sIgE Results Research Articles

A real-world data analysis of distribution and inconsistency between total serum IgE and allergen-specific IgE results in clinical practice.

The inconsistency between serum total IgE (tIgE) and allergen-specific IgE (sIgE) results is often encountered in clinical practice, but the distribution and influencing factors of the inconsistent results have not been fully understood. The aim of this study was to analyze the distribution and inconsistency between tIgE and sIgE test results. A retrospective study, from the electronic medical records of 2139 patients who underwent both tIgE and sIgE tests, from January to December 2023 was reviewed. The tIgE and sIgE results and their distribution, as well as their inconsistency, were analyzed based on sex, age, and disease subgroups. 36.2% of the patients had a positive sIgE, and 43.7% had an elevated tIgE level. sIgE and tIgE results were discordant in nearly 30% of patients, with no difference between genders, while individuals aged over 60 exhibited a significantly higher inconsistency rate than the other age groups, and the inconsistency rate between tIgE and sIgE results was significantly different among different tIgE levels, sIgE grades, positive allergen count and positive allergen types. In addition, patients with chronic urticaria (CU) had a higher inconsistency rate than those with other allergic diseases, but the difference was not statistically significant. The overall inconsistency rate between tIgE and sIgE results was about 30%. The elderly group older than 60 years old is more likely to have inconsistent results, and tIgE level, sIgE level, the number and type of positive allergens also affected the consistency of tIgE and sIgE results.

Evaluation of the local and systemic pattern of sensitization to allergens in patients with adenotonsillar hypertrophy.

Adenotonsillar hypertrophy (ATH) is a medical condition characterized by the enlargement or swelling of the tonsils. The role of allergy in ATH has not been persuasivelyevidenced. Therefore, we investigated the state of humoral immunity and the presence of specific immunoglobulin E (sIgE) in tissues and sera in children suffering from TH. According to the skin prick test (SPT) result, 44 ATH children were divided into the atopic and non-atopic groups. The level of sIgE against 30 inhalants and food allergens in the sera and tissue homogenates was measured by a commercial allergy immunoblotting kit. In addition, we evaluated the following variables in both tonsillar tissue homogenates and serum: total IgE, IgA, IgM, IgG, and tissue eosinophil counts. Our results showed that 21 (47.7%) of patients with ATH were sensitized to at least one allergen in the adenotonsillar sample and/or sera. Only two patients were negative for sIgE in the atopic group, but in the non-atopic group, only one had positive sIgE results. In the atopic group, 19 (86.4%) patients had positive sIgE in tonsillar tissues, and 18 (81.8%) had sensitized serum. There were no statistical differences in the case of other antibodies except IgE levels between the two groups. The average eosinophilic count was significantly higher in atopic patients than in the non-atopic group. The results of this study support the role of allergy in the pathogenesis of ATH and confirmed local allergic inflammation in tonsillar tissue.

Sustained unresponsiveness development in wheat oral immunotherapy: predictive factors and flexible regimen in the maintenance phase.

Background and aim. Immunotherapy may induce sustained unresponsiveness (SU) in which the patient can tolerate the allergen without any severe symptoms after discontinuing immunotherapy. The present study evaluated serum and cutaneous markers for predicting SU in patients with wheat anaphylaxis who underwent oral immunotherapy. Moreover, we investigated the effectiveness of a flexible regimen of 5 to 10 g wheat protein (WP) in the maintenance phase of oral immunotherapy (OIT). Methods. This study was conducted on 19 patients with wheat anaphylaxis who underwent OIT. The result of the skin prick test (SPT), besides specific serum IgE (sIgE) and IgG4 (sIgG4) to WP, were evaluated before the desensitization. The maintenance dose started from the preferred dose of 5 to 10 g WP after the build-up phase, if the patient could tolerate it. All patients were recruited 7 to 9 months after undergoing this flexible regimen, and the results of SPT and sIgE, and sIgG4 levels were obtained once more. The patients underwent oral food challenge (OFC) after a 3-4-week avoidance to evaluate SU. Results. There was an association between mean IgE reduction and SU (p less than 0.0006), while no association was observed between the mean increase in specific IgG4 (p = 0.1) and the mean wheal diameter decrease (p = 0.29). In the present study, a 50% reduction in sIgE was associated with SU. Thirteen patients were considered to have a SU. Moreover, there was no association between the flexible regimen and the desensitization rate. Conclusions. The results revealed that the reduction of 50% sIgE is a predictive factor for SU in patients with IgE-mediated wheat allergy.

