IgE Antibody Test Research Articles

Persistence of allergy to anaesthetic drugs.

Intradermal testing and RIA testing for specific IgE antibodies to neuromuscular blocking drugs (NMBDs) were performed in patients referred to an Anaesthetic Allergy Clinic. Six patients were initially investigated four to 29 years after clinical anaphylaxis during anaesthesia and two of these patients and sixteen others were investigated by intradermal testing on two occasions at least four years apart. Seven patients had RIA tests for NMBD-specific IgE antibodies on two occasions at the time of skin testing. In all but two patients the evidence for drug-specific antibodies persisted 4-29 years after the reactions. In one patient all tests became negative and in another the skin test became negative but the positive RIA persisted. Evidence of antibodies to NMBDs persisted in 21 of 22 patients who had had anaphylactic reactions to these drugs during anaesthesia. In the absence of evidence of allergy diminishing with time in the majority of patients it would seem wise to avoid drugs responsible for reactions for the rest of the patient's life.

Evaluation of a multiple food specific IgE antibody test compared to parental perception, allergy skin tests and RAST

This study was set up to evaluate the food panel of a multiple specific IgE antibody assay in 67 atopic asthmatic children by comparing it to the conventional radioallergosorbent test (RAST) and skin-prick tests (SPT) and then comparing the results of these investigations with the parents' perceptions of food related problems. Fifteen food specific IgE antibodies were measured using the multiple chemiluminescence assay (MAST-CLA). IgE antibodies to five of these food allergens were also measured by conventional RAST and SPTs were performed in 43 using 11 standardized food extracts matched to the multiple allergosorbent chemiluminescent assay (MAST-CLA) profile. SPT and MAST-CLA results showed good agreement with one another, range 68.8-96.7% (average 87%), with significant correlation for most allergens tested. MAST-CLA was discrepant with RAST and/or SPTs in 58/210 (27.6%). A questionnaire was sent to the parents to determine their perception of food related symptoms. Sixty-two (92%) questionnaire replies were received, of which 56% reported symptoms with food. The most frequent symptom perceived to be due to food intolerance was behavioural disturbance. The commonest foods implicated were additives (39%), egg (27%), milk (26%), chocolate (23%) and orange (15%). History, SPT, MAST-CLA and RAST were compared for five allergens in 42 patients (210 values). In 14/210 (6.7%), all the tests were negative despite reported symptoms. Conversely in 49/210 (23.3%) at least one test was positive without symptoms. This study did not support a benefit of multipole testing instead of individually selected RASTs or SPTs.(ABSTRACT TRUNCATED AT 250 WORDS)

Trichophyton tonsurans allergen. I. Characterization of a protein that causes immediate but not delayed hypersensitivity.

Fungal infections of skin or nails are extremely common and often caused by dermatophyte fungi of the genus Trichophyton. These fungi are unusual in that they can give rise to delayed hypersensitivity (DH) or immediate hypersensitivity (IH) responses. Recently, IH to Trichophyton tonsurans has been demonstrated in patients by skin tests, serum IgE antibody test (RAST), and positive nasal and bronchial challenges. To further investigate the immunology of Trichophyton, a 30-kDa T. tonsurans allergen was isolated by gel filtration and hydrophobic interaction chromatography. This protein, Tri t I, gave a single band on SDS-PAGE, and the 30 amino-terminal amino acids have been determined. Among patients with positive IH skin tests, 34 of 48 (71%) had IgG antibody and 26 of 48 (54%) had IgE antibody to Tri t I. Among those who had positive responses to both skin tests and RAST, 22 of 30 (73%) had IgE antibodies to Tri t I; thus, this protein represents a major allergen. Twelve clones of murine IgG mAb antibodies were produced. Two clones, 2F2-F7 and 6B11-C2, were found to define separate epitopes on Tri t I and were used to develop an immunometric assay for the quantitation of Tri t I. Twenty-three of 38 volunteers with a history of athlete's foot were found to have either IH and/or DH to Trichophyton mix and underwent further testing with purified Tri t I. Of the nine found to have IH to the mix, eight were sensitive to Tri t I. Seven of these eight had IgG and IgE antibodies to Tri t I, by Ag-binding RIA, and all were RAST positive to the unpurified extract. An additional 14 had either DH alone (n = 7) or a wheal and flare response followed by DH at 48 h (n = 7). Of these 14 who had DH responses to Trichophyton mix, only one showed DH to an equivalent quantity of purified Tri t I; among this group, none showed IH or serum IgE antibodies and only one had detectable IgG antibody to Tri t I. The results suggest that the majority of subjects with DH to Trichophyton are responding to a protein other than Tri t I and that the wheal that precedes DH reactions is some patients is not associated with IgE antibodies.

