Measurement Of Specific IgE Antibodies Research Articles

Indoor Mold.

According to self-reported frequencies, every fifth or sixth dwelling in Germany is affected by dampness and/or mold. This carries a potential risk to health. This review is based on pertinent publications retrieved by a selective literature search and inquiry in the GENESIS database, on the AWMF guideline on the medical clinical diagnosis of indoor mold exposure, as updated in 2023, and on the relevant contents of other current guidelines. Based on this research, we present an algorithm for the evaluation of health problems that may be due to mold in indoor environments. A rational diagnostic work-up begins with history-taking and physical examination, with attention to risk factors-above all, immune compromise and atopy. If there is evidence of atopy, targeted allergy diagnostics should be performed, consisting of a skin prick test and/or measurement of specific IgE antibodies, supplemented whenever indicated by provocative testing and cellular test systems. If the patient's immune response is compromised, the immediate cessation of mold exposure has absolute priority. Any suspected invasive fungal infection should be evaluated with radiological, microbiological, serological, and immunological testing. Indoor measurements of mold fungi, microbial volatile organic compounds (MVOC), and/or mycotoxins are generally not indicated as part of the medical evaluation; nor are blood or urine tests for particular mold components or metabolites. Mold in indoor environments should be dealt with by rapid exposure elimination for patients at risk, the rational diagnostic evaluation of any symptoms and signs of disease, and patient education about the possibilities and limitations of diagnostic testing and the generally limited utility of measurements in the affected interior spaces.

House dust mites among allergic patients at the Allergy and Immunology Unit, Zagazig University: an immunologic and serologic study.

In the twenty-first century, the occurrence of allergic diseases has increased. Prevention and control of house dust mites (HDMs) are required as they play a major role in allergic conditions. The present work aimed to detect HDM allergy (Dermatophagoides pteronyssinus and Dermatophagoides farinae) among allergic patients attending the Allergy and Immunology Unit, Zagazig University. Ninety-six patients with a history of allergic diseases were included in this study. They were examined for allergy to D. pteronyssinus and D. farinae using different diagnostic tools: the skin prick test (SPT) and measurement of specific IgE antibodies to HDM allergen extracts. Ninety-six allergic patients were recruited in this study [60 females (62.5%) and 36 males (37.5%) aged between 5-60years]. SPT (81.2 and 79.2%) and IgE (70.9 and 75%) gave positive results for both D. pteronyssinus and D. pteronyssinus, respectively. The common risk factors were use of cotton bedding >10years old, older homes>20years, crowded homes, family history, home dampness and homes at the ground floor. It was concluded that allergies to D. pteronyssinus and D. farinae contribute to allergic diseases in Zagazig City. Use of the SPT and IgE level is a promising diagnostic tool in the diagnosis of D. pteronyssinus and D. farinae.

Measurement of specific IgE antibodies to Ses i 1 improves the diagnosis of sesame allergy.

The number of reported cases of allergic reactions to sesame seeds (Sesamum indicum) has increased significantly. The specific IgE tests and skin prick tests presently available for diagnosis of sesame allergy are all based on crude sesame extract and are limited by their low clinical specificity. Thus, oral food challenge (OFC) is still the gold standard in the diagnosis. The aim was to identify the allergen components useful to diagnose sesame-allergic children with the goal to reduce the number of OFCs needed. Ninety-two sesame-sensitized children were consecutively enrolled and diagnosed based on OFC or convincing history. Specific IgE to purified native 11S globulin (nSes i 11S), 7S globulin (nSes i 7S), 2S albumin (nSes i 2S), and two recombinant 2S albumins (rSes i 1 and rSes i 2) was measured by ELISA and/or ImmunoCAP (rSes i 1/streptavidin application). Based on area under curve (AUC) values from receiver operating characteristic (ROC) analysis, rSes i 1 was shown to have the best diagnostic performance of the allergen components in ELISA. The experimental rSes i 1 ImmunoCAP test had larger AUC (0.891; 95% CI, 0.826-0.955) compared to the commercially available sesame ImmunoCAP (0.697; 95% CI, 0.589-0.805). The clinical sensitivity and specificity for the rSes i 1 ImmunoCAP test at optimal cut-off (3.96 kUA /L) were 86.1% and 85.7%, respectively. Sensitization to Ses i 1 is strongly associated with clinical sesame allergy. Measurement of specific IgE to rSes i 1 could reduce the numbers of OFCs needed.

