Specific IgE levels in the diagnosis of immediate hypersensitivity to cows’ milk protein in the infant

García-Ara, Carmen; Boyano-Martínez, Teresa; Díaz-Pena, José María; Martín-Muñoz, F; Reche-Frutos, Marta; Martín-Esteban, Manuel

doi:10.1067/mai.2001.111592

Cited by 296 publications

(198 citation statements)

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“…69,70 Wheal size has assumed greater diagnostic signifi cance due to the positive correlation with clinical symptoms severity. [71][72][73][74] Investigating graduated test responses and establishing probability decision points might improve diagnostic accuracy and predict positive reactions during organ challenge. 75 In a previous study, especially regarding food allergy, Sporik 74 defined specific wheal diameters as '100 % diagnostic'.…”

Section: Reading and Interpretationmentioning

confidence: 99%

Skin prick tests and allergy diagnosis

Antunes

Borrego

Romeira

et al. 2009

Allergologia et Immunopathologia

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Skin testing remains an essential diagnostic tool in modern allergy practice. A signifi cant variability has been reported regarding technical procedures, interpretation of results and documentation. This review has the aim of consolidating methodological recommendations through a critical analysis on past and recent data. This will allow a better understanding on skin prick test (SPT) history; technique; (contra-) indications; interpretation of results; diagnostic pitfalls; adverse reactions; and variability factors. Skin has an important physiological role in the internal balance homeostasis and constitutes a crucial barrier against external aggressions, with well-known immunological properties. 1 It has been used by allergists for decades as an easily assessed laboratory of the immunological status of the individual.The fi rst skin testing technique was developed by Charles H. Blackley in 1865, a Manchester homeopathic physician with allergic rhinitis. He abraded a quarter-inch area of his skin with a lancet and then applied grass pollen grains. 2 The so-called scratch test was later adopted by Schloss for the diagnosis of food allergy in children. 3 Epicutaneous tests can be divided into scratch tests and prick/puncture tests. The fi rst method, proposed by Blackley 2 , implied a linear scratch without drawing blood and could either be performed fi rst, with the extract then dropped on the abraded skin, or be made through a drop of extract. 4 Although it was used extensively in the past, this technique became progressively obsolete due to patient discomfort, poor reproducibility, possible residual lesions and newer and innocuous procedures. 4 Therefore, scratch test is mentioned here for historical purposes only. It was Sir Thomas Lewis who, in 1924, fi rst applied skin prick tests (SPT). 5 Nevertheless, their generalised use in clinical practice only became a reality about 30 years ago, as a result of technique modifi cations proposed by Pepys. 6 For the purpose of this review and for easier comprehension, skin testing will be referred interchangeably as SPT, whatever device is used for its application.In 1966, Ishizaka's work on immunoglobulin E (IgE) and immediate hypersensitivity reactions 7 established the scientifi c corpus to what was done till then on a strictly empiric basis.As written by Dr Walzer in 1974, "the fact that skin testing has not turned out to be a simple and completely reliable technique does not detract from the fact that, when it is intelligently and skilfully performed, it remains the most effective diagnostic procedure in reaginic allergic disorders". 8 The reliability of skin testing and proper documentation of test results are essential in allergy practice. A recent survey to all physician members and fellows of the American College of Allergy, Asthma and Immunology practicing in the

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Section: Reading and Interpretationmentioning

confidence: 99%

Skin prick tests and allergy diagnosis

Antunes

Borrego

Romeira

et al. 2009

Allergologia et Immunopathologia

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“…Nevertheless, depending on the food investigated, a huge overlap in individual sIgE reactivity between healthy subjects and subjects with food allergy also became evident. [35], [87], [88], [89] and [90] Several reasons might be suggested to explain the overlap in test reactivity. First, low sIgE signals in allergic patients might be attributed to sensitization to a low-abundance, highly resistant protein with particular allergenic potency.…”

Section: Quantification Of Ige Antibodiesmentioning

confidence: 99%

“…[58], [99] and [100] In general, these studies verified that increasing sIgE titers correlate with an increasing risk of reactivity on challenge and that reasonable threshold values can be defined to avoid challenges in a subgroup of patients. [58], [71], [89], [101], [102], [103], [104] and [105] However, diagnosis of food allergy based on decision points is hampered by a huge overlap in test reactivity between healthy subjects and patients with food allergy. The definition of more stringent cutoff values has the potential to improve the specificity, as well as the positive predictive value.…”