Anaphylactic anaesthetic reactions. The value of paper radioallergosorbent tests for IgE antibodies to muscle relaxants and thiopentone

The three currently available paper radioallergosorbent tests ('suxamethonium', alcuronium and thiopentone) were evaluated. 'Suxamethonium' radioallergosorbent test (which employs choline conjugated to paper discs) proved to be reliable in the detection of allergy to neuromuscular blockers, which were confirmed as the most common cause of anaphylactic reaction during general anaesthesia. Thiopentone radioallergosorbent test may also be useful, and is recommended in conjunction with 'suxamethonium' radioallergosorbent test in the preliminary investigation of reactions. Patients with positive 'suxamethonium' radioallergosorbent test usually require further testing, including alcuronium radioallergosorbent test, skin testing with a wide range of drug concentrations or leucocyte histamine release test.

The influence of exposure to house dust mite, cat, pollen and fungal allergens in the home on primary sensitisation in asthma

The homes of 68 atopic asthmatic children were studied to estimate the concentrations of perennial and seasonal aeroallergens (Der pl, Fel d1, grass pollen, tree pollen, Cladosporium, Aspergillaceae and Alternaria) to which children were likely to have been exposed during their first few months of life, by sampling in the child's month of birth. There was a strong association between the presence or absence of the house dust mite allergen Der p1 in the air with the skin test and IgE antibody test results (p < 0.001), with a similar association for cat allergen Pel d 1 (p < 0.01), when using a low volume sampler (equivalent to the minute tidal volume of a small baby). No significant correlation was found between levels of allergen in carpet dust and air in the same room. There was a strong indication that the presence of a cat at birth was linked with a higher risk of development of allergy to cat, but high levels of Fel d 1 were sometimes found in homes even when there was no cat present, indicating that allergen may be introduced from other sources. The levels of tree pollen were significantly higher in the homes of tree pollen‐allergic children than in the homes of patients without this sensitivity (p < 0.01); and the degree of sensitivity, determined by RAST, correlated significantly to the level of tree pollen in the home (p < 0.001). However, no relationship was found between specific sensitivity and the levels of Cladosporium, Aspergillaceae, Alternaria or grass pollen measured in the homes. The effect of high allergen exposure was most prominent in children under 7 yr and not beyond that age.

Comparison of two IgE antibody tests with skin test and clinical history in asthmatic patients

The multiple allergosorbent chemiluminescent assay (MAST‐CLA) is a system to measure total and allergen‐specific IgE in human serum by means of a chemiluminescent immuno‐enzymatic system. The test has been compared with skin test, RAST and clinical history in 67 atopic, asthmatic children. The individual percentage agreement between MAST‐CLA and skin test was grass pollen 67%, tree pollen 82%, cat 76%, dog 84%, house dust mite 87%, alternaria 64%, aspergillus 79%, cladosporium 84%, penicillium 93%, milk 78% and egg 76% and between MAST‐CLA and RAST was grass pollen 62%, tree pollen 72%, cat 75%, dog 72% and mite 87%. The total IgE levels on MAST‐CLA did not agree with PRIST results. MAST‐CLA was randomly duplicated and proved repToducible in 85% of tests. Changes between positive and negative results occurred in only 4% of tests. Clinical history predicted allergy diagnosis accurately in 21 (31. 5%) cases whilst MAST‐CLA provided additional information in 14 (21%). MAST‐CLA proved least reliable for grass pollen allergy diagnosis, which has prompted a change in allergen composition for this assay. MAST‐CLA is a simple in vitro test for specific IgE to 35 allergens which compares favourably with RAST. The variation in correlates with other techniques of allergy diagnosis, however, indicates that there are differences in credibility for each result within the multiple test system.