Component Ana o 3 versus extract for cashew nut allergy: A diagnostic test accuracy study in adults.

Component Ana o 3 versus extract for cashew nut allergy: A diagnostic test accuracy study in adults.

The relationship of D. pteronyssinus allergic component sIgE and sIgG4 in house dust mite allergic rhinitis or/and allergic asthma patients

Objective: House-dust mite sensitization is an important cause of allergic asthma and/or rhinitis in southern China. This study aimed to analyze the immune effect and relationship between the Dermatophagoides pteronyssinus components specific immunoglobulin E (sIgE) and sIgG₄. Methods: The serum levels of sIgE and sIgG₄ to D. pteronyssinus allergen components Der p 1, 2, 3, 5, 7, 10, and 23 were detected in 112 patients with allergic rhinitis (AR) and/or allergic asthma (AA). Results: Overall, Der p 1 had the highest positive rate of sIgE (72.3%), followed by Der p 2 (65.2%) and Der p 23 (46.4%). Meanwhile, the highest positive rates of sIgG₄ were for Der p 2 (47.3%), Der p 1 (33.0%), and Der p 23 (25.0%). The patients with AR and AA had a higher positive rate (43.4%) of sIgG₄ than that in the patients with AR (42.4%) and the patients with AA (20.4%; p = 0.043). In patients with AR, the positive rate of sIgE in Der p 1 (84.8%) was higher than that in sIgG₄ (42.4%; p = 0.037), but the positive rate of sIgG₄ in Der p 10 (21.2%) was higher than that in sIgE (18.2%; p < 0.001). Most of the patients were positive for sIgE and sIgG₄ of Der p 2 and Der p 10 at the same time. However, positive results for sIgE alone were just found in Der p 7 and Der p 21. Optimal scale analysis showed that Der p 2, Der p 7, and Der p 21 sIgG₄ were closely related to AR and AA (Cronbach α = 0.917). Conclusion: Herein, the D. pteronyssinus allergen components showed different characteristics among the patients with AR, patients with AA, and patients with AR and AA in southern China. Thus, sIgG₄ may be play an important role in allergic reactions.

The importance of specific IgE antibodies in the epidemiology of allergic rhinitis and asthma (ECAP survey): part four. The relationship between the concentration of specific IgE antibodies in serum and types of asthma.

Specific immunoglobulins E (sIgE) are important parameters for the estimation of severity of allergic diseases. To determine the relationship between the concentration of specific IgE antibodies in serum and types of asthma. The concentration of sIgE antibodies against allergens Dermatophagoides pteronyssinus, cat dander, timothy grass, and Alternaria alternata were determined in the serum of 4077 respondents randomly selected from 8 regions (ECAP study). The positive results of sIgE (≥ 0.35 IU/ml or ≥ 0.7 IU/ml) were correlated to clinical diagnosis (types of asthma, skin-prick tests). sIgE antibodies against any allergen were detected in 9.9% (classes 1-6)/7.6% (classes 2-6) of healthy respondents. Comparing sIgE antibodies of respondents with intermittent asthma to sIgE antibodies of respondents with persistent asthma, no statistically significant differences were identified. Relating to allergens of D. pteronyssinus, cat dander, and A. alternata, sIgE antibodies were more frequently detected in respondents with atopic asthma and a negative skin-prick test as compared to healthy respondents with a negative skin-prick test (p < 0.005 to p < 0.001). Relating to allergens of D. pteronyssinus, cat dander, and timothy grass, sIgE antibodies were more frequently detected in respondents with atopic asthma and a weakly positive skin-prick test as compared to healthy respondents with weakly positive skin-prick test (p < 0.05 to p < 0.001). Regarding subjects with a negative or weakly positive skin test, when sIgE antibodies to the same allergen are detected, asthma is much more likely to occur.

