Specific IgE Values Research Articles

The Value of Specific IgE to Peanut and Its Component Ara h 2 in the Diagnosis of Peanut Allergy

To avoid unnecessary oral food challenges, which are time consuming, stressful, and risky, improved in vitro diagnostic methods for food allergy such as component resolved diagnostics are still under investigation. To investigate the role of whole peanut- and peanut-component (Ara h 1, Ara h 2, Ara h 3, Ara h 6 and Ara h8)-specific IgE levels in the diagnostic procedure of peanut allergy as well as the diagnostic properties of peanut-specific IgG and IgG4. Sixty-one children underwent oral peanut challenge tests for diagnostic purposes irrespective of their peanut-specific IgE levels. Peanut-specific serum IgE, IgG, and IgG4 levels were determined by ImmunoCAP FEIA and specific IgE against individual peanut proteins by Immuno Solid-phase Allergen Chip. Thirty-four of 61 patients (56%) had a peanut allergy. No significant difference was observed for peanut-specific IgG or peanut-specific IgG4 levels between patients who were allergic and tolerant patients, whereas peanut-specific IgE was significant higher in patients who were allergic than in tolerant patients (P < .005). Twenty-five of 61 children had peanut-specific IgE above a previously proposed cutoff level of 15 kUA/L; however, 7 of these 25 children (28%) were clinically tolerant. Ara h 2-specific IgE was significantly lower in tolerant than in patients with allergies (P < .0001). Interestingly, 94% of the patients with peanut allergies showed IgE-binding to Ara h 2. Unfortunately, 26% of the sensitized but tolerant patients have shown IgE binding to Ara h 2 too. Neither the level of specific IgE to peanut nor to Ara h 2 was able to clearly distinguish patients with clinical relevant peanut allergy from those who were clinical tolerant in our population. As expected, peanut-specific IgG and IgG4 did not improve the diagnostic procedure.

Evaluation of commercial skin prick test solutions for selected occupational allergens

Skin prick testing (SPT) is an important step in the diagnosis of IgE-mediated occupational allergic diseases. The outcome of SPT is related to the quality of allergen extracts. Thus, the aim of the study was to assess different commercially available SPT solutions for selected occupational allergens. SPT was performed in 116 bakers, 47 farmers and 33 subjects exposed to natural rubber latex (NRL), all with work-related allergic symptoms. The SPT solutions from different manufacturers (n=3-5) for wheat flour, rye flour, soy, cow hair/dander, storage mites (Tyrophagus putrescentiae, Lepidoglyphus destructor, Acarus siro) and NRL were analysed with respect to their protein and antigen contents. SPT was carried out in 16 allergy centres in six European countries using standardized procedures. Specific IgE values were used as the gold standard to calculate the sensitivity and specificity of SPT solutions. The optimal cut-point for each SPT solution was determined by Youden Index. Protein and antigen contents and patterns of the SPT solutions varied remarkably depending on the manufacturer. While SPT solutions for wheat flour and soy reached overall low sensitivities, sensitivities of other tested SPT solutions depended on the manufacturer. As a rule, solutions with higher protein and antigen content showed higher sensitivities and test efficiencies. There is a wide variability of SPT solutions for occupational allergens, and the sensitivity of several solutions is low. Thus, improvement and standardization of SPT solutions for occupational allergens is essential.

Relationship between serum total IgE, specific IgE, and peripheral blood eosinophil count according to specific allergic diseases

Purpose: Elevated IgE, and blood eosinophil count are considered the hallmarks of allergic diseases, while the levels of those parameters are shared with normal population. This study is aimed to investigate the relationship between those factor and clinical value according to specific allergic diseases. Methods: We reviewed medical records of 946 patients with allergic diseases who had taken the allergy tests from 2001 to 2010. The effects of age, sex, specific diagnoses of diseases, such as atopic dermatitis (AD), allergic rhinitis (AR), bronchial asthma (BA), urticarial on allergy tests were assessed. Results: In contrast to those of total eosinophil counts, there was the trend of increasing IgE value with the age in children with allergic diseases. The titer of total IgE and eosinophil count were higher than those of control group of patients with acute urticaria. There was the positive relation between total IgE and eosinophil count in patients with allergic diseases. The positive predictive value and negative predictive value of total IgE for specific IgE were higher than those of total eoshinophil count. Conclusion: There were the positive relation of total IgE and total eosinophil count in allergic diseases and the higher value of those compared with the control in this study. These values over a certain level have a positive predictive value of serum specific IgE and help us to determine whether we should test the serum specific IgE in patients with allergic diseases. (Allergy Asthma Respir Dis 2013; 1:123-128)

Diagnostic de l’allergie alimentaire à la noisette chez l’enfant : il faut rester prudent !

