Test IgE Research Articles

Developing a Prediction Model for Determination of Peanut Allergy Status in the Learning Early About Peanut Allergy (LEAP) Studies.

The Learning Early About Peanut Allergy (LEAP) study team developed a protocol-specific algorithm using dietary history, peanut-specific IgE, and skin prick test (SPT) to determine peanut allergy status if the oral food challenge (OFC) could not be administered or did not provide a determinant result. To investigate how well the algorithm determined allergy status in LEAP; to develop a new prediction model to determine peanut allergy status when OFC results are not available in LEAP Trio, a follow-up study of LEAP participants and their families; and to compare the new prediction model with the algorithm. The algorithm was developed for the LEAP protocol before the analysis of the primary outcome. Subsequently, a prediction model was developed using logistic regression. Using the protocol-specified algorithm, 73% (453/617) of allergy determinations matched the OFC, 0.6% (4/617) were mismatched, and 26% (160/617) participants were nonevaluable. The prediction model included SPT, peanut-specific IgE, Ara h 1, Ara h 2, and Ara h 3. The model inaccurately predicted 1 of 266 participants as allergic who were not allergic by OFC and 8 of 57 participants as not allergic who were allergic by OFC. The overall error rate was 9 of 323 (2.8%) with an area under the curve of 0.99. The prediction model additionally performed well in an external validation cohort. The prediction model performed with high sensitivity and accuracy, eliminated the problem of nonevaluable outcomes, and can be used to estimate peanut allergy status in the LEAP Trio study when OFC is not available.

The comparison of skin prick test, serological specific IgE test and solid phase immunoassay in the diagnosis of infantile allergic diseases.

This retrospective study was designed in order to compare the usefulness of skin prick tests, serological specific IgE tests and solid phase immunoassays in the diagnosis of infantile allergic diseases. Two hundred infants with allergic diseases (120 infants with eczema and 80 infants with asthma), diagnosed in the Pediatric Clinic of our hospital between June of 2011 and June of 2016, were selected to participate in the study. 100 healthy infants were included in a control group. All infants received a skin prick test, a serological specific IgE test or a solid phase immunoassay. A total of 38 allergens were used for the infants receiving skin prick test. The IgE in the serum samples of infants was detected by immunoblotting. And, allergens were detected by solid phase immunoassay in the infants receiving solid phase immunoassay. The positive predictive value, negative predictive value, specificity and sensitivity for these 3 diagnostic methods were analyzed after generating a ROC curve. In the eczema group, the AUCs (the area under the ROC curve) for skin prick test, serological specific IgE test and solid phase immunoassay were 0.8685±0.0187, 0.8137±0.024 and 0.9682±0.0358, respectively. The sensitivities for skin prick test, serological specific IgE test and solid phase immunoassay were 85.70%, 83.62% and 88.72%, respectively. And, the specificities were 74%, 68% and 83%, respectively. The positive predictive values were 87.27%, 92.37% and 90.00%; and the negative predictive values were 57.04%, 51.11% and 78.15%, respectively. In the asthma group, the AUCs for skin prick test, serological specific IgE test and solid phase immunoassay were 0.8186±0.0161, 0.8037±0.0241 and 0.952±0.0421, respectively. The sensitivities for skin prick test, serological specific IgE test and solid phase immunoassay were 84.70%, 88.62% and 96.72%, respectively. The specificities were 76%, 64% and 81%, respectively; the positive predictive values were 81.34%, 85.59% and 84.54%, respectively. The negative predictive values were 69.29%, 67.14% and 70.08%, respectively. While all three methods were effective in the diagnosis of infantile allergic diseases, the solid phase immunoassay was superior to the other two methods, as evidenced by the obtained values and we recommend it for clinical application as a goal standard.

K-means cluster analysis of characteristic patterns of allergen in different ages: Real life study.