The importance of specific IgE antibodies in the epidemiology of allergic rhinitis and asthma (ECAP survey): part five. The relationship between the concentration of specific IgE antibodies in serum and types of rhinitis.

Specific immunoglobulins E (sIgE) are important parameters for the estimation of severity of allergic diseases. To determine the relationship between the concentration of specific IgE antibodies in serum and types of rhinitis. The concentration of sIgE antibodies against allergens Dermatophagoides pteronyssinus, cat dander, timothy grass, and Alternaria alternata were determined in the serum of 4077 respondents randomly selected from 8 regions (ECAP study). The positive results of sIgE (≥ 0.35 IU/ml or ≥ 0.7 IU/ml) were correlated to clinical diagnosis (types of rhinitis, skin-prick tests). sIgE antibodies are more frequently detected in respondents with intermittent/seasonal allergic rhinitis and a negative skin-prick test as compared to healthy respondents with a negative skin-prick test (p < 0.05 to p < 0.001). Relating to allergens of D. pteronyssinus and cat dander, sIgE antibodies are more frequently detected in respondents with persistent/perennial allergic rhinitis and a negative or weakly positive skin-prick test as compared to healthy respondents with a negative or weakly positive skin-prick test (p < 0.05 to p < 0.001). The occurrence of intermittent/seasonal allergic rhinitis is much more probable in respondents with a negative skin-prick test, when IgE antibodies against the same allergen are detected. And the occurrence of persistent/perennial allergic rhinitis is much more probable in respondents with a negative or weakly positive skin-prick test with allergens of D. pteronyssinus or cat dander, when IgE antibodies against the same allergen are detected.

Comparative characteristics of methods of allergological examination for house dust mite allergy in children with bronchial asthma and allergic rhinitis

Objective. To determine the diagnostic significance of methods of allergological diagnostics: skin prick tests (SPT), quantitative determination of specific immunoglobulin E (sIgE) and nasal provocative test (NPT) in children with allergy to house dust mites (HDM) diagnosed with allergic rhinitis (AR) or AR in combination with asthma. &#x0D; Methods. Patients underwent a targeted history taking for possible domestic sensitization, SPT with HDM allergens, NPT with HDM, and sIgE to HDM allergens was determined by the ImmunoCAP method. &#x0D; Results. The statistical processing group included 109 children (67 boys, 42 girls, aged 5 to 17,9 years (mean age 8,9±2,52 years)), in whom sensitization to HDM was confirmed by at least one of the methods used in the study. A higher sensitivity of SPT then of sIgE was determined (96,3% and 81,6%, respectively). According to SPT and sIgE results, sensitization to both types of mites (D. pteronyssinus and D. farinae) is more common than isolated. Coincidence of positive results of SPT and sIgE was obtained in 84 cases (77,1%). &#x0D; Conclusion. SPT can be considered as the first line of investigation. The use of a complex of examination methods is necessary to determine the role of sensitization to HDM, if NPT is taken as the «gold» standard of diagnosis.

Real-life evaluation of molecular multiplex IgE test methods in the diagnosis of pollen associated food allergy.