Immune reactions to Pityrosporum ovale in adult patients with atopic and seborrheic dermatitis

Pityrosporum ovale is a lipophilic yeast commonly present in the seborrheic areas of the skin of adults. Fifty-five young adult patients with atopic dermatitis, 19 patients with seborrheic dermatitis, and 19 healthy control subjects were examined for immune reactions to P. ovale, including tests for specific IgE antibodies (prick test, histamine release), IgG antibodies and epicutaneous testing. IgE antibodies against P. ovale were found in two thirds of the patients with atopic dermatitis and were more frequent in patients with lesions predominantly in the seborrheic areas. In addition, some atopic patients had positive reactions to epicutaneous tests, which suggest that delayed allergic reactions to P. ovale may also be important. In patients with seborrheic dermatitis, no evidence of immediate or delayed hypersensitivity to P. ovale was found. IgG antibody levels were low in all groups.

Atopy and IgE in patients with leprosy

The atopic status of patients with leprosy was assessed by medical history, physical examination, serum total IgE, and specific IgE antibodies to common allergens (by skin testing and RAST). Tests for specific IgE antibody to Mycobacterium leprae were performed by RAST and immunoblotting technique. We studied 28 patients with leprosy and 49 control subjects. The two groups did not differ significantly in the prevalence of atopic disease. The IgE level was significantly higher in the patients, however, than in the control subjects, whether there was atopy (296.1 versus 96.3 IU/ml) or not atopy (72.9 versus 18.9 IU/ml). Neither RAST nor immunoblotting technique detected significant levels of IgE antibodies to M. leprae. Our data indicate that leprosy was associated with increased total IgE level, but clinical atopy in patients with leprosy was similar to that in control subjects. The observed IgE increase in patients with leprosy appears to be generally nonspecific.

Induction of Eczematous Skin Reaction in Experimentally Induced Hyperplastic Skin of Balb/C Mice by Monoclonal Anti-DNP IgE Antibody: Possible Implications for Skin Lesion Formation in Atopic Dermatitis

Biphasic skin reaction with peak response at 1 and 24 h with prominent mast cell degranulation was induced by intravenous application of a monoclonal anti-DNP IgE antibody and subsequent skin test. This reaction was hapten-specific and mast-cell-dependent because no reaction was observed when oxasolone was used as an elicitation antigen or skin test was elicited in genetically mast-cell-deficient mice (W/Wvv). A partial spongiotic reaction and mononuclear cell infiltration into the epidermis were observed in mice with hyperplastic epidermis induced by topical retinoic acid. Cotransfer of DNFB-sensitized lymph node cells with anti-DNP IgE antibodies failed to enhance the skin test reaction in unsensitized mice. These results suggest that, to some degree, IgE antibody may play some role in the development of eczematous skin lesions in the rodent system without the involvement of cellular hypersensitivity.

THE STUDY OF GENETICS IN ASTHMATIC CHILDREN

HLA population study was performed in asthmatic children. The frequencies of HLA class I (A, B, C), II (DR, DQ, DRW) antigens were measured in the following groups. Forty-eight asthmatic children, aged 5-17 years, were diagnosed by clinical manifestation alone. Thirty-one asthmatic children, aged 5-16 years, were diagnosed by clinical manifestation and high serum level of DF-specific IgE antibody, Fifty-two healthy control group, aged 15-45 years, were documented by absence of symptoms, negative DF specific IgE antibody and negative DF skin test. Our results suggest no significant difference in the frequency of HLA antigen in the 3 groups.