Section: Quantification Of Ige Antibodiesmentioning

confidence: 99%

Potential, pitfalls, and prospects of food allergy diagnostics with recombinant allergens or synthetic sequential epitopes

Steckelbroeck¹,

Ballmer‐Weber²,

Vieths³

2008

Journal of Allergy and Clinical Immunology

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This article aims to critically review developments in food allergy diagnostics with regard to the verification of specific IgE antibodies and the identification of the responsible allergens. Results of IgE-binding tests with food extracts are hampered by cross-reactive proteins, low-quality test agents, or both. Specificity can be increased by defining adequate cutoff values, whereas sensitivity can be improved by using high-quality test agents. IgE-binding tests with purified allergens enabled reliable quantification of allergen-specific IgE titers, with higher levels found in individuals with food allergy compared with individuals without food allergy. However, the overlap in individual test reactivity between allergic and nonallergic subjects complicates interpretation. Recombinant allergens and synthetic sequential epitopes enabled detection of sensitization profiles, with IgE specific to several allergens and substructures now being suggested as markers of severity, persistence, or both. However, high-power quantitative studies with larger numbers of patients are required to confirm these markers. This article aims to critically review developments in food allergy diagnostics with regard to the verification of specific IgE antibodies and the identification of the responsible allergens. Results of IgE-binding tests with food extracts are hampered by cross-reactive proteins, low-quality test agents, or both. Specificity can be increased by defining adequate cutoff values, whereas sensitivity can be improved by using high-quality test agents. IgE-binding tests with purified allergens enabled reliable quantification of allergen-specific IgE titers, with higher levels found in individuals with food allergy compared with individuals without food allergy. However, the overlap in individual test reactivity between allergic and nonallergic subjects complicates interpretation. Recombinant allergens and synthetic sequential epitopes enabled detection of sensitization profiles, with IgE specific to several allergens and substructures now being suggested as markers of severity, persistence, or both.However, high-power quantitative studies with larger numbers of patients are required to confirm these markers. IgE-mediated and non-IgE-mediated syndromes, where IgE-mediated manifestations are responsible for the majority of food-induced, immediate-type, immune-mediated hypersensitivity reactions. 3 The development of an IgE-mediated response to food requires a series of molecular and cellular interactions, which involve antigenpresenting cells, T lymphocytes, and B lymphocytes. [4] and [5] Depending on the route of sensitization, food allergy is the result of either genuine reactivity to comestibles through the gastrointestinal tract (class I food allergens) or secondary sensitization to cross-reactive food allergens as a consequence of the initial reactivity to homologous pollen-related allergens (class II food allergens). [6] and [7] The majority of class I food allergens are heat stable and resistan...

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“…Thus, it is necessary for the physician to get a feeling for the probability curve related to the allergy in question. A further complication is that the threshold values also differ by age [26][27][28][29]. Thus, patients with…”

Section: Ige -A Quantitative Approachmentioning

confidence: 99%

In vitro diagnosis of allergy: how to interpret IgE antibody results in clinical practice

Ahlstedt

Murray

2006

Primary Care Respiratory Journal

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SummaryThe basis of any diagnosis of allergy requires a good history and examination, which should then provide a certain degree of confidence as to whether or not allergy is present. However, the diagnosis cannot be confirmed on the basis of symptoms alone, because both allergic and non-allergic conditions can present with similar symptoms. Based on prevalence figures, about half of the patients presenting with allergic symptoms in primary care may be non-allergic. Therefore, allergy testing in the form of specific IgE (sIgE) measurement and/or skin prick testing is an invaluable aid in demonstrating both the presence and severity of such an allergy. The usefulness of such tests extends beyond just the positive or negative result. Often, more information can be gleaned by using the test results in a form of a continuous variable in order to determine the likelihood that allergy can be attributed as an explanation for patients' symptoms and disease. In this review, we describe the rationale for utilising specific IgE antibody tests in diagnosing allergy. Furthermore, to optimize the information gained from allergy testing, we describe how to employ one particular well-validated IgE testing system for determining the likelihood that an individual patient's disease can be attributed to allergy.

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Specific IgE levels in the diagnosis of immediate hypersensitivity to cows’ milk protein in the infant

Cited by 296 publications

References 0 publications

Skin prick tests and allergy diagnosis

Skin prick tests and allergy diagnosis

Potential, pitfalls, and prospects of food allergy diagnostics with recombinant allergens or synthetic sequential epitopes

In vitro diagnosis of allergy: how to interpret IgE antibody results in clinical practice

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