Allergy--current insights into prevention and diagnostic workup of immediate-type allergy and treatment of allergic rhinoconjunctivitis.

In recent decades, the incidence of allergic diseases has dramatically increased, by now affecting a large percentage of the population. For a long time, allergen avoidance was considered the most crucial measure in primary allergy prevention. However, studies have increasingly shown that exposure to allergens is an essential prerequisite for the development of immunological tolerance. Diagnostic workup is based on patient history, skin tests, and measurement of specific IgE antibodies. The introduction of component-based diagnostic workup offer an option to differentiate between primary sensitization and cross-reactivity caused by sensitization to panallergens or sensitization to cross-reactive carbohydrate epitopes. Symptomatic treatment only leads to temporary relief of allergic symptoms. By contrast, specific immunotherapy (SIT) may have long-lasting therapeutic effects and potentially even result in a complete cure. The selection of allergens for SIT is guided by the principle of major allergens. It is recommended to use those preparations that have been proven safe and effective in controlled clinical studies. With respect to subcutaneous immunotherapy, a host of tested and approved extracts are available for a wide range of different allergens. Large clinical trials have also confirmed the efficacy of sublingual immunotherapy with grass and also birch pollen extracts, which has led to the official approval of some preparations containing these allergens.

Food allergy in childhood (infancy to school age).

Food allergy is a potentially life-threatening condition affecting almost 10% of children, with an increasing incidence in the last few decades. It is defined as an immune reaction to food, and its pathogenesis may be IgE mediated, mixed IgE and non-IgE mediated, or non-IgE mediated. Potentially all foods can cause food allergy, but a minority of foods are responsible for the vast majority of reactions reported. A good clinical history is crucial for an accurate diagnosis. Allergy tests, including the skin prick test and measurement of specific IgE antibodies, are useful tools in the case of IgE-mediated or mixed allergy but have not been shown to be of any help in delayed allergic reactions to foods.

The significance of an allergological examination in asthma and COPD

Of the two most common obstructive lung diseases - bronchial asthma and chronic obstructive pulmonary disease (COPD) - asthma is clearly associated with a possible allergic background, therefore an allergological examination should be included in the work-up of this disease. COPD on the other hand is usually not expected to be linked with an atopic diathesis. Medical history, clinical manifestations, the presence of other atopic diseases, prick tests and measurement of specific IgE antibodies in the serum provide an indication of an allergic genesis of the obstructive pulmonary disease. Bronchial asthma can be roughly divided into an allergic phenotype (TH2-weighted) and a non-allergic phenotype (non-TH2-weighted). The TH2- weighted form leads to an infiltration of eosinophils into the bronchial wall allowing the possibility of a higher concentration of nitrogen oxide in the exhaled air (FeNO measurement) to be detected. In addition to the differentiation between allergic and non-allergic bronchial obstruction, an evaluation of symptoms associated with the workplace (work related asthma) must take place. Furthermore, questions about an intolerance to aspirin (aspirin - exacerbated respiratory disease) or exercise induced symptoms (exercise-induced asthma) should be asked. After a careful interpretation of clinical symptoms and findings in allergy tests, an allergologist can analyze the usefulness of a specific immunotherapy (SIT). For children who suffer from allergic rhinoconjunctivitis, an early SIT can prevent the shift to inflammation of the lower respiratory tract (asthma). Due to the overlapping pathophysiology and symptomatology between bronchial asthma and chronic obstructive pulmonary disease an allergological examination should be considered also in COPD patients.