Diagnosis of food allergies is challenging, as combining information from specific IgE (sIgE)-sensitization pattern and skin prick tests (SPTs) with clinical history is necessary for a personalized management of allergic patients. The aim of this study was to compare two molecular tests, the ImmunoCAP ISAC (ISAC) and the Allergy Explorer, version 2 (ALEX2 ) in the context of pollen food syndrome (PFS) diagnosis in a real-life scenario, to assess the benefit of multiplex testing in PFS patients. Diagnosis of food allergy was performed in 53 patients. Allergen-sIgE concentrations were measured with ISAC and ALEX2 . Results for sIgE were statistically compared with each other, with SPT results and with clinical presentation of the patients. Using ISAC as reference test for sIgE measurements, the average sensitivity of ALEX2 for PR-10 allergens was 83.2% and the average specificity 88.0%. If only low sIgE concentrations were included, the sensitivity was 60.8% and the specificity 91.1%. Apple and hazelnut sensitizations were confirmed in most patients by concordance of sIgE and SPT results. Significant correlations were shown between clinical symptoms and Mal d 1- and Gly m 4-sIgE levels measured by both tests and for Cor a 1-sIgE levels measured by ALEX2 . In eight patients, profilin related symptoms were supported by Hev b 8-sensitization. Multiplex testing is beneficial to understand patient-specific individual sensitization profiles and to providing personalized management recommendations. In the future, custom-designed test kits might enable reducing costs of multiplex testing for specific patient groups without compromising the diagnostic value.

Place of residence, gender, month of birth and age influence on the concentration of specific IgE antibodies in serum. The Epidemiology of Allergic Diseases in Poland (ECAP survey): part three.

IntroductionSpecific immunoglobulins E (sIgE) are important parameters to estimate the severity of allergic diseases.AimTo determine the influence of gender, age and place of residence on the concentration of specific IgE antibodies in serum.Material and methodsThe concentration of sIgE antibodies against allergens of Dermatophagoides pteronyssinus, cat dander, timothy grass, Alternaria alternata were determined in serum of 4077 respondents randomly selected from 8 regions (ECAP study). The positive results of sIgE (≥ 0.35 IU/ml) were correlated with answers to ECAP questionnaires.ResultsIgE antibodies are less frequently detected in respondents living in the country (p < 0.05 to p < 0.005); and they are less frequently detected in respondents living in cities of hardly industrialised regions than in respondents living in cities of industrialised regions (D. pteronyssinus p < 0.05, cat dander p < 0.01). IgE antibodies are more frequently detected in men (p < 0.005 to p < 0.001). IgE antibodies are more frequently detected in respondents born in May-July (timothy grass p < 0.005, Alternaria alternata p < 0.005) and less frequently detected in respondents born in August-October (timothy grass p < 0.005, Alternaria alternata p < 0.05).ConclusionsCharacteristics of the urban environment, non-specific factors and gender affect the concentration of specific IgE antibodies in serum. Influence of seasonal allergens within the first months of life and/or in the course of the foetal period alters the production of specific IgE antibodies.

Nationwide pharmacovigilance data for cetuximab-induced anaphylaxis and predictive model validation using prospective specific IgE detection

BackgroundCetuximab (chimeric monoclonal antibody to human epidermal growth factor receptor) is used to treat colorectal and head and neck cancers. Due to cross-reactivity with galactose-α-1,3-galactose (alpha-gal), it can induce hypersensitivity even at first administration. We aimed to determine the incidence and clinical manifestation of cetuximab-induced anaphylaxis, and to establish a means of predicting its incidence in patients ahead of treatment. MethodsNationwide and single-center pharmacovigilance data from 2010 to 2017 were collected from the Korea Institute of Drug Safety-Korea Adverse Event Reporting System and Severance Regional Pharmacovigilance Center. Patients scheduled for cetuximab administration were enrolled prospectively. A skin prick test was carried out and serum IgE specific to cetuximab and cross-reactive allergens were measured. Reactions were monitored after cetuximab infusion. ResultsOver 8 years, there were 23 reports of anaphylaxis nationwide. In a single-center study, incidence of cetuximab-induced anaphylaxis was 1.1%. Most anaphylaxis occurred at first injection (93.3%), even under pretreatment with anti-allergic drugs. Four of 64 patients (6.3%) experienced severe anaphylaxis. The median cetuximab-specific IgE titer was 6.9 kUA/L in patients experiencing anaphylaxis and 0 kUA/L in those who did not (P < 0.001). The results of alpha-gal, beef sIgE, and cetuximab skin prick testing were similar to those of cetuximab sIgE. Patients who did not experience hypersensitivity were negative in all 4 allergy tests. Its positive and negative predictive values were 100%. ConclusionsSpecific IgE detection of cetuximab or alpha-gal can accurately predict cetuximab-induced anaphylaxis prior to first administration.