Diagnosing of hazelnut allergy was recently enhanced by value of serum specific IgE versus recombinant fractions, Cor a 1 and Cor a 8. Their positivity could be linked with clinical benignity for Cor a 1 and severity for Cor a 8. The authors report four cases contradicting this aphorism. The oral food challenge to hazelnut induced in these patients a severe clinical response with a severe increase of serum tryptase at the end of the challenge. The level of serum specific IgE to Cor a 8 was negative (or very low). For Cor a 1 the level was very high or low. We discuss the clinical relevance of the aphorism “Cor a 1=benignity; Cor a 8=severity”, which use should be modulated in clinical practice. Other allergenic fractions could account for these cases.

Predictive value of specific IgE for clinical peanut allergy in children: relationship with eczema, asthma, and setting (primary or secondary care)

The usefulness of peanut specific IgE levels for diagnosing peanut allergy has not been studied in primary and secondary care where most cases of suspected peanut allergy are being evaluated. We aimed to determine the relationship between peanut-specific IgE levels and clinical peanut allergy in peanut-sensitized children and how this was influenced by eczema, asthma and clinical setting (primary or secondary care). We enrolled 280 children (0–18 years) who tested positive for peanut-specific IgE (> 0.35 kU/L) requested by primary and secondary physicians. We used predefined criteria to classify participants into three groups: peanut allergy, no peanut allergy, or possible peanut allergy, based on responses to a validated questionnaire, a detailed food history, and results of oral food challenges.Fifty-two participants (18.6%) were classified as peanut allergy, 190 (67.9%) as no peanut allergy, and 38 (13.6%) as possible peanut allergy. The association between peanut-specific IgE levels and peanut allergy was significant but weak (OR 1.46 for a 10.0 kU/L increase in peanut-specific IgE, 95% CI 1.28-1.67). Eczema was the strongest risk factor for peanut allergy (aOR 3.33, 95% CI 1.07-10.35), adjusted for demographic and clinical characteristics. Asthma was not significantly related to peanut allergy (aOR 1.93, 95% CI 0.90-4.13). Peanut allergy was less likely in primary than in secondary care participants (OR 0.46, 95% CI 0.25-0.86), at all levels of peanut-specific IgE.The relationship between peanut-specific IgE and peanut allergy in children is weak, is strongly dependent on eczema, and is weaker in primary compared to secondary care. This limits the usefulness of peanut-specific IgE levels in the diagnosis of peanut allergy in children.

The diagnostic value of specific IgE to Ara h 2 to predict peanut allergy in children is comparable to a validated and updated diagnostic prediction model

A diagnostic prediction model for peanut allergy in children was recently published, using 6 predictors: sex, age, history, skin prick test, peanut specific immunoglobulin E (sIgE), and total IgE minus peanut sIgE. To validate this model and update it by adding allergic rhinitis, atopic dermatitis, and sIgE to peanut components Ara h 1, 2, 3, and 8 as candidate predictors. To develop a new model based only on sIgE to peanut components. Validation was performed by testing discrimination (diagnostic value) with an area under the receiver operating characteristic curve and calibration (agreement between predicted and observed frequencies of peanut allergy) with the Hosmer-Lemeshow test and a calibration plot. The performance of the (updated) models was similarly analyzed. Validation of the model in 100 patients showed good discrimination (88%) but poor calibration (P < .001). In the updating process, age, history, and additional candidate predictors did not significantly increase discrimination, being 94%, and leaving only 4 predictors of the original model: sex, skin prick test, peanut sIgE, and total IgE minus sIgE. When building a model with sIgE to peanut components, Ara h 2 was the only predictor, with a discriminative ability of 90%. Cutoff values with 100% positive and negative predictive values could be calculated for both the updated model and sIgE to Ara h 2. In this way, the outcome of the food challenge could be predicted with 100% accuracy in 59% (updated model) and 50% (Ara h 2) of the patients. Discrimination of the validated model was good; however, calibration was poor. The discriminative ability of Ara h 2 was almost comparable to that of the updated model, containing 4 predictors. With both models, the need for peanut challenges could be reduced by at least 50%.

