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.
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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.
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.
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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.
DR WIDODO JUDARWANTO SpA
children’s ALLERGY CLINIC
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