy in subjects with celiac disease.

IgE Stewardship: Does the IgE Food Allergy Screening Panel Have a Role?

IgE Stewardship: Does the IgE Food Allergy Screening Panel Have a Role?

Cupressus arizonica: an emerging aeroallergen for East Mediterranean children.

Cupressus sempervirens is a tree native to the Mediterranean region. We aimed to investigate the frequency of sensitization/allergy to Cupressus arizonica pollen, which is not native to Anatolia. Patients aged 5-18 years who underwent respiratory allergy screening in Türkiye's largest referral center over a 1-year period were reviewed retrospectively for a diagnostic study of Cupressus allergy. Of 246 patients, 207 (67.6% male) with a median age of 11.7 (IQR 9.2-15) years were found to be aeroallergen-sensitive and C. arizonica (32%) was the second most common sensitivity after grass pollen (83.6%). In the C. arizonica-sensitive subgroup, only 3% (2/67) were monosensitive, and grass (77.6%), cat (38.8%), and weeds (38.8%) were the most common co-sensitivities. Cup a 1 specific IgE (sIgE) was measured in 26 patients with C. arizonica sensitivity and all were found to be positive. A nasal allergen challenge (NAC) was performed for 44 of 67 patients with C. arizonica sensitivity, and 13 of 44 patients had a positive outcome (NAC+) at the highest two extract concentrations. The Cupressus wheal sizes and Cup a 1 sIgE levels of the NAC+ subgroup were higher than those of the NAC- subgroup but reached significance only for wheal size [6 (5-7.5) vs. 4.5 (4-6), p=0.004]. The NAC+ subgroup reported more frequent nasal discharge, congestion, and eye symptoms than the NAC- subgroup during the relevant pollen season. C. arizonica sensitivity has increased in the East Mediterranean region, similarly to North Mediterranean data, and this is associated with the presence of allergy both clinically and in laboratory findings. C. arizonica should be included in the aeroallergen screening panels of children from the East Mediterranean.

Frequency and predictors of multisystem reactions to peanut in infant oral food challenges

Among 52 children younger than 1 year with positive food challenges to peanut, a substantial minority had multi-system reactions and were treated with epinephrine. IgE to Ara h2 was associated with reaction severity, supporting use of this test in screening for peanut allergy.

Paediatric reference ranges for plasma chromogranin A.

Neuroendocrine neoplasms (NENs) are a heterogeneous group of rare diseases with varied aggressiveness originating from endocrine cells belonging to the diffuse endocrine system and most often produce and secrete chromogranin A (CgA). CgA in plasma is therefore used to screen, diagnose, and monitor for NENs in both adults and children with sporadic or familial NENs. Plasma CgA was measured using the Brahms Kryptor assay in 268 healthy children/adolescents; 85 children were tested as part of a familial cancer screening program and 183 additional children younger than 20years of age underwent screening for allergies. Repeated measurements (month - years) was used to calculate the intra-individual variation. The dataset was analysed in R using the referenceInterval package. The plasma CgA concentration decreased with age and was 32-118µg/L for children aged 0-3years, 18-85 µg/L for children aged 4-13years, and 6-79µg/L for adolescents aged 14-19years. Earlier reported CgA reference intervals for adults have upper limits from 88 to 102µg/L while no lower limits have been reported. The median for the three groups were 78, 51, and 39µg/L, respectively. The median intra-individual variation was 14% (25%-centile 9.4%/75%-centile 21%). The reference interval will be useful when screening, diagnosing, and monitoring children for NENs respecting the limitations plasma CgA has.

Objective markers of allergic inflammation

Introduction: According to the results of modern research, allergic rhinitis (AR) affects 10% to 40% of the population. There is a need for an effective objective and dynamic method of assessing the quality of treatment of such patients. Purpose: to assess the relationship between the level of eosinophil cationic protein (ECB), VAS indicators, nasocytogram, Phadiatop inhalation allergy screening and disease activity in patients with allergic rhinitis. Methods and materials: Two research groups were created. The main group – 48 patients with allergic rhinitis in a state of exacerbation, the control group – 41 people with chronic rhinitis without manifestations of allergies and the absence of allergic rhinitis in the anamnesis. In both groups, the level of eosinophil cationic protein, the level of blood eosinophils, a nasocytogram was performed, the Phadiatop inhalation allergy screening was determined, and the patients noted their condition according to the VAS. Patients from the 1st study group formed a self-control group, which was examined after treatment for 2 weeks. Results: Indicators of the level of eosinophil cationic protein, the level of eosinophils in the blood and nasal mucosa, the Phadiatop inhalation allergy screening index in patients of the main group are statistically significantly higher compared to the indicators of patients in the control group. Patients of the main group were divided into two subgroups. The first subgroup included patients with a mild form of allergy and a VAS score of less than 5 points. They received treatment with topical corticosteroid mometasone furoate. The second subgroup included patients with moderate and severe allergic rhinitis and a VAS score of more than 5 points. They received treatment with topical corticosteroid mometasone furoate in combination with a blocker of H1-histamine receptors of cetirizine hydrochloride. The evaluation of indicators after 2 weeks of treatment revealed the presence of a strong positive correlation (0.796) of the dynamics of eosinophil cationic protein and VAS, an average positive correlation (0.518) of the dynamics of blood eosinophils and VAS, an average positive correlation (0.641 ) indicators of the dynamics of the percentage of eosinophils among inflammatory cells according to the nasocytogram and VAS, the Phadiatop inhalation allergy screening indicator does not change much. Conclusions: Patients' assessment of their condition according to VAS before and after treatment for two weeks has the highest correlation with the eosinophil cationic protein index and medium correlation with the level of eosinophils in the blood and in the nasal mucosa according to nasocytogram data. The Phadiatop Inhalation Allergy Screening Rate does not change much. The degree of increase or decrease in the level of eosinophil cationic protein makes it possible to assess with high accuracy the severity of an exacerbation of allergic rhinitis and monitor the effectiveness of patient treatment. It reflects disease activity and can be useful as a marker of allergic inflammation.