Characterization of occupational sensitization by multiallergen immunoblotting in workers exposed to laboratory animals

BackgroundStudies have estimated that 10% to 23% of workers exposed to laboratory animals report symptoms of laboratory animal allergy. ObjectivesTo determine the level of occupational sensitization in workers exposed to laboratory animals and to develop a diagnosis system based on a multiallergen IgE immunoblot. MethodsA total of 75 workers exposed to laboratory animals were initially studied with skin prick tests performed with animal epithelia extracts. The workers with suspected occupational disease and positive skin prick test results were further studied with the ImmunoCAP system to determine specific IgE levels to urine and epithelia allergens and with multiallergen IgE immunoblotting to detect specific IgE levels to epithelia allergens and bovine serum albumin. ResultsTwenty of the 75 workers were studied with ImmunoCAP and multiallergen IgE immunoblotting. Nine were polysensitized and 3 were sensitized to only one animal. The results obtained by ImmunoCAP and multiallergen IgE immunoblotting were concordant except for in 3 workers, who had low or negative values of specific IgE determined by ImmunoCAP but positive allergen detections by immunoblotting. On the basis of the results of the study and the clinical symptoms related by workers, 16% were diagnosed as having occupational allergy. ConclusionsMultiallergen immunoblotting by means of a unique test offers a graphic representation of sensitization to the different animals to which workers are exposed, providing additional information on the clinical symptoms caused by the involved allergens. The results presented suggest that this system can improve the diagnosis of laboratory animal allergy by obtaining a sensitization profile for each exposed worker.

88 Clinical Features and Diagnostic Value of Specific IGE to Component Allergen in Bee Venom Allergy in Korea

BackgroundAlthough history taking is primary method in the diagnosis of bee venom allergy, serum specific IgE detection is critical to identify causative bee and assess the effect of immunotherapy. Component-resolved diagnosis (CRD) in allergy has been used for its high sensitivity and specificity in many allergy diseases caused by food, cat, birch, and grass pollens. The purposes of this study are to evaluate diagnostic value of serum specific IgE to 3 bee venom component allergens and observe the changes of allergen specific IgE during bee venom immunotherapy.MethodsFifty-six bee venom anaphylaxis patients receiving bee venom immunotherapy were recruited from Ajou University Hospital. Clinical manifestations and serum specific IgE levels to bee venoms and component allergen (rApi m1 of Apidae, rVes v5 and rPol d5 of Vespidae) measured by using ImmunoCAP (Phadia, Sweden) were analyzed retrospectively.ResultsThirty-five (62.5%) patients were male and 33 (73.3%) were atopics. Their mean age was 44.9 ± 13.8 years ranged from 11 to 73 years. Local reactions were found in 13 (23.2%) patients, while systemic reactions, in 43 (76.8%) patients. The most frequent manifestation was anaphylaxis which were severe (37.5%) and moderate (39.3%) manifestations followed by urticaria and angioedema. Yellow Jacket (80.8%) was the most prevalent bee followed by yellow hornet, white faced hornet, honey bee and paper wasp at the time of diagnosis with concurrent sensitization in both Apidae and Vespidae at 70.9% patients. The positive predictive value (PPV) of serum specific IgE levels to rVes v5 and rPol d5 were 85.7 and 87.5%, and they significantly correlated with conventional serum specific IgE level (r = 0.762 and r = 0.757, respectively), however, PPV of rApi m1 was only 34.8% at the time of initial diagnosis. After 3 years of bee venom immunotherapy, all kinds of bee venom specific IgE levels tended to decline compared to those collected before allergen immunotherapy, especially in component specific IgE to Vespidae.ConclusionsYellow jacket sting and male gender may be risk factors for bee venom allergy in Korea. Component allergen specific IgE to Vespidae, not Apidae had a diagnostic and monitoring value comparable to conventional specific IgE in bee venom allergy.

Alergia a proteínas de leite de vaca: um desafio diagnóstico.

