Integration of in vitro allergy test results and ratio analysis for the diagnosis and treatment of allergic patients (INTEGRA)

Abstract

The introduction of molecular diagnosis into routine clinical practice has substantially improved the diagnosis and management of allergic patients by allowing clinicians to precisely identify the allergenic molecule responsible for immunoglobulin E (IgE)‐mediated allergies. However, it can be challenging to accurately interpret the results of molecular assays, partly due to the limited evidence base. In this context, a panel of experts with extensive experience in interpreting in vitro measures of total and serum specific IgE reviewed the available scientific evidence. After this review, the panel selected a series of representative case studies to demonstrate how determination of specific and total IgE values and the relationship between them (ratio analysis) can add value to the diagnostic process by more precisely defining the patient’s sensitization profile. Finally, the experts developed a series of recommendations on the clinical application of ratio analysis to optimize and complement the classical approach to allergy diagnosis.

Low Levels Matter: Clinical Relevance of Low Pru p 3 sIgE in Patients With Peach Allergy

“…In summary, the ratio Pru p 3/Peach was similar in both groups and superior to 1, which would confirm a sensitization due to Pru p 3 on our population ( 13 ). About 45% of our patients of grLOW are allergic, highlighting the importance of considering Pru p 3 sIgE > 0.1 as potentially clinically relevant, despite 0.35 has traditionally been used as the cut-off, BAT reactivity (similar in both groups) demonstrated the presence of functional sIgE in patients with low levels.…”

“…Besides the theory reported by Kleine-Tebbe and Jakob ( 14 ) exposing that a 0.01 or greater ratio of specific IgE to total IgE, translated as a fraction of 1% of bound total IgE, is enough for basophil half-maximal activation, we observe basophil activation with a lower percentage. Thus, reliable quantitative detection of sIgE and the ratios analysis of specific and total IgE on these patients is relevant for an accurate diagnosis ( 13 , 15 ).…”

Molecular Allergy Diagnosis in Clinical Practice: Frequently Asked Questions

“…Singleplex testing offers an enhanced assay sensitivity and should be the preferred assay when the aim is to determine the extent of sensitization attributable to a given allergic component, ratio between the levels of sIgE to the component and the sIgE to the whole extract (we-sIgE/c-sIgE) [9], or when the purpose of the study to monitor a sensitization over time.…”

“…and sIgE to CCDs (MUXF3). The ratio between whole extract sIgE (we-sIgE) and tIgE (if detected with the same technique) inform us of the relevance of this allergenic source in the venom allergy of the patient and is especially important in cases of low levels of tIgE [9]. The ratio between the allergen component sIgE and whole extract sIgE (c-sIgE/ we-sIgE) allows us to evaluate the extent of sensitization attributable to a given allergic component [9].…”

“…Recently, Pascal et al have proposed the use of ratios of the sIgE of a given specific allergen component (c-sIgE) to the levels of sIgE to its whole extract (we) (c-slgE/ we-sIgE) to evaluate the extent of sensitization attributable to this specific allergic component [9].…”