Stimulation of an immune system by different types of allergens causes seasonal (late spring and summer) factors to increase probability of allergic rhinitis symptoms. The Epidemiology of Allergic Diseases in Poland (ECAP) survey: part two.

IntroductionSpecific immunoglobulins E (sIgE) are important parameters to estimate severity of allergic diseases.AimTo determine the relationship between the concentration of sIgE antibodies in serum and clinical outcome of allergic diseases.Material and methodsThe concentration of sIgE antibodies against allergens Dermatophagoides pteronyssinus, cat dander, Timothy grass, Alternaria alternata were determined in serum of 4077 respondents randomly selected from 9 regions (ECAP study). Positive results of sIgE (≥ 0.35 IU/ml) were correlated with answers in ECRHSII and ISAAC questionnaires.ResultsIgE antibodies are more frequently detected in respondents aged over 4 years when they had their first attack of asthma (cat dander p < 0.05, Timothy grass p < 0.05). IgE antibodies are less frequently detected in respondents aged over 29 years when they had the first allergic rhinitis symptoms as compared to respondents aged 0–19 years when they had the first allergic rhinitis symptoms (p < 0.05 to p < 0.001). Among respondents showing allergic rhinitis symptoms, IgE antibodies are more frequently detected in respondents showing those symptoms from May to August (p < 0.05 to p < 0.005).ConclusionsThe first attack of asthma appears later mainly in patients whose immune systems are more strongly stimulated by allergens. Development of allergic rhinitis in patients aged over 29 years presumably needs weaker stimulation of their immune systems by allergens than in patients aged 0–19 years. Stimulation of an immune system by different types of allergens modifies its response in such a way that seasonal (late spring and summer) factors increase probability of allergic rhinitis symptoms.

Sensitization to aeroallergens in an atopic population of Algiers (Algeria)

Aeroallergen sensitization is increasing worldwide. The optimal management of allergic disease requires the identification of the allergic sensitivities of the patient. The aim of the present study was to evaluate the profile of specific IgE reactivity of patients with clinically suspected allergic diseases seeking medical care in Algiers. The prevalence of 29 aeroallergens’ sensitization was investigated by using in vitro test Allergy screen, for 1461 patients diagnostics allergic at Mustapha Pasha Hospital in Algiers (Algeria), from the period between January 2016 and June 2019. Patients were categorized according to the demographic and clinical aspects. Statistical tests were applied to differentiate between age, gender, season of maximum attack and the polysensitization. The prevalence of sIgE was 55% (807/1461). The age groups of 16–40 years and ≤ 16 were more sensitized than that of ≥ 40 years. House dust mites, namely Dermatophagoides pteronyssinus and Dermatophagoides farinae, elicited most prevalent sIgE results (29.22% (427) and 25.05% (366), respectively), followed by Alternaria alternata and Cladosporium herbarum (17.72% (259) and 12.93% (189), respectively). Allergic rhinitis, urticaria, conjunctivitis and asthma were recorded as the common symptoms. Moreover, a significant correlation has been found in patients with polysensitization, especially between dust mites and molds. Following the increasing trend, house dust mite sensitization still held the dominance like in any other Mediterranean population reported earlier. Determining the allergic profile in this region will facilitate early diagnosis, management and prevention of allergic diseases.