Cow's Milk Protein Allergy (CMPA) is the most common food allergy in infants. It can manifest itself through a wide variety of symptoms depending on the type of immune response is IgE or non-IgE mediated. In most cases acquisition of tolerance to cow's milk protein (CMP) occurs until the second year of life. To evaluate the cases of CMPA followed in our Outpatient Clinic of Pediatric Gastroenterology and compare IgE and non-IgE mediated CMPA. CMPA patients observed between December 1992 and December 2009 were included in this prospective study and followed-up according to our CMPA protocol. 199 children were included in the protocol, but only 130 cases were confirmed the diagnoses of CMPA, 77 were IgE mediated (group A) and 53 non-IgE mediated (group B). Comparing the two groups, 45% vs 36% had positive family history of atopy. The median age of onset was 10 and six weeks respectively, and the interval between introduction of PLV into the diet and the onset of symptoms was four and five days. Infant formula was, in both groups, the main dairy product that triggered symptoms (71% vs 81%). In group A over half the children did the first dose of PLV in first 24 hours of life. The value of specific IgE to the major PLV was identified in 76 children and only 15.6% were positive. The most frequent symptoms in both groups were cutaneous (85.7% vs 50.6%), especially urticaria and angioedema, gastrointestinal symptoms (40% vs 38%), including vomiting and diarrhea.

Diagnosis of cross-reactivity in patients with birth pollinosis

Material and Methods The clinical history and the positive SPT with the birch extract were the condition for qualifications. 23 patients included in the first group were only birch allergic. 35 patients in the other group had birch pollen allergy and they reported symptoms after eating apple, celery, carrot, tomato, banana, peach, peanut and hazelnut. The skin tests were performed and serum IgE concentration (total and specific) were determined for all individuals. The immunoblotting was performed for the patients with the positive value of birch, apple, celery and/or carrot specific IgE.

Outcomes of office-based, open food challenges in the management of food allergy

This letter reports the largest series of open oral food challenges in the literature to date. It describes the feasibility and utility of oral food challenge, further justifying its use in the everyday practice of allergy.

Examination of seasonal difference in serum interleukin-17 and interleukin-5 concentrations in ragweed-sensitized children

Dysregulation of inflammatory mediators is characteristic for chronic inflammation in allergy. The aim was to determine the values of serum IL-17 and IL-5 in ragweed-sensitized children. The study included children analyzed during the ragweed pollen season compared to children analyzed out of season. Serum total IgE, specific IgE, and eosinophil cationic protein (ECP) were determined by fluoroimmunoassay while the concentrations of IL-5 and IL-17 were determined by flow cytometry. Patients evaluated during the pollen season, have higher values of total and specific IgE, eosinophil and neutrophil count than patients studied outside the pollen season. There was no statistically significant seasonal and out of season differences for the concentration of IL-17, IL-5, and ECP. Natural exposure to ragweed pollen allergen was not crucial for the induction of increased IL-17 and IL-5 synthesis, and factors other than allergen exposure should be investigated, especially in longitudinal studies of patients.

Identification and quantification of tomato allergens: in vitro characterization of six different varieties

The prevalence of sensitization to tomato has been estimated in 6.5% in a Mediterranean population. To characterize the allergenic profile of 6 commonly ingested varieties of tomato and to identify and quantify the most representative allergens. Rama, Rambo, Canario, Kumato, Pera and Raf tomato varieties were carefully peeled and extracts from peel and pulp prepared. The extracts were characterized by SDS-PAGE and immunoblot. Lyc e 3 and osmotin-like protein (OLP) were identified by LC MS/MS and PG2A by immunoblot with a specific polyclonal antibody. Protein content and allergen concentration (Lyc e 3 and PG2A) were measured by scanning densitometry after identification. One hundred and ninety-one patients were enrolled in the study. Specific IgE to all tomato extracts was evaluated by direct ELISA. Eighty (41.7%) individuals reported symptoms after contact/ingestion with tomato, most of them oral symptoms. Protein profile and allergen quantification of the 6 varieties showed differences in the allergen composition. Lyc e 3 was visualized in all extracts, being the most abundant in all cases. PG2A and OLP were identified in all peel extracts and in some pulp extracts. Higher specific IgE values were obtained for the Kumato variety. Immunoblot showed the existence of several bands with IgE-binding capacity, especially at 12 and 45-50 kDa. The study demonstrates differences in the antigenic and allergenic profiles of the analyzed varieties and variations in their allergenic composition, affecting the diagnostic capacity. LTP and PG2A are important tomato allergens in our population but other IgE-binding capacity proteins are also involved.

Is it possible to use specific IgE to single latex allergens to discriminate between spina patients with natural rubber latex allergy and sensitization?