Atopy varies in people of different ages owing to different physical conditions and exposure to allergens. We aimed to cluster ages based on atopic severity using K-means cluster analysis and identify atopic incidence, severity, as well as the association among peripheral eosinophils, IgE and sensitisation. Consecutive patients (n=7654) with allergic symptoms and undergoing allergen-specific IgE tests were included from 2013 to 2017. Age, sex, specific-IgE, peripheral eosinophil counts and total-IgE were collected. Five age categories were identified: 1-17, 18-36, 37-52, 53-69 and 70-100years. The incidences of atopy and poly-sensitisation decreased with increasing age. Similar trend was observed for aeroallergens, egg and milk but not for peanuts, soy or seafood. Dust mites remain the crucial factor bothering patients with allergic symptoms, especially for children and adolescents. In patients aged <52years, sensitisation to aeroallergens was more prevalent than food. In group 37-52years, incidence of females' atopy was higher than that of males. The overlap of atopy, high eosinophils, and high total-IgE was found in only 19.18% of patients. The trend of allergen-test positivity is not parallel to total IgE and peripheral eosinophil counts. Age-grouping based on cluster analysis helps to find the changes in atopic status and distribution of sensitised allergens with age. Allergen tests are still necessary in the clinical diagnosis and treatment. An innovative exploration of the influence of age and allergens on total-IgE and eosinophil counts is helpful for the development of bio-targeted precision therapy. ChiCTR2300067700.

TREATMENT OF HERPES ASSOCIATED ERYTHEMA MULTIFORME (HAEM)

Introduction: Herpes Associated Erythema Multiforme (HAEM) is Erythema multiforme (EM) caused herpes virus infection. EM a caused by an acute hypersensitivity reaction that occurs in the mucocutaneous area. HAEM is hypersensitivity reaction that occurs due to a hypersensitivity reaction to the herpes virus. Case: 17 year old male complaints of itching and dry on his lips since 5 days ago. patient said that ± 7 days ago he had a fever which lasted for 2 days then after the fever went down his lips felt itchy and dry. On clinical examination, desquamation with yellowish brown crusts was found on the vermilion of the upper and lower lips. Case Treatment: patient is given Aloclair® Gel and Becomzet®. Patient is referred for a complete blood count, Total IgE and IgM and IgG HSV-1 antibody testing. The patient was then given hydrocortisone cream 2.5% used 3 times a day. The patient recovered 10 days after the first visit. Discussion: HAEM is triggered by an immunological response in which an immune complex reaction occurs as a result of an immune response to certain antigens such as the herpes simplex virus or certain types of drugs. In cases of HAEM the herpes virus that triggers it is usually HSV-1 &amp; HSV-2. Diagnosis is confirmed by Total IgE and HSV-1 Antibody Tests. Conclucion: Management of cases of HAEM can be successfully determined by establishing the correct diagnosis which requires investigations so that we can rule out the differential diagnosis and provide appropriate treatment

Analysis of related factors for postoperative recurrence of antrochoanal polyps in children

Objective:To analyze the correlation between nasal resistance and lung function in children with allergic rhinitis（AR）, and explore whether AR children with increased nasal resistance are accompanied by potential lower respiratory tract involvement. Methods:A total of 88 children diagnosed with AR from December 2021 to December 2022 were selected as the study group, while 20 normal children were selected as the control group during the same period. Both the study group and the control group children underwent lung function tests, bronchodilator tests, and nasal resistance measurements. Spearman correlation analysis and multiple linear regression analysis were performed on the results of nasal resistance and lung function tests to explore the relationship and influencing factors between the two groups.According to the results of nasal resistance measurement, children with increased nasal resistance and abnormal lung function were divided into a mild increase in nasal resistance with abnormal lung function group and a moderate to severe increase in nasal resistance with abnormal lung function group. The degree of increased nasal resistance was analyzed to determine whether it would affect lung function. Results:The FEF25, FEF50, and FEF75 levels in the study group were significantly lower than those in the control group（P<0.05）. The FEV1of children with moderate to severe increase in AR nasal resistance was significantly lower than that of children with mild increase in AR nasal resistance（P<0.05）. There was a correlation between nasal resistance and FEV1/FVC, R20 in AR children, and FEV1/FVC, R20 were the influencing factors of nasal resistance in AR children（P<0.05）. There was no correlation between total serum IgE, lung function, and bronchodilation test in AR patients（P>0.05）. Conclusion:The nasal ventilation function of AR patients has changed, and there is a downward trend in small airway function. Children with moderate to severe increase in AR nasal resistance have a more significant decrease in lung ventilation function than those with mild increase. The nasal resistance of AR children is influenced by FEV1/FVC and R20, and FEV1/FVC and R20 decrease as the nasal resistance value increases. The improvement rate of lung function and FEV1 are not influencing factors for the elevation of total serum IgE.

Can clarithromycin be used without testing in patients with penicillin allergy?

