Posted by: Indonesian Children | July 20, 2009

Overview of in vitro allergy tests

Most tests for “allergy” are actually tests for allergic sensitization, or the presence of allergen-specific IgE. Most patients who experience symptoms upon exposure to an allergen have demonstrable IgE that specifically recognizes that allergen, making these tests essential tools in the diagnosis of allergic disorders.

The demonstration of sensitization is not sufficient to diagnose an allergy, however, because a sensitized individual may be entirely asymptomatic upon exposure to the allergen in question. Venom- and food-specific IgE has been reported in up to 25 and 60 percent of the general population, respectively [1-4]. Less commonly, patients who react to an allergen may not have any allergen-specific IgE that is detectable with routine testing [5,6]. Furthermore, IgE molecules recognizing specific epitopes of an allergen may differ in their ability to trigger allergic reactions, and the currently available tests do not distinguish among them.

The clinical response of a sensitized individual to the suspect allergen is best understood as a dynamic physiologic event with multiple variables, of which the presence of allergen-specific IgE is just one. Thus, allergy tests must be interpreted in the context of the patient’s specific clinical history, and the diagnosis of an allergic disorder cannot be based solely on a laboratory result. This is true for in vitro assays, as well as for skin testing. (See “The role of IgE in allergy”).

This topic provides an overview of in vitro tests for IgE-mediated allergic disease. Skin testing for allergic disease and the application of different tests to the diagnosis of food allergy are reviewed separately. (See “Overview of skin testing for allergic disease” and see “Diagnostic tools for food allergy”).

Laboratory testing in cases of suspected anaphylaxis is reviewed in greater detail elsewhere. (See “Laboratory tests to support the clinical diagnosis of anaphylaxis”).

The pathogenesis of allergic inflammation is becoming increasingly understood, although still incompletely revealed. A vast literature emphasizes the role of immunoglobulin E (IgE) in allergic phenomena; however, its primacy as the only mechanism of allergic disease is clearly not consistent with current knowledge.

The biological activities of IgE, and a survey of its most well-documented clinical associations will be reviewed here. We will conclude with clinical data regarding the effects of IgE depletion on the course of various allergic disorders.

Reference :

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  3. Nopp, A, Johansson, SG, Lundberg, M, Oman, H. Simultaneous exposure of several allergens has an additive effect on multisensitized basophils. Allergy 2006; 61:1366.
  4. Shreffler, WG, Beyer, K, Chu, TH, et al. Microarray immunoassay: association of clinical history, in vitro IgE function, and heterogeneity of allergenic peanut epitopes. J Allergy Clin Immunol 2004; 113:776.
  5. Kairemo, KJ, Lindberg, M, Prytz, M. IgE myeloma: a case presentation and a review of the literature. Scand J Clin Lab Invest 1999; 59:451.
  6. Nolte, H, Storm, K, Schiotz, PO. Diagnostic value of a glass fibre-based histamine analysis for allergy testing in children. Allergy 1990; 45:213.
  7. Boumiza, R, Monneret, G, Forissier, MF, et al. Marked improvement of the basophil activation test by detecting CD203c instead of CD63. Clin Exp Allergy 2003; 33:259.
  8. Rak, S, Lowhagen, O, Venge, P. The effect of immunotherapy on bronchial hyperresponsiveness and eosinophil cationic protein in pollen-allergic patients. J Allergy Clin Immunol 1988; 82:470.
  9. Kips, JC, Pauwels, RA. Serum eosinophil cationic protein in asthma: what does it mean?. Clin Exp Allergy 1998; 28:1.

10. van Velzen, E, van den, Bos JW, Benckhuijsen, JA, et al. Effect of allergen avoidance at high altitude on direct and indirect bronchial hyperresponsiveness and markers of inflammation in children with allergic asthma. Thorax 1996; 51:582.

11. Beyer, K, Teuber, SS. Food allergy diagnostics: scientific and unproven procedures. Curr Opin Allergy Clin Immunol 2005; 5:261.