ピーナッツアレルギー診断におけるAra h 2特異的IgE抗体測定の意義

【背景】Ara h 2は，ピーナッツアレルギーにおいて最も重要なコンポーネントであることが知られている． 【目的】日本人のピーナッツアレルギー診断におけるAra h 2特異的IgE抗体（以下，Ara h 2-IgE）測定の有用性を明らかにする． 【方法】ピーナッツアレルギーを疑った152症例（ピーナッツアレルギー（PA）68症例，非ピーナッツアレルギー（NPA）84症例）を対象に，イムノキャップ®により5種のピーナッツコンポーネントに対する特異的IgEを測定した． 【結果】Ara h 2-IgEの診断効率が最も良く，95％陽性的中率（PPV）を与える抗体価は4.71 UA/mlで，その時の感度は57.4％であった．現行のピーナッツ粗抽出抗原を用いた特異的IgE抗体（以下，f13-IgE）では，50.8 UA/mlでPPVが95％となり，この時の感度は20.6％，Sampsonの報告した14 UA/mlでの感度は36.8％であった．また，f13-IgEの抗体価に関わらずAra h 2-IgEの陰性的中率（NPV）は89.3％であった． 【結語】Ara h 2-IgEは，f13-IgEと組み合わせることでより正確なピーナッツアレルギーの診断に有用であり，経口負荷試験を実施する患者数を減少させることが可能となる．

Molecular diagnosis of egg allergy

Allergy to hen's egg is common in infancy and childhood. Oral food challenges are often required to diagnose egg allergy, because of the limitation in the diagnostic accuracy of skin test and specific IgE to egg white. New molecular diagnostic technologies have been recently introduced into allergological research. In this article, we will review the recent literature regarding the potential value of these tests for the clinical management of egg-allergic patients. Component-resolved diagnosis that can be combined with the microarray technology is promising as measurement of specific IgE antibodies to individual egg white components has been shown to predict different clinical patterns of egg allergy. Specific IgE to ovomucoid has been identified as a risk factor for persistent allergy and could indicate reactivity to heated egg. Ovomucoid and ovalbumin IgE and IgG4-binding epitope profiling could also help distinguish different clinical phenotypes of egg allergy. Particularly, egg-allergic patients with IgE antibodies reacting against sequential epitopes tend to have more persistent allergy. Using recombinant allergens, IgE-binding epitopes, and microarrays, molecular-based technologies show promising results. However, none of these tests is ready to be used in clinical practice and oral food challenge remains the standard for the diagnosis of egg allergy.

Bronchiale Provokationsteste

This is an updated overview of indications, contraindications, performance and interpretation of bronchial challenge tests. As speciality, the diagnostic step by step scheme comprises in addition to the clinical case history a detailed exposure (occupational) history, lung function testing, assessment of nonspecific bronchial hyperresponsiveness, allergological diagnostics (skin prick test, measurement of specific IgE antibodies), privation and reexposure test and as gold standard specific bronchial challenge tests. The last mentioned tests are of particular importance in the framework of a diagnostic backup with regard to specific therapeutic and preventive measures and insurance regulations (occupational disease?). Specific bronchial challenge tests and their variant, the workplace-related challenge test, serve to objectify or exclude the clinical relevance and the current state of a respiratory sensitization. They require a comprehensive experience of the physician performing the tests. The majority of diseases does not necessitate these tests, especially if case history, lung function testing, allergy tests, privation and reexposure test provide unanimously positive results. If allergic symptoms of conjunctiva or the upper respiratory tract are of prime importance the performance of a specific conjunctival or nasal challenge test is recommended.

Diagnostik der Allergien vom Soforttyp – „State of the Art”