BackgroundPenicillin hypersensitivity is a common cause of suspected and proven drug allergy and drug-induced anaphylaxis in medical records and causes social and economic burdens. ObjectiveSince the rate of clarithromycin hypersensitivity is low in the general population, we aimed to investigate whether clarithromycin can be prescribed to patients with penicillin allergy without a provocation test. MethodsThe medical records of 186 patients referred to our clinic between 2015 and 2021 with a history of penicillin allergy were evaluated retrospectively. Patients having a history of at least two immediate-type hypersensitivity reactions with penicillin antibiotics or having a history of immediate-type hypersensitivity with penicillin and diagnosed by positive penicillin V/G specific IgE and/or penicillin skin tests were included in the study. Penicillin skin tests were performed according to the manufacturer's instructions. Concentrations of serum specific IgE against phenoxymethylpenicillin (penV) and benzylpenicillin (pen G) were determined using The Phadia CAP System FEIA method. An oral drug provocation test with clarithromycin was performed in all patients. ResultsThe data of 64 patients diagnosed with penicillin allergy and who underwent clarithromycin oral provocation test were analyzed. Oral provocation test with clarithromycin was positive in only two of these patients (3%). These two patients had a history of multidrug hypersensitivity, and one of them also had food and venom allergies. ConclusionWe suggest that clarithromycin can be given without an oral provocation test when an alternative antibiotic is required in patients with penicillin allergy and without multidrug hypersensitivity.

Allergic Rhinitis in Preschoolers: A Systematic Review of Diagnostics.

Most studies that seek to analyze the prevalence of allergic rhinitis do not include preschool children and the diagnosis in this age group is difficult. Identify complementary tests to the diagnosis of allergic rhinitis in preschool children and verify if there is scientific robustness to propose a diagnostic algorithm for this condition in this age group. Systematic review of the literature in four databases: SCIELO, PubMed/MEDLINE, LILACS and SCOPUS. Each article was initially chosen by title, abstract and by the keywords "allergic rhinitis," "diagnosis" and "preschool." Those articles selected entered the complete reading and data extraction phase. The study was registered in the International Prospective Register of Systematic Reviews under number CRD42020207053. Fourteen articles were suitable for analysis. In the assessment using Quality Assessment of Diagnostic Accuracy Studies - 2, all studies had at least one domain considered "high risk" or "undetermined risk." Seven reports of nasal cytology, seven of specific IgE, four of immediate hypersensitivity skin test, one of nasal nitric oxide, three of total IgE and one of urinary leukotriene E4 were found. Eight articles evaluated more than one diagnostic test. There are no defined criteria for the diagnosis of allergic rhinitis in preschool children. Nasal cytology, serum specific IgE and immediate hypersensitivity skin test were the most used tests. A reliable diagnostic criterion in this age group is necessary so that in the future it is possible to propose a diagnostic algorithm for allergic rhinitis in preschool children.

Food Protein-induced Enterocolitis Syndrome: Outcomes from Standardized Oral Food Challenges

Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food hypersensitivity, for which testing such as food-specific IgE and skin prick testing (SPT) is not predictive; instead, oral food challenges (OFC), which are burdensome and resource-intensive, remain the gold standard for diagnosing FPIES. We aim to characterize outcomes from standardized OFC.

Allergic bronchopulmonary aspergillosis in identical twins: Effectiveness of dupilumab

Allergic bronchopulmonary aspergillosis in identical twins: Effectiveness of dupilumab

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.

Analysis of the Safety of Drug Allergy Workups in a Spanish University Hospital: Drug Characteristics, Type of Reaction, and Patients’ Age at the Initial Assessment

Introduction: The drug provocation test (DPT) is the gold standard for the drug allergy workup; however, it is not free from severe adverse reactions. Our aim was to obtain robust data that predict a reaction during or after the DPT at the first contact with the patient in the allergy outpatient clinic. Methods: The population of this cross-sectional study comprised all patients undergoing a drug allergy workup (clinical assessment, specific IgE, or skin tests, or DPT) at University Hospital Fundacion Alcorcon in 2016. DPTs were performed until therapeutic doses were reached, and late reactions were checked. The clinical disorders assessed in our study were classified mainly as absence of allergic reactions, morbilliform rash, urticaria, anaphylaxis, and other cutaneous disorders. Results: Physicians from the Allergy Unit programmed drug allergy workups in 977 patients (median age, 52 years; women, 64.54%). DPTs were not performed for 165 drugs involved in the reactions. Patients who did not undergo DPT were older than patients who did (positive or negative) (p = 0.0001). Positive DPT results were detected in 6.00% of DPTs performed, and most were for amoxicillin and metamizole (15–25% each). Multinomial logistic regression showed that positive reactions were more probable after DPT if the same clinical disorder was diagnosed at the first visit, including the episodes not considered allergic episodes (OR = 0.2, <0.01), except for anaphylaxis, which favored not performing DPTs (OR = 11, p < 0.001). Conclusion: We conclude that clinical practice in the diagnosis of drug allergy in our Allergy Department is safe, without over-diagnosis.