Fatal anaphylactic reaction to suxamethonium: new screening test suggests possible prevention

A 40-year-old woman suffered cardiovascular collapse, cardiac ischaemia and arrest during induction of anaesthesia. Severe cerebral ischaemic damage was sustained during this episode and the patient died 4 days later. This fatal reaction was shown to be anaphylactic in origin; the causative agent was suxamethonium. High levels of IgE antibodies specific to the quaternary ammonium group (two of which are present in suxamethonium) were detected by the radioallergosorbent test. Results of the leucocyte histamine release test were less clear, partly as a result of steroid treatment. The two most relevant points were the absence of a history of previous anaesthesia, and involvement of the heart as the principal target of the reaction. This unfortunate and extreme case indicates the necessity for allergy testing (screening) before anaesthesia, and the need for organisation and funding of this procedure, if these fatal or near-fatal reactions are to be prevented. It is a timely reminder that action should be taken, since neuromuscular blockers have been confirmed as the most common culprits, and that specific tests for IgE antibodies are now available against haptenic groups generally common to all neuromuscular blockers.

Isolated late cutaneous skin test response to ampicillin: A distinct entity

A case presentation describes a young woman with a history of two reactions to ampicillin therapy and a reproducible skin test reaction of intermediate timing that disappeared within 48 hours. The skin test response was to ampicillin only and not to other penicillin-related skin test reagents. Tests for serum IgE and IgG antibody to ampicillin were negative. The histology was that of a mononuclear and neutrophilic cellular infiltrate with neutrophil margination in the vessels. There was no immunoglobulin, complement, or fibrin deposition. The skin test reaction began and ended earlier than would be expected for a classic delayed hypersensitivity reaction. It is considered to be an isolated late cutaneous response but cannot yet be designated a late cutaneous allergic response. Reactants characteristic of an Arthus reaction were not present, and no alternative immunologic basis was confirmed.

Diagnosis of animal allergy.

The aims of the diagnostic evaluation are to establish the presence and severity of disease and the importance of animal exposure as the etiology of the disease. The evaluation of the importance of animals may be part of a general allergy evaluation or specifically directed toward an animal in certain cases, such as occupational exposure. The diagnostic techniques are medical history, physical examination, allergy skin tests or in vitro tests for IgE antibody and correlation of improvement in symptoms with animal avoidance.

Verträglichkeitsuntersuchungen bei Plasma-Protein-Lösung 3,5 %

In a prospective study we found 112 patients out of 9549 who had been given 3.5% plasma protein solution during the preceding year but no other blood derivatives and who had not received any immunosuppressive treatment. 68 patients agreed to be tested for sensitisation to 3.5% plasma protein solution. An intracutaneous test was performed as screening test. Two patients had a false positive reaction, but one of them had urticaria factitia and therefore a positive reaction to NaCl 0.9%. The other patient showed circumscribed reddening in the early phase only, whereas later readings were negative. Neither the test of total IgE by Paper Radio Immuno Sorbent Test (PRIST) nor the test for specific IgE antibodies by Radio Allergo Sorbent Test (RAST) showed any positive results. According to these findings there was no sensitisation to 3.5% plasma protein solution.

Diagnosis of Allergy: In Vitro Testing

Relatively few laboratory tests are of proven value in the differential diagnosis and management of allergic diseases. Immunoassays for IgE and for IgE antibodies are the mainstays. Measurement of IgE in serum is advocated as a first-order laboratory test in the differential diagnosis of allergic disease in children and adults. The usefulness of laboratory tests for IgE antibodies in serum, once a subject of debate in the clinical allergy literature, is now firmly established. Confusion, in respect to the use of these tests, is most evident in clinical situations which have been the subject of limited clinical investigation, e.g., the use of tests for IgE antibodies to screen for allergic disease, the indications for their use in patients treated with allergen immunotherapy, and the diagnostic specificity of IgE antibodies to foods as an indicator of food-induced allergic symptoms. Confusion is also apparent in the interpretation of borderline test results, i.e., results which may indicate the presence of low titers of IgE antibodies, and in defining the optimum format for reporting results to maximize the analytical sensitivity of the test method. This review addresses the ambiguities noted above in the interpretation of results. The paragraphs that follow also consider the possible uses of laboratory tests for inflammatory mediators of immediate hypersensitivity, for IgG antibodies to allergens, and of tests designed to evaluate the in vitro functions of lymphocytes in patients with allergic disease.