Comparative study of Allergy Explorer (ALEX) versus ImmunoCAP platforms

Objective. In this study, technical performance of the new multiplex ALEX test was compared with results from ImmunoCAP single tests (tIgE, sIgE) and the multiplex platform ImmunoCAP ISAC sIgE 112. Materials and methods. Eleven whole allergen extracts and corresponding allergen components from different allergen groups were used for the analysis of 64-66 patients’ sera by all three platforms. Results. For the whole allergens, 55% false negative results were obtained with the ALEX test comparing to the ImmunoCAP sIgE tests while for allergen components the ALEX test gives 33% false negative results when compared to ImmunoCAP sIgE test results. Additionally, the ALEX test is characterized by a low dynamic range - the platform demonstrated no results above 36 kUA/L for samples giving &gt;100 kUA/L using ImmunoCAP Specific IgE tests in the analysis of sIgE response to the whole allergens. For the allergen components, ALEX showed no results above 38 kUA/L for samples of up to 150 kUA/L according to ImmunoCAP Specific IgE test results. Comparing to ImmunoCAP single plex tests, ALEX show low dynamic range and poor agreement in quantitative results for tIgE and sIgE both for whole allergens and allergen components, while in the comparison with ImmunoCAP ISAC sIgE 112 platform, the agreement is better, but the sensitivity and dynamic range are still low._ Conclusions. The ALEX test has some serious limitations in its performance comparing to both types of ImmunoCAP platforms.

Comparative study of Allergy Explorer (ALEX) versus ImmunoCAP platforms

Objective. In this study, technical performance of the new multiplex ALEX test was compared with results from ImmunoCAP single tests (tIgE, sIgE) and the multiplex platform ImmunoCAP ISAC sIgE 112. Materials and methods. Eleven whole allergen extracts and corresponding allergen components from different allergen groups were used for the analysis of 64-66 patients sera by all three platforms. Results. For the whole allergens, 55% false negative results were obtained with the ALEX test comparing to the ImmunoCAP sIgE tests while for allergen components the ALEX test gives 33% false negative results when compared to ImmunoCAP sIgE test results. Additionally, the ALEX test is characterized by a low dynamic range - the platform demonstrated no results above 36 kUA/L for samples giving 100 kUA/L using ImmunoCAP Specific IgE tests in the analysis of sIgE response to the whole allergens. For the allergen components, ALEX showed no results above 38 kUA/L for samples of up to 150 kUA/L according to ImmunoCAP Specific IgE test results. Comparing to ImmunoCAP single plex tests, ALEX show low dynamic range and poor agreement in quantitative results for tIgE and sIgE both for whole allergens and allergen components, while in the comparison with ImmunoCAP ISAC sIgE 112 platform, the agreement is better, but the sensitivity and dynamic range are still low._ Conclusions. The ALEX test has some serious limitations in its performance comparing to both types of ImmunoCAP platforms.