L’induction de tolérance orale à la noix de cajou et/ou à la pistache chez 50 patients : l’expérience rémoise

IntroductionWe present the results of a retrospective study conducted for a pediatric DES dissertation on oral immunotherapy (OIT) with cashew nuts and/or pistachios. ObjectiveTo evaluate the efficacy of OIT (evolution of skin test size, specific IgE (IgEs), and total cumulative dose (TCD) tolerogenic and/or reactogenic at 12 months of OIT) and the adverse effects. Material and MethodCashew and/or pistachio OIT was proposed to 50 patients agedto 18 years with cashew and/or pistachio allergy or sensitization between January 2017 and June 2020.Tolerogenic or reactogenic TCD were determined when oral provocation test (OPT) were performed at 0, 6, and 12 months from the start of OIT. IgE and skin tests were performed before each OPT. ResultsAt 12 months of OIT the mean skin test size (mm) tended to decrease for cashew (from 9.4 to 6.4) and pistachio (from 8.62 to 5.04). Mean IgEs values (AU/mL) tend to decrease for cashew (from 3.61 to 2.02), rAnao3 (from 4.05 to 1.60) and pistachio (from 4.68 to 2.34). Mean DCT tended to increase (from 1042 to 5506mg). Allergic reactions were mild, 44% of patients at 1st OPT, 11% at 2nd OPT and 15% at 3rd OPT had grade 1 reactions according to Ring and Behrendt classification. 36% of patients were mild home adverse events (grade 1). 14% at 1st OPT had grade 2 reactions and 10% had grade 3 reactions. There were no reactions grade 4 or more. ConclusionCashew and/or pistachio OIT is effective, as evidenced by the decrease in skin tests and IgEs, but especially the increase in TCD protecting the child from anaphylactic accident and this without significant adverse effects either in day hospitalization or at home. The use of protocols with tolerogenic rather than reactogenic TCD and close medical and therapeutic education support contribute to these results.

Component-Resolved Diagnosis Based on a Recombinant Variant of Mus m 1 Lipocalin Allergen.

Exposure to the Mus m 1 aeroallergen is a significant risk factor for laboratory animal allergy. This allergen, primarily expressed in mouse urine where it is characterized by a marked and dynamic polymorphism, is also present in epithelium and dander. Considering the relevance of sequence/structure assessment in protein antigenic reactivity, we compared the sequence of the variant Mus m 1.0102 to other members of the Mus m 1 allergen, and used Discotope 2.0 to predict conformational epitopes based on its 3D-structure. Conventional diagnosis of mouse allergy is based on serum IgE testing, using an epithelial extract as the antigen source. Given the heterogeneous and variable composition of extracts, we developed an indirect ELISA assay based on the recombinant component Mus m 1.0102. The assay performed with adequate precision and reasonable diagnostic accuracy (AUC = 0.87) compared to a routine clinical diagnostic test that exploits the native allergen. Recombinant Mus m 1.0102 turned out to be a valuable tool to study the fine epitope mapping of specific IgE reactivity to the major allergen responsible for mouse allergy. We believe that advancing in its functional characterization will lead to the standardization of murine lipocalins and to the development of allergen-specific immunotherapy.

Atopic Dermatitis due to House Dust Mite: A Review

Atopic dermatitis (AD), a chronic skin condition brought on by malfunction of the skin barrier, frequently manifests as eczema and itchy lesions in the flexural folds and other recognizable distributions. Environmental factors and immune system changes may also contribute to the development of these lesions. The chance of getting AD can be impacted by exposure to house dust mites. Atopic sensitization and allergy illness are primarily brought on by house dust mites (HDMs) globally. The primary source of allergens in HDM is mite feces, notably those from the species Dermatophagoides pteronyssinus, Dermatophagoides farinae, Euroglyphus maynei, and Blomia tropicalis. When a patient has AD brought on by HDM, atopy patch testing and prick testing can help with the diagnosis. Immunotherapy with allergens should be taken into consideration as the sole etiological therapy currently available when avoiding triggering variables is insufficient to minimize symptoms and IgE sensitization as demonstrated by skin prick testing and/or IgE testing. Physical and pharmacological therapies are used to lessen or prevent exposure to HDM (living, dead mites, and feces). Physical barriers, like mattress covers, are one type of physical intervention. Others include changing the floor coverings, getting rid of soft furnishings, vacuuming, air filtration, removing dolls and other delicate toys, heating, freezing, and washing (55°C or higher). Due to the apparent symbiotic interaction between mites and fungi, chemical interventions such as acaricide sprays and antifungal medications seem to diminish the amount of HDMs.