Materials and methods Sera of 30 spina bifida patients with specific IgE to NRL were tested for allergen-specific IgE antibodies (sIgE) to natural rubber latex (NRL) and 13 single Hev b allergens using the ImmunoCAP system. The results of the specific IgE values against single allergens were plotted (frequency of antibodies against the single allergen vs. the percentage of the total latex-specific IgE-response). Minor and major allergens for spina bifida patients sensitized or allergic against NRL could be identified.

Dermatite atopique de l’enfant : quand penser à l’allergie alimentaire ?

Background. There is a debate concerning the prevalence and relevance of food allergy (FA) in atopic dermatitis (AD). The aim of the study was to investigate the prevalence and risk factors of FA in a cohort of children with AD attending a multidisciplinary pediatric allergology clinic. Methods. The analysis was performed in 400 children consecutively evaluated for AD in the Department of Dermatology. A diagnosis of FA was established based on positive skin tests and/or specific IgE value above a threshold level or positive oral food challenge. Univariate and multivariate logistic regression were performed to assess risk factors associated with FA. Results. AD was confirmed in 386 children, 196 (50.8%) were boys. The median age was 4.0 years (IQR: 1.7-7.7). Prevalence of FA was 17.8% ( n=69; CI 95%: 14.1-22.0). The most frequent foods involved were egg, peanut and milk. A total of 26 (37.7%) of children had two or more positive food reactions. Risk factors associated with FA were young age (OR=7.9 for children younger than 2 compared to children older than 5, CI 95%: 3.3-19.0; p<10 -3), moderate to severe AD (OR=7.8 for severe AD ; CI 95%: 1.9-31.4; p<10 -3 and OR=2.4 for moderate AD; CI 95%: 1.2-4.8; p<10 -3) and onset of AD before 3 months of age (OR=5.7; CI 95%: 1.8-18.3; p<10 -3). Conclusion. Prevalence of FA in children with AD using stringent criteria is lower than previously reported. Risk factors of food allergy are young age, moderate to severe AD and early onset of AD.

Explorations biologiques en allergologie

Allergy is in constant progression in industrialized countries, where it affects almost one out of five people and changes the quality of life of those who suffer from it. These hypersensitivity conditions require early diagnosis which, in addition to the initial care of the illness, allows its evolution to be anticipated. Studies on the quantitative value of specific serum IgE have allowed us to associate such data with the likelihood of a clinical reaction or to establish the probable evolution of the disease. Recent progress in molecular biology, which has led to the synthesis of individual allergenic components (native and recombinant), has provided a real turning point for allergy diagnosis. With these molecules, it is now possible to establish for each patient a spectrum of IgE sensitivities, which can be associated with prognostic factors in terms of severity and/or persistence of the allergic disease.

Cow’s milk allergy related pediatric constipation: Appropriate time of milk tolerance

Cow's milk allergy (CMA) has different clinical presentations according to age. The study aimed to evaluate the extent of CMA as a cause of pediatric constipation and determine the appropriate timing of tolerance to cow milk in such patients. The study included 60 patients suffering from chronic functional constipation, 27 of whom did not respond to 2 month laxative therapy (group I). Thirty age and sex matched apparently healthy infants and children were studied as a control group (group II). Serum specific IgE to cow milk proteins was measured. Withdrawal of cow milk and dairy products for a 1 month period was then followed by cow milk re-challenge over 2 wk. Patients were classified into: responders to this schedule (cow milk allergic=group Ia; n=21) and non-responders (non-cow milk allergic=group Ib; n=6). Eighteen CMA patients continued the study where nine of them underwent milk reinstitution after 6 months and another nine patients after 12 months of elimination. The frequency of CMA among constipated patients was 77.7%. Mean values of serum specific IgE to whole cow milk protein and beta-lactoglobulins were significantly higher in constipated patients (0.82+/-0.08, 0.79+/-0.13 IU/ml, respectively) compared with controls (0.26+/-0.14, 0.27+/-0.14 IU/ml, respectively) and in group Ia (0.99+/-0.08, 0.95+/-0.14 IU/ml, respectively) compared with group Ib (0.39+/-0.06, 0.37+/-0.10 IU/ml, respectively). Serum specific IgE was positive in 85.7% of CMA group, predominantly in class 2. Tolerance to cow milk was achieved after 6 months in only 22.2% compared with 88.8% after 12 months of elimination. In conclusion, CMA is shown to be a significant etiologic factor for constipation in infants and young children. Serum levels of IgE to cow milk proteins are helpful although not definitive for diagnosis. Based on this limited study, tolerance is better achieved after 12 months of strict cow's milk elimination.