12. Golden, DB, Marsh, DG, Freidhoff, LR, et al. Natural history of Hymenoptera venom sensitivity in adults. J Allergy Clin Immunol 1997; 100:760.

13. Pereira, B, Venter, C, Grundy, J, et al. Prevalence of sensitization to food allergens, reported adverse reaction to foods, food avoidance, and food hypersensitivity among teenagers. J Allergy Clin Immunol 2005; 116:884.

14. Stevenson, MD, Sellins, S, Grube, E, et al. Aeroallergen sensitization in healthy children: racial and socioeconomic correlates. J Pediatr 2007; 151:187.

15. Golden, DB, Tracy, JM, Freeman, TM, Hoffman, DR. Negative venom skin test results in patients with histories of systemic reaction to a sting. J Allergy Clin Immunol 2003; 112:495.

16. Hoffman, DR. Fatal reactions to hymenoptera stings. Allergy Asthma Proc 2003; 24:123.

17. Hamilton, RG, Franklin Adkinson, N Jr. In vitro assays for the diagnosis of IgE-mediated disorders. J Allergy Clin Immunol 2004; 114:213.

18. Yalow, RS, Berson, SA. Immunoassay of endogenous plasma insulin in man. J Clin Invest 1960; 39:1157.

19. Wide, L, Bennich, H, Johansson, SG. Diagnosis of allergy by an in-vitro test for allergen antibodies. Lancet 1967; 2:1105.

20. Sampson, HA, Ho, DG. Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol 1997; 100:444.

21. Sampson, HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol 2001; 107:891.

22. Nolte, H, DuBuske, LM. Performance characteristics of a new automated enzyme immunoassay for the measurement of allergen-specific IgE. Summary of the probability outcomes comparing results of allergen skin testing to results obtained with the HYTEC system and CAP system. Ann Allergy Asthma Immunol 1997; 79:27.

23. Williams, PB, Dolen, WK, Koepke, JW, Selner, JC. Comparison of skin prick testing and three in vitro assays for specific IgE in the clinical evaluation of immediate hypersensitivity. Ann Allergy 1992; 68:35.

24. Williams, PB, Barnes, JH, Szeinbach, SL, Sullivan, TJ. Analytic precision and accuracy of commercial immunoassays for specific IgE: Establishing a standard. J Allergy Clin Immunol 2000; 105:1221.

25. Hamilton, RG, Biagini, RE, Krieg, EF. Diagnostic performance of Food and Drug Administration-cleared serologic assays for natural rubber latex-specific IgE antibody. The Multi-Center Latex Skin Testing Study Task Force. J Allergy Clin Immunol 1999; 103:925.

26. Sampson, HA. Update on food allergy. J Allergy Clin Immunol 2004; 113:805.

27. Kelso, JM, Sodhi, N, Gosselin, VA, Yunginger, JW. Diagnostic performance characteristics of the Phadebas RAST, modified RAST, and Pharmacia CAP system versus skin testing. Ann Allergy 1991; 67:511.

28. Wood, RA, Segall, N, Ahlstedt, S, Williams, PB. Accuracy of IgE antibody laboratory results. Ann Allergy Asthma Immunol 2007; 99:34.

29. Division of Clinical Laboratory Devices, Office of Device Evaluation. Review criteria for the assessment of allergen-specific immunoglobulin E (IgE) in vitro diagnostic devices using immunological methods. Washington: Public Health Service, 2000. p.1.

 

Provided by

DR WIDODO JUDARWANTO SpA
children’s ALLERGY CLINIC

JL TAMAN BENDUNGAN ASAHAN 5 JAKARTA PUSAT, JAKARTA INDONESIA 10210

PHONE : (021) 70081995 – 5703646

email :  judarwanto@gmail.com\

htpp://www.childrenallergyclinic.wordpress.com/

 

 

 

Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.

Copyright © 2009, Children Allergy Clinic Information Education Network. All rights reserved.

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