IgE-Dependent Allergy in Patients with Celiac Disease: A Systematic Review.

In order to answer the question if an IgE-mediated allergy (A-IgE) may occur in subjects with celiac disease (CD), a systematic review was performed of available publications collected in the United States National Institute for Biotechnology Information/National Institutes of Health/National Library of Medicine/PubMed database up to 28 December 2022, with the use of the following keywords "allergy&celiac/coeliac", "sensitization&celiac/coeliac", and "anaphylaxis&celiac/coeliac" compared in the form of a conjunction. In total, the search returned 2013 publications from these keywords in any section of the article. As numerous review articles included the above-mentioned entries in the abstract, we decided to focus on the publications with the entries only in the title (n = 63). After rejecting studies unrelated to the topic, narrative reviews, book chapters, conference abstracts, symposium reports, letters to the editor, or non-English articles, 18 publications (6 observational original studies and 12 case reports describing a total of 15 cases of A-IgE developed after a diagnosis of CD) were included to this review. Our study is the first systematic review on allergy occurrence in CD patients. The analysis indicated that the possibility of a coexistence of A-IgE with any food and inhalant allergens in subjects diagnosed with CD should be considered. A sensitization to wheat was the most frequently described in subjects with CD. The clinical manifestation of A-IgE in CD was similar to that in subjects without CD; e.g., with possible atopic dermatitis, vomiting, urticaria, angioedema, or anaphylactic shock. Screening for allergies in subjects with CD should be considered, especially in those cases where symptoms persist after introducing a gluten-free diet. The elimination of wheat from the diet of patients with CD may lead to a loss of immune tolerance and to the development of sensitization, which may even manifest as anaphylaxis. In conclusion, although there are few studies assessing the occurrence of A-IgE in subjects with CD, they show the possibility of a coexistence of both diseases and the high clinical significance of this phenomenon, which indicates the need for further studies.

Allergy screening with extract-based skin prick tests demonstrates higher sensitivity over in vitro molecular allergy testing.

As extract-based skin testing as well as in vitro tests for major allergens have their own advantages, both procedures are usually performed in routine settings. In times of shortages in medical staff and supplies, we asked ourselves, how many patients would be underdiagnosed, if only one test could be used. In a retrospective analysis, we investigated a cohort of 2646 patients seen by a single physician in a large Austrian outpatient allergy clinic in 2018. Only patients with an allergen source-specific history and pairs of extract-based skinprick (SPT) and in vitro molecular allergy tests to major allergens were included. For all tested allergen sources, sensitivity was higher for SPT than for sIgE-based molecular allergy testing. Concerning 1006 birch pollen-allergic patients, 791 (78.6%) had positive results with both tests, while 153 (15.2%) only with the SPT and 62 (6.2%) only with the sIgE to Bet v1. The other allergen sources showed similar results: For house dust mite 816/1120 (72.9%), grass pollen 1077/1416 (76.1%) and cat 433/622 (69.6%) remained test-positive with both procedures, whereas in 276 (24.6%), 224 (15.8%) and 173 (27.8%) times only the SPT and 28 (2.5%), 115 (8.1%) and 16 (2.6%) times only the sIgE to Der p1/2/23, Phl p1/5 and Fel d1 showed a positive result. Each comparison was statistically significant (each p<0.0001, Chi-squared test). Screening for allergy with major molecular allergens has lower sensitivity when compared with extract-based skin tests. A combination of both is required for an optimal sensitivity.

Impact of EMR Intervention on Reducing Food Allergy Panel Testing

Indiscriminate food allergy (FA) screening can result in unnecessary food avoidance and anxiety. A retrospective chart review of 236 pediatric patients with FA testing at our institution revealed that the majority (76%) of testing was done for non-IgE mediated symptoms, such as chronic abdominal pain and behavioral issues.

Time Trends in Atopic Dermatitis Incidence and Use of Skin Prick Tests and Oral Challenges Among Commercially Insured Infants in the United States, 2013-2020

The 2017 NIAID Guidelines recommend peanut allergy screening and testing for infants with severe eczema. We examined trends for atopic dermatitis (AD) incidence, skin prick testing (SPT), and oral challenge (OC) in a population of commercially insured infants in the U.S. from 2013 – 2020.

Laboratory Strategies to Improve Allergy First-Line Screening in Primary Care.

There are nonestablished protocols in use for first-line allergy screening based on IgE testing. These protocols attempt to address an unmet need for sustainability of clinical laboratories, at a time when demand is increasing. To present a novel protocol for first-line allergy screening and to evaluate the implementation benefits for patients, the health care system, and payers. We carried out an observational retrospective study analyzing 4359 interventions on primary care testing requests. Interventions included overriding redundant serum IgE (sIgE) testing for allergen mixes, extracts included in mixes, low-prevalence extracts, and milk and egg molecular components without previous positive results when exposed to extracts. We also added prevalent allergen testing. The strategy saved 683 tests from being performed unnecessarily. Test volume decline was primarily driven by the cancelation of 2186 egg and milk components tests; 561 tests were added for mixes, together with 942 allergen extracts tests. The results of this study show how the allergy laboratory plays a key role in actively managing demand for sIgE testing, leading to optimized diagnosis.