Bei allergischen Erkrankungen kommt der Differenzialdiagnostik, die aus den Schritten Anamnese, Hauttest, in-vitro-Diagnostik und Provokationstest bestehen sollte, eine zentrale Bedeutung zu. Die zweifellos wichtigste und praxistauglichste in-vitro-Untersuchung ist die Bestimmung von allergenspezifischen IgE-Antikörpern (sIgE) im Serum. Der Nachweis von sIgE bedeutet, dass eine spezifische Sensibilisierung gegenüber entsprechenden Allergenen vorliegt. Die Aussagekraft der Allergiediagnostik ist massiv von der Qualität der verwendeten Allergenextrakte und der Methoden abhängig. Im Falle der Allergiediagnostik hat die alleinige Bestimmung des Gesamt-IgEs keinen diagnostischen Wert, da damit keine Aussage zur spezifischen Sensibilisierung getroffen werden kann. Sie kann allerdings als Interpretationshilfe zur Beurteilung der allergenspezifischen IgE-Konzentrationen im Patientenserum dienen und gibt ergänzende Hinweise auf das Vorliegen einer allergischen Disposition. Die Bildung von allergenspezifischen IgG-Antikörpern ist Teil der normalen Immunantwort auf eine Fremdstoffexposition. Da keine Korrelation zur klinischen Symptomatik mit der allergischen Soforttypreaktion besteht und ihre Rolle in der Pathogenese des Asthma bronchiale bzw. der Allergie unbekannt ist, gilt die Krankheitsrelevanz der IgG-Antikörper als völlig ungesichert. Für alle zellulären Testsysteme gilt bislang: Sie sind methodisch aufwendig, kostspielig, häufig ungeeignet für den Versand von Proben und anspruchsvoll in Durchführung und Interpretation. Obwohl sie für die Routinediagnostik zum größten Teil wenig geeignet sind, können sie allerdings bei gezielter Indikation, kontrollierter Durchführung und kritischer Interpretation einen potenziellen Baustein für die spezialisierte in-vitro-Allergiediagnostik darstellen. Für die einzelnen Teste sind allerdings Standardprotokolle inklusive Ringversuche und entsprechende Qualitätskontrollen zu fordern. Verwendete Antigene/Allergene müssen charakterisiert und standardisiert werden (Haupt- und Leitallergene). In unklaren Fällen sind alle Möglichkeiten einzubeziehen, sodass eine für den Patienten zielführende Diagnostik vorgenommen werden kann.

Utility of ovomucoid-specific IgE concentrations in predicting symptomatic egg allergy

Children with allergy to raw egg white might tolerate low amounts of heated egg. Ovomucoid-specific IgE antibodies have been suggested to be predictors of whether children could tolerate heat-treated egg. The aim was to evaluate the clinical usefulness and added diagnostic value of measurements of IgE antibodies to egg white, ovalbumin, and ovomucoid in children with egg allergy. One hundred eight patients (median age, 34.5 months) with suspected egg allergy underwent double-blind, placebo-controlled food challenges with raw and heated egg. The outcomes of the challenges were related to the serum concentration of specific IgE antibodies and total IgE by using ImmunoCAP. Reactions to heated egg white were observed in 38 patients (considered allergic to raw and heated egg), 29 patients reacted to only raw egg white, and 41 patients were tolerant. Correlation was observed between the serologic parameters studied. Receiver operating characteristic analysis showed that egg white ImmunoCAP was useful in the diagnosis of allergy to raw egg white. The positive decision point, based on 95% clinical specificity, was 7.4 kU(A)/L, and the negative decision point, based on 95% clinical sensitivity, was 0.6 kU(A)/L. For reaction to heated egg white, ovomucoid ImmunoCAP was superior. The positive decision point was 10.8 kU(A)/L, and the negative decision point was 1.2 kU(A)/L. Quantitative measurements of specific IgE antibodies to both egg white and ovomucoid and the evaluation against the suggested positive and negative decision points for specific IgE will be useful in the diagnosis of egg allergy.

In Vitro Measurement of Specific IgE Antibodies to Betalactams: Comparison of Two Immunoassays

In vitro quantification of IgE to penicillins can be done by either radioallergosorbent test (RAST) or sepharose radioimmunoassay (SEPH). The aim of the study was to compare sensitivity and specificity of both methods.

Insulin allergy: clinical manifestations and management strategies

Insulin allergy in patients with diabetes mellitus on insulin treatment is a rare condition. It is suspected upon noticing immediate symptoms following insulin injections. The immediate vital implications for the patient call for prompt diagnosis and management of insulin allergy. We review current knowledge and procedures based on four diabetic patients who presented in our clinic. Insulin allergy was suspected as they showed immediate symptoms after insulin injection (urticaria, rash, angioedema, hypotension, dyspnea). A detailed allergologic work-up was performed and adequate therapy was initiated. In three of the four patients, a specific immunotherapy was started whereas in one patient a switch to oral antidiabetics was possible and consequently initiated. By standard prick testing and measurement of specific IgE antibodies, a type 1 IgE-mediated allergy was confirmed. After initiation of insulin immunotherapy, the symptoms completely resolved in two out three of patients and significantly improved in the third patient. The fourth patient was successfully switched to oral antidiabetics. Insulin allergy is a rare but severe condition that calls for immediate allergological work-up. It can be managed well in close cooperation between the diabetologist and the allergologist. Specific immunotherapy is efficient and should be considered.