Evaluation of the predictive value of total IgE and absolute eosinophil levels on allergy test positivity.

Atopic diseases are the most common chronic conditions in childhood. The best treatment for allergic disease is possible with early diagnosis. The purpose of the study was to assess the predictive value of total immunoglobulin E (IgE) and eosinophil levels for allergy test positivity in patients diagnosed with asthma, allergic rhinitis (AR), atopic dermatitis (AD), and food allergy (FA). Pediatric patients between 0 and 18 years old diagnosed with asthma, AR, AD, and FA were included in the study. Demographic characteristics of the patients, total IgE, eosinophil (absolute and %) values, specific igE (SPIGE), and skin prick test (SPT) results were recorded. The data of 2665 patients were evaluated in the study. Of the patients, 58.6% were male, whereas 41.4% were female. The median age of the children was significantly higher both in SPT-positive and SPIGE-positive patients (p<0.001). If the criteria positivity is accepted as total IgE value is ≥104.5 (for AD: 86.5, asthma: 116.5, AR: 120.5, FA: 42.5) and absolute eosinophil ≥500 and/or eosinophil (%) ≥5%; test positivity was higher for each disease and all patients (p<0.001). Total IgE and eosinophil levels can be used to identify atopy in patients with symptoms of AD, asthma, and AR. Total IgE and eosinophil values are suitable and easily obtainable parameters for better evaluation of health-care resources for the diagnosis and follow-up of atopic illnesses.

Severe perioperative anaphylaxis: Incidence in a tertiary hospital in Spain over a 20-year period. A historical cohort study.

To assess the incidence of severe perioperative anaphylaxis, the mechanisms involved, the value of laboratory/skin tests, and the most effective treatments. A historical cohort study conducted in a tertiary public hospital in Spain. Patients that had undergone anaesthesia during the 20-year period were included. In these patients, 66 cases of severe anaphylaxis were found. In patients with suspicion of severe anaphylaxis, levels of blood histamine at less than 15min and serum tryptase at 2, 6, and 24h following the reaction were determined. Skin and specific IgE tests were performed between 4 and 8 weeks later. Over the 20-year period, 288 594 anaesthetic procedures were performed. We observed cases of 66 severe anaphylaxis reaction (59% men; age, 60.8±17.3 years. Symptoms observed were cardiovascular (86%), respiratory (73%), and mucocutaneous (56%). Elevated serum tryptase levels were associated with degree of severity at 2 (P<.0001) and 6h (P=.026) and were highest in IgE-mediated reactions (P=.020). All patients required treatment, and 3 events were fatal. In 84.8% of patients, skin and/or specific IgE tests were positive for antibiotics (35.8%), non-steroidal anti-inflammatory drugs (23.1%), neuromuscular blocking agents (15.4%) and latex (15.4%). The incidence of severe anaphylaxis in our hospital was 1 in 4.373 anaesthetic procedures, with a death rate of 4.5%. All cases required treatment. Serum tryptase was a good predictor of reaction severity. The most frequent causative agents were antibiotics, non-steroidal anti-inflammatory drugs, neuromuscular blocking agents and latex.

Reported Cases and Diagnostics of Occupational Insect Allergy: A Systematic Review.

A significant part of adult-onset asthma is caused by occupational exposure to both high- and low-molecular-mass agents. Insects are occasionally described to cause occupational allergy in professions including anglers and fishers, laboratory workers, employees of aquaculture companies, farmers, bakers, sericulture workers and pet shop workers. Occupational insect allergies are often respiratory, causing asthma or rhinoconjunctivitis, but can be cutaneous as well. The European Union recently approved three insect species for human consumption, enabling an industry to develop where more employees could be exposed to insect products. This review overviews knowledge on occupational insect allergy risks and the tools used to diagnose employees. Despite the limited availability of commercial occupational insect allergy diagnostics, 60.9% of 164 included reports used skin prick tests and 63.4% of reports used specific IgE tests. In 21.9% of reports, a more elaborate diagnosis of occupational asthma was made by specific inhalation challenges or peak expiratory flow measurements at the workplace. In some work environments, 57% of employees were sensitized, and no less than 60% of employees reported work-related symptoms. Further development and optimization of specific diagnostics, together with strong primary prevention, may be vital to the health conditions of workers in the developing insect industry.

