May 29, 2016

A new framework for the interpretation of IgE sensitization tests

DOI: 10.1111/all.12939
  1. Graham Roberts1,*
  2. Markus Ollert2
  3. Rob Aalberse3
  4. Moira Austin4
  5. Adnan Custovic5
  6. Audrey DunnGalvin6
  7. Philippe A Eigenmann7
  8. Filippo Fassio8
  9. Clive Grattan9
  10. Peter Hellings10
  11. Jonathan Hourihane11,
  12. Edward Knol12
  13. Antonella Muraro13,
  14. Nikolaos Papadopoulos14,15
  15. Alexandra F. Santos16,17,18
  16. Sabine Schnadt19and
  17. Kassiani Tzeli15
Abstract
IgE sensitization tests, such as skin prick testing and serum specific IgE, have been used to diagnose IgE-mediated clinical allergy for many years. Their prime drawback is that they detect sensitization which is only loosely related to clinical allergy. Many patients therefore require provocation tests to make a definitive diagnosis; these are often expensive and potentially associated with severe reactions.
The likelihood of clinical allergy can be semi-quantified from an IgE sensitization test results. This relationship varies though according to the patients’ age, ethnicity, nature of the putative allergic reaction and co-existing clinical diseases such as eczema. The likelihood of clinical allergy can be more precisely estimated from an IgE sensitization test result, by taking into account the patient's presenting features (pre-test probability). The presence of each of these patient specific factors may mean that a patient is more or less likely to have clinically allergy with a given test result (post-test probability). We present two approaches to including pre-test probabilities in the interpretation of results. These approaches are currently limited by a lack of data to allow us to derive pre-test probabilities for diverse setting, regions and allergens. Also, co-factors, such as exercise, may be necessary for exposure to an allergen to result in an allergic reaction in specific IgE positive patients. The diagnosis of IgE-mediated allergy is now being aided by the introduction of allergen component testing which may identify clinically relevant sensitization. Other approaches are in development with basophil activation testing being closest to clinical application.

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