Sensitivity and specificity of recombinant ω‐5 gliadin‐specific IgE measurement for the diagnosis of wheat‐dependent exercise‐induced anaphylaxis

A recent study has shown that the measurement of specific IgE antibodies to B-cell epitope peptides of wheat omega-5 gliadin (Pep A) and high molecular weight glutenin subunit (Pep B) are useful to diagnose wheat-dependent exercise-induced anaphylaxis (WDEIA). We sought to compare the sensitivity and specificity of the in vitro tests for measuring the specific IgE antibodies to recombinant omega-5 gliadin (romega-5 gliadin) with those for wheat, gluten, Pep A, and Pep B in identification of patients with WDEIA. Fifty patients with WDEIA, 25 healthy subjects and 25 patients with atopic dermatitis with specific IgE antibodies to wheat but without experience of allergic reactions after ingestion of wheat products were enrolled in this study. The concentrations of specific IgE antibodies were measured using ImmunoCAP. The empirical receiver operating characteristics curves (ROC) for each test were prepared and the areas under the ROC curve (AUC) were compared. In patients with WDEIA, the sensitivities of the allergen-specific IgE tests for wheat, gluten, Pep A, Pep B and romega-5 gliadin were 48%, 56%, 76%, 22%, and 80%, respectively. The seven of 10 WDEIA patients with no specific IgE antibodies to romega-5 gliadin had specific IgE antibodies to Pep B. The highest AUC (0.850) was observed in the test for romega-5 gliadin. Measuring the concentration of specific IgE antibodies to romega-5 gliadin is more useful than to wheat, gluten, or Pep A in the identification of patients with WDEIA.

Diagnostik arbeitsbedingter obstruktiver Atemwegserkrankungen allergischer und chemisch-irritativer Genese unter besonderer Berücksichtigung des spezifischen inhalativen Provokationstests

Several recent investigations demonstrate that approximately 10% of all asthma and COPD diseases are caused by occupational exposures to allergens or irritants. This review covers the stepwise diagnostic procedure. Of special importance is the initial, detailed clinical and occupational history supplemented by lung function testing including the measurement of unspecific bronchial hyperreagibility, allergological examinations (skin prick testing, measurement of specific IgE antibodies) and avoidance/reexposure tests. Furthermore, the specific inhalative challenge test with its variant, the occupational-type inhalative exposure test, as gold standard is described in detail. Its indications and contraindications are given. If the occupational history reveals a pneumoconiosis risk, chest X-ray examinations are required. A definitive diagnosis is obligatory due to legal aspects with regard to insurance (is there evidence for an occupational disease?) and for the initiation of aimed preventive measures.

Validation of an asthma questionnaire for use in healthcare workers

Background: Previous studies have described increased occurrence of asthma among healthcare workers, but to our knowledge there are no validated survey questionnaires with which to study this occupational group. Aims:...

Skin symptoms and work‐related skin symptoms among grape farmers in Crete, Greece

Grape farmers are exposed to a variety of agents capable of inducing occupational skin disease. We conducted a study to measure the prevalence of skin symptoms and work-related skin symptoms among grape farmers in the Malevisi region of Crete and to provide data on associated risk factors. One hundred twenty grape farmers and 100 controls participated in the study. The protocol consisted of a questionnaire, skin prick tests for 16 common allergens, and measurement of specific IgE antibodies against 8 allergens. Self-reported itchy rash (OR, 2.31; 95%CI, 1.10-4.84, P<0.05) within the last 12 months, and work-related itchy rash (OR, 4.08; 95%CI, 1.01-20.33, P<0.05) were significantly higher in grape farmers than in controls, after adjusting for age and sex. Sensitization to pollens (OR, 4.20; 95% CI, 1.41-12.82, P<0.01) and allergic rhinitis (OR, 3.06; 95% CI, 1.21-8.28, P<0.05) were found to be significantly associated with self-reported itchy rash in the grape farmers group. Grape farmers reported skin symptoms more frequently than non-exposed controls, and IgE-mediated sensitization to pollens was found to be significantly associated with the reported symptoms. Further studies are needed to evaluate the impact of specific occupational agents on skin diseases among grape farmers.