Oral Food Challenge Failures Among Foods Restricted Because of Atopic Dermatitis

To evaluate the frequency of office-based oral food challenge (OFC) failures to previously tolerated foods eliminated from diets to treat atopic dermatitis (AD) based on positive skin prick test (SPT) results and/or specific immunoglobulin E (sIgE) testing.A total of 442 patients were included who had undergone OFCs to peanut, wheat, soy, milk, and egg (the top 5 allergens in the United States) at the allergy clinics of Riley Hospital for Children at Indiana University Health from 2008 to 2014.By retrospective chart review, subjects were classified into 3 groups according to the reason for food avoidance, as follows: food allergy (defined as typical signs of an allergic reaction within 2 hours of ingestion, with supporting SPT or sIgE results), sensitization without introduction (food item never introduced because of positive SPT and/or sIgE results found during evaluation for AD or other food allergies), and avoidance based on positive SPT and/or sIgE test results found during AD workup (all had previously tolerated the food without reaction within 2 hours). OFCs were offered if the subject had sIgE levels predicting passing the OFC on the basis of 95% positive predictive values and no reaction to the food in the last 12 months. Plain and extensively heated milk OFCs were grouped together, as were those for egg. Extensively heated food challenges were offered regardless of sIgE levels. Total IgE levels were not reported.Indications for OFCs were a history of food allergy (320 of 442, 72.4%) and sensitization (77 of 442, 17.4%) and AD (45 of 442, 10.2%). There were no significant differences among these 3 groups at OFC in age, sex, race, asthma, allergic rhinitis, or percentage of positive SPT results to the food. The overall OFC failure rate was 20.1%, including 21.9% of the food allergy group, 16.9% of the sensitization group, and 13.3% of the AD group, which was not statistically significant comparing groups (P = .30). There was no significant difference with regard to OFC pass and fail rates among the 5 foods challenged or the length of time of food avoidance (range: 3–120 months, P = .97). Wheat was significantly more likely to be avoided because of AD (P < .001), and milk was likely to be avoided because of food allergy (P = .002).In this study, 13.3% of children with AD who had removed a previously tolerated food from their diet because of a positive SPT and/or sIgE test result failed an OFC to that food in as quickly as after 3 months of avoidance. This demonstrates the potentially rapid loss of tolerance that can occur with food elimination for AD therapy and bolsters evidence that SPT and/or sIgE test results in patients with AD who do not have a history of immediate reaction to the foods tested are often clinically irrelevant.Data on the role of food triggers in AD have been conflicting, but overall there is lack of high-quality evidence. Aggressive skin care regimens should be pursued over elimination diets, which carry the risk of loss of tolerance to a food previously consumed without immediate reaction.

Immunological methods for diagnosis and monitoring of IgE-mediated allergy caused by industrial sensitizing agents (IMExAllergy).

Industrial sensitizing agents (allergens) in living and working environments play an important role in eliciting type 1 allergic disorders including asthma and allergic rhinitis. Successful management of allergic diseases necessitates identifying their specific causes (ie, identify the causative agent(s) and the route of contact to allergen: airborne, or skin contact) to avoid further exposure. Identification of sensitization by a sensitive and validated measurement of specific IgE is an important step in the diagnosis. However, only a limited number of environmental and occupational allergens are available on the market for use in sIgE testing. Accordingly, specific in‐house testing by individual diagnostic and laboratory centers is often required. Currently, different immunological tests are in use at various diagnostic centers that often produce considerably divergent results, mostly due to lack of standardized allergen preparation and standardized procedures as well as inadequate quality control. Our review and meta‐analysis exhibited satisfactory performance of sIgE detection test for most high molecular weight (HMW) allergens with a pooled sensitivity of 0.74 and specificity of 0.71. However, for low molecular weight (LMW) allergens, pooled sensitivity is generally lower (0.28) and specificity higher (0.89) than for HMW tests. Major recommendations based on the presented data include diagnostic use of sIgE to HMW allergens. A negative sIgE result for LMW agents does not exclude sensitization. In addition, the requirements for full transparency of the content of allergen preparations with details on standardization and quality control are underlined. Development of standard operating procedures for in‐house sIgE assays, and clinical validation, centralized quality control and audits are emphasized. There is also a need for specialized laboratories to provide a custom service for the development of tests for the measurement of putative novel occupational allergens that are not commercially available.

Importance of wasp and honey bee recombinant allergens in the diagnosis of hymenoptera venom anaphylaxis