Immunoregulatory role of gamma delta T cell receptor in atopic asthma--association with the IgE response to molds antigen

To evaluate the role of gamma delta T cells in atopic asthma, we examined the relationship among atopy bronchial asthma, and genetic polymorphism of the gamma chain of T cell receptors (TCR) in families through atopic asthmatic probands. We recruited 5 families (69 subjects). Total serum IgE levels were estimated by a radioimmunosorbent test (IgE RIST). Skin prick tests were done with inhaled allergens consisting of house dust, grass and tree pollens, common molds, and animal danders. Antigen-specific IgE levels in response to these allergens were also measured by multiple antigen simultaneous test (IgE MAST). The atopic phenotype was determined by the presence of a positive skin test, an elevated antigen specific IgE value, an elevated total IgE level, or some combination of these. Although linkage of atopy or bronchial asthma to the gene encoding the gamma chain of TCR was excluded, the lod score between this gene and molds-specific IgE responses was 0.42 at the recombination fraction of 0.1. In an association study, a 19 kb allele of the gamma chain of the TCR gene was found more frequently in asthmatic subjects than in non-asthmatic subjects (p = 0.068). Also, molds-specific IgE responses were significantly associated with this allele (p = 0.018). These findings suggest that molds-specific IgE responses underlying atopic asthma are partly regulated by the gene encoding the gamma chain of the TCR.

In vitro cross-reactivity between tomato and other plant allergens

Cross-reactivity among fruits and different pollen and fruit species has been extensively reported. To investigate the in vitro cross-reactivity between tomato and pollen, fruit, and latex extracts and to identify the proteins involved. A serum pool was prepared from 18 individuals residing on the Spanish Mediterranean coast (9 men and 9 women; mean [SD] age, 27.4 [10.1] years) who had positive skin prick test reactions to tomato peel. Extracts from 10 pollens, 12 fruits, and latex were tested. Levels of specific IgE to each extract were measured. The allergenic profile was evaluated by means of immunoblot. The percentage of inhibition between extracts and tomato peel extract was analyzed by means of CAP inhibition, and the allergens implicated were elucidated by immunoblot inhibition. For pollens, the highest specific IgE values were obtained for grasses. Most pollen extracts showed a capacity of inhibition similar to that of tomato peel extract; high percentages were obtained with Artemisia vulgaris and Poa pratensis. The most strongly inhibited allergens in tomato corresponded to bands of 32 and 45 kDa. For fruits, the highest value of specific IgE was detected for peach. High percentages of inhibition were obtained with peach and hazelnut. No inhibition was detected with latex. Peach, chestnut, and melon inhibited high molecular weight bands (32 and 45 kDa) and a band of approximately 10 kDa. Cross-reactivity between tomato and pollen and fruit extracts has been demonstrated. Allergens with a high molecular weight range seem to be responsible in pollen extracts. A 10-kDa band seems to be responsible in Platanus acerifolia, Salsola kali, peach, chestnut, and melon.

Different Th1/Th2 responses to Anisakis simplex are related to distinct clinical manifestations in sensitized patients

Anisakis simplex is a fish parasite capable of inducing inflammatory and allergic reactions in humans who eat raw or undercooked fish. The aim of this study was to characterize the T helper type 1 (Th1)/Th2 immune response to parasite crude (CE) and thermostable (TsE) extracts in A. simplex-sensitized patients. Cytokines were quantified by a multiplex flow cytometric method in short-term whole blood cultures. Higher concentrations of IL-2, IL-4 and IL-5, measured with the CE and TsE, were found in patients than in controls. Patients showing urticaria-angio-oedema or anaphylaxis (UA/A) had higher total and specific IgE levels than those with gastrointestinal symptoms (GI). The UA/A group showed high levels of IL-5 and IL-4 and low expression of IFN-gamma than the GI group. The GI group had significantly higher IFN-gamma/IL4 ratio than the UA/A group. Four patients with severe GI symptoms reporting a delayed skin test reaction had very low values of specific IgE to A. simplex and higher IFN-gamma/IL4 ratios than that observed in other patients belonging to the GI group. This short-term whole blood test can be useful for immune response characterization in Anisakis infection and showed that heated parasite antigens are still capable of inducing cellular immune response in sensitized patients.