Decrease of selective immunoglobulin E response to amoxicillin despite repeated administration of benzylpenicillin and penicillin V

Subjects with IgE responses to betalactams can develop selective or cross-reactive responses after the administration of penicillin derivatives. After the reaction, however, the hapten induces a boosting phenomenon, which may increase the titre and the affinity of the antibody, with the resulting risk of developing allergic reactions to other penicillins. To determine in subjects with selective responses to amoxicillin (AX) and good tolerance to benzylpenicillin (BP) and penicillin V (PV) whether the administration of these compounds induced any change in specificity, measured by either skin or in vitro testing, which could predict the appearance of cross-reactivity. Ten subjects with a selective response to AX were followed-up for 2 years with the periodic administration of penicillin G and V (Group A) and compared with another group composed of 10 persons with identical clinical characteristics but without repeated penicillin administration (Group B). Periodic in vitro and in vivo measurements of specific IgE antibodies were performed at 6-month intervals. Patients were randomized to Group A or B according to their order of inclusion. In both groups, skin test reactivity tended to decrease, and although greater in Group A, the difference was not significant compared with Group B. Median RAST values also decreased over time and showed no differences in the exposed group compared with the controls. One patient in Group A became positive to benzylpenicilloyl (BPO), despite becoming negative to AX. Subjects with selective IgE responses to side-chain-specific determinants seem to become negative, with no influence from subsequent administration of a closely related penicillin.

Food allergy diagnostics: scientific and unproven procedures

The accurate diagnosis of food allergy is crucial not only for the right treatment but also for the avoidance of unnecessary diets. The diagnostic work-up of suspected food allergy includes the measurement of food-specific IgE antibodies using serologic assays, the skin prick test, elimination diets and oral provocation tests. In addition, some approaches are either under further rigorous investigation (the atopy patch test) or are already in widespread use, particularly by practitioners of alternative or complementary medicine, but are considered unproven. These diagnostic methods include specific IgG to foods, provocation/neutralization testing, kinesiology, cytotoxic tests and electrodermal testing. This review covers some of the most common scientifically validated and unproven approaches used in the diagnosis of food allergy. For specific serum IgE and the SPT, decision points have been established for some foods, allowing prediction of clinical relevance. The APT may be helpful, especially when considered in combination with defined levels of specific IgE. In regard to other approaches, most scientific studies do refute the usefulness of these approaches. In most patients, controlled oral food challenges remain the gold standard in the diagnostic work-up of suspected food allergy. The skin prick test and measurement of specific IgE antibodies to food extracts, individual allergens or allergenic peptides are helpful in the diagnostic approach. Food-specific IgG continues to be an unproven or experimental test. The other alternative and complementary techniques have no proven benefit and may endanger patients via misdiagnosis.

Enzymes as occupational and environmental respiratory sensitisers

A literature review shows that airborne enzymes occurring in the general environment and in purified form in industrial production have a high allergenic potential to the airways, causing rhinitis, conjunctivitis and asthma. It can be assumed that this also applies to the increasing number of enzymes manufactured by the cloning of fast-growing genetically engineered microorganisms. Cross-sectional studies demonstrate exposure-response relations for IgE-mediated sensitisation and airway disorders. Atopic individuals are more susceptible to enzyme allergy than non-atopic individuals. Skin prick testing and measurement of specific IgE antibodies have been shown to be useful diagnostic tools. Very high concentrations of proteases may lead to emphysema. There is also evidence for non-allergic airway inflammation by proteases, probably via protease-activated receptor-2 and intracellular Ca(2+) release. It is recommended that all enzymes be classified with the risk phrase R42 (may cause sensitisation by inhalation) and that their inhalative uptake be totally avoided.