Background: Hymenoptera venom-allergic patients frequently present multiple sensitisations. Objectives: To define the allergic profile by components in Hymenoptera venom allergic patients. To study the usefulness of specific IgE to components in cases of negative results of sIgE to the venoms. Patients (n = 86) with a diagnosis of allergic systemic reaction following honey bee or wasp stings were included in the study. Skin prick tests (SPT) and intradermal reaction were performed. sIgE to complete extracts of honey bee (Apis mellifera), Vespula (Vespula spp.), venom and recombinant allergens rApi m1, rApi m 5; rVes v5 and rVes v1 5 were analysed by ImmunoCAP (Phadia). sIgE concentration higher than 0.35 kU/l were considered positive. Results: 86 patients (40 male, 46 female) were included. No sIgE to Honey bee/Vespula was detected in 15 patients. In 7 of them only component diagnosis (Api m1 and Ves v5) confirmed hymenoptera allergy. Positive correlation between severity of anaphylactic reaction and sIgE to rVes v1 concentration was observed (r = 0,85; p < 0.05) and sIgE to rApi m1 (r = 0.87; p < 0.05). None such correlation was observed with specific IgE to other venom components. Conclusions: Components analysis can be useful to make diagnosis more accurate. Determination of sIgE towards phospholipase A2 (Apis mellifera) and phospholipase A1 (Vespula spp.) may reflects severity of allergic reaction after hymenoptera sting.

Specific immunoglobulin E in nasal secretions for the diagnosis of local allergic rhinitis

The diagnostic value of serum specific Immunoglobulin E (sIgE) and nasal allergen provocation test (NAPT) has been well investigated in local allergic rhinitis (LAR). We hypothesized that nasal local sIgE could be used for the diagnosis of LAR instead of NAPT. This was a prospective single center study. Overall, 212 chronic rhinitis patients were screened, of whom 73 were recruited based on negative findings for serum IgE and positive findings for local eosinophils. Ten healthy subjects were also recruited as controls. All participants completed questionnaires at recruitment to record their demographic data, nasal symptom severity, and physician-diagnosed comorbid asthma. Symptom severity was recorded using a visual analogue scale (VAS) of 10 cm and allergic status was assessed by serum sIgE. Nasal secretions were collected for analysis of local sIgE and eosinophils, and NAPT was performed for confirmation of LAR. Overall, 14 patients demonstrated positive local sIgE results. Twelve of these patients had significantly higher local sIgE levels compared to controls, and also demonstrated positive NAPT results. The VAS scores, nasal airway resistance measured by active rhinomanometry, and the levels of local sIgE, ECP, histamine and leukotriene C4 were significantly increased from baseline values following NAPT. Sensitivity, specificity, and diagnostic accuracy of local sIgE for diagnosis of LAR were 91.7% respectively. The measurement of local sIgE levels in nasal secretion is a reliable and effective diagnostic method for LAR.

Can evaluation of specific immunoglobulin E serum concentrations of antibodies to aeroallergens in atopic dermatitis patients replace skin prick tests method in clinical practice?

IntroductionPositive skin prick tests (SPT) results with protein allergens are the minor Hanifin and Rajka’s atopic dermatitis (AD) criterion. In adults, they mainly concern aeroallergens. The inflammation of skin often prevents SPT, but does not exclude the assessment of serous specific immunoglobulin E (sIgE) concentrations.AimTo assess usefulness of testing AD patients to aeroallergens with SPT and sIgE concentrations, and the correlation of these results and the clinical AD course.Material and methodsIn 286 AD patients, total IgE and sIgE (14 aeroallergens) were measured. SPTs were performed with 17 aeroallergens. The AD severity was determined depending on the concurrent co-existence of asthma, allergic rhinitis, extensive skin flares and severe itching.Results59.1% and 66.1% of patients have had positive results of sIgE and SPT, respectively (p > 0.05). The concentration of total IgE has positively correlated with the number of positive sIgE results (rho = 0.588, p < 0.001) and their intensity (rho = 0.592, p < 0.001). Among the patients with at least one high positive sIgE score, severe AD patients have been dominant (59.8% vs. 40.2%, p < 0.04). Among the patients with positive results without any high scores, the percentages are 21.6 and 78.4, respectively (p < 0.001).ConclusionsThe compatibility of SPT results and IgE concentrations indicates that the two methods equally assess aeroallergy in AD patients. The assessment of sIgE concentrations is especially advisable in patients with an elevated total IgE level. The obtained results may suggest that presence of a high specific IgE level of antibodies to aeroallergens may be the factor predicting a severe clinical AD course.