Usefulness of Gly m 4‐specific IgE test in the diagnosis of Rosaceae fruit‐oral allergy syndrome caused by Betulaceae pollen sensitization

AbstractBackgroundPollen‐food allergy syndrome (PFAS) is caused by the cross‐reaction of the specific IgE to pollen allergens with similar allergens contained in fruits, vegetable, and nuts. The representative allergen responsible for this cross‐reaction is pathogenesis‐related protein (PR)‐10. Specific IgE test using Gly m 4, soybean PR‐10, is widely used to diagnose soy allergy. We aimed to investigate whether the Gly m 4‐specific IgE test is useful for predicting oral allergy symptoms (OAS) to Rosaceae fruits in PFAS caused by Betulaceae pollen sensitization.MethodsForty‐one patients with suspected PFAS were enrolled. Specific IgE levels were measured against alder pollen, apple, peach, pear, and Gly m 4, and correlation between test results and allergic symptoms was assessed to compare the accuracy of these allergen‐specific IgE tests.ResultsOf the 41 patients, 32 were positive for alder pollen‐specific IgE. Of those, 16 showed OAS to at least one of apple, peach, and pear (OAS (+) group), and the rest 16 cases showed no symptoms (OAS (−) group). The Gly m 4‐specific IgE value was significantly higher in the OAS (+) group (p = .014), and the highest in area under the receiver operating characteristics curve. The cut‐off value for detection of the OAS (+) group was 2.65 UA/ml, with a sensitivity of 62.5% and a specificity of 81.3%. Other allergen‐specific IgE values were not significantly different between the two groups.ConclusionsIn the subjects sensitized to Betulaceae pollen allergens, the Gly m 4‐specific IgE test is useful for predicting OAS of Rosaceae fruits.

Changes in infant food-specific serum IgE testing from 2015 to 2020

Food allergy affects approximately 8% of children in the United States.1 Direct medical costs account for an estimated $4.3 billion annually2 and the economic impact of serum food-specific IgE (sIgE) testing is likely substantial. Beginning in 2012, the Choosing Wisely initiative highlighted subjects for patient–physician conversations with an emphasis on unnecessary tests. Two topics chosen by the American Academy of Allergy, Asthma & Immunology included statements discouraging the use of indiscriminate IgE tests for allergy evaluation and recommending that food IgE testing not be performed in the absence of a history consistent with IgE-mediated food allergy.

RELIABILITY OF BANANA-SPECIFIC IGE TESTING PRIOR TO ORAL FOOD CHALLENGE

<h3>Introduction</h3> Allergy to direct fruit is relatively rare, and when present is commonly associated with fruits such as kiwi and avocado. True IgE-mediated allergy to banana is uncommonly reported in the literature, as is data regarding the reliability of specific IgE testing prior to oral food challenge (OFC). <h3>Methods</h3> Retrospective chart review was performed on six patients with purported banana allergy who underwent banana-specific IgE testing prior to banana OFC. Their charts were reviewed for demographic data, banana-specific IgE testing, total IgE testing, other food allergies, atopic conditions, and banana OFC results. <h3>Results</h3> All six patients were found to have a history of atopic conditions and other food allergies. Two of the six patients failed their OFC, and the remaining four patients passed. The primary symptom(s) reported at initial ingestion was emesis for the patients who failed versus hives/rash and facial swelling for those who passed. Average banana-specific IgE for patients who failed OFC=1.56 (SD:1.12 N=2), patients who passed OFC=3.13 (SD:3.65 N=4), and all patients=2.60 (SD:2.98 N=6). <h3>Conclusion</h3> This study finds that elevated banana-specific IgE is likely not a reliable pre-test predictor for OFC failure. In our study sample, average banana-specific IgE was higher in patients who passed OFC than in those who failed. However, symptomatology may provide better predictive value given that the patients who failed OFC both had emesis with initial banana exposure versus dermatologic symptoms in patients who passed OFC.