The radioallergosorbent test (RAST) for the serological diagnosis of human anisakiasis

The serum of patients with parasitologically confirmed and one patient with a clinically presumptive case of anisakiasis were tested by the radioallergosorbent test (RAST) and counter-electrophoresis (CEP) for IgE and IgG antibodies, respectively, using antigens prepared from larval (L3) stage Anisakis simplex and larval (L2) stage Toxocara canis. All sera were RAST-positive to the A. simplex antigen and RAST-negative to the T. canis antigen. All sera were CEP-negative to both antigens. The presence of a specific IgE antibody suggests that the RAST could serve as a useful technique for the serodiagnosis of anisakiasis in man.

Development and comparative evaluation of a multiple-antigen RAST as a screening test for inhalant allergy

We have developed a modified in vitro test for IgE antibodies, the multi-RA ST, to detect antibodies of different allergen specificities simultaneously in a single tube. The multi-RAST is as sensitive for detecting low concentrations of individual IgE antibodies as the discrete RAST. We also evaluated the multi-RAST as a screening test for respiratory allergy to inhalant allergens in children by comparing the results of the multi-RAST performed by use of a mixture of SRP, TGP, and DF allergen-immunosorbents with the results of skin tests, discrete RAST tests for the same allergens, serum total IgE concentrations, and nasal smears for eosinophils in 100 children referred for allergic-disease evaluation. The results of the multi-RAST were more sensitive, specific, and efficient than the results of tests for serum IgE concentration and nasal eosinophils in establishing the diagnosis of inhalant allergy; the multi-RAST was the only diagnostic test that yielded results that were significantly associated with the clinician's impression of allergy. We conclude that the multi-RAST is a useful and cost-effective screening test for inhalant allergy in children.

HOW NECESSARY ARE SPECIFIC IgE ANTIBODY TESTS IN ALLERGY DIAGNOSIS?

In a 12-month study 301 patients referred to hospital consultants with putative allergic symptoms were tested for specific IgE antibodies to a panel of allergens and for total serum IgE levels. Examination of the data in relation to clinical information and the results of skin prick tests showed that the specific IgE antibody test has a limited role in the investigation of such patients.

Occupational asthma: a challenge in patient management and community care.

Occupational exposure to irritants accounts for 2% to 15% of all cases of asthma. Most of the offending agents evoke an IgE allergic reaction, but some seem to act through pharmacologic rather than immunologic pathways. Usually, symptoms are worse during working hours and improve in the evening and over the weekend, but in some cases onset is delayed. Symptoms may persist for weeks after exposure ceases. Skin tests or serologic tests for IgE antibody are helpful in diagnosis. Bronchial challenge with the suspected agent is valuable research procedure that occasionally is clinically useful in diagnosis. Management requires the cooperation of the medical and industrial communities. It consists of identifying asthmatic workers, removing them from exposure to the affecting environment, and treating their symptoms; preventing exposure of susceptible people through preemployment screening; and setting and adhering to reasonable occupational safety standards.

The development of a radioallergosorbent test (RAST) for murine IgE antibodies

A purified monoclonal IgE preparation, isolated from the ascitic fluid of mice bearing a hybridoma secreting IgE with specificity to ovalbumin, was used for the production of goat anti-murine IgE (GAME) antiserum, which was then rendered monospecific for the epsilon chain. Another monoclonal hybridoma IgE preparation with specificity for the 2,4-dinitrophenyl group was isolated from ascitic fluid in a relatively pure state by affinity chromatography and used in the form of an immunosorbent to isolate antibodies from the monospecific goat serum. The GAME antibodies were 125I-labeled and used to develop a radioallergosorbent test (RAST) for the quantitation of murine IgE antibodies specifically adsorbed onto antigen-coupled paper discs. The RAST was specific for antibodies of the IgE class only and was as sensitive as and more accurate than PCA assay. RAST results on sera of mice treated with tolerogenic conjugates indicated a reduction in the affinity and concentration of the IgE antibody populations on suppression of the IgE response. The effect of interference by non-IgE antibody populations on the RAST curves has been discussed.