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Kumar R, Gaur S, Agarwal M, Menon B, Goel N, Mrigpuri P, Spalgais S, Priya A, Kumar K, Meena R, Sankararaman N, Verma A, Gupta V, Sonal, Prakash A, Safwan MA, Behera D, Singh A, Arora N, Prasad R, Padukudru M, Kant S, Janmeja A, Mohan A, Jain V, Nagendra Prasad K, Nagaraju K, Goyal M. Indian Guidelines for diagnosis of respiratory allergy. Indian J Allergy Asthma Immunol 2023. [DOI: 10.4103/0972-6691.367373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Shikha G, Swami H. Trends of sensitization pattern to aeroallergens among the patients with allergic rhinitis and/or bronchial asthma in Bangalore: A cross sectional study. Med J Armed Forces India 2022; 78:430-436. [PMID: 36267519 PMCID: PMC9577270 DOI: 10.1016/j.mjafi.2020.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 11/16/2020] [Indexed: 11/22/2022] Open
Abstract
Background Allergic rhinitis (AR) is rather erroneously viewed as a trivial disease. It is a chronic or recurrent allergen-specific, IgE-mediated inflammation that primarily affects the membrane lining the nose. However, due to the united airway concept, it is also found to be associated with bronchial asthma. AR commonly remains underdiagnosed or misdiagnosed and thus, leads to either undertreatment or inappropriately prolonged medication. Methods Four hundred adults having allergic rhinitis and/or bronchial asthma, fulfilling the criteria as per Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines, underwent skin prick test (SPT). Those having rhinitis due to nonallergic causes were excluded. SPT was carried out using a customized panel of 21 aeroallergens. The result was compared with the reaction of histamine, which was taken as a positive control. Results Majority of 228 (58.02%) of the patients showed a positive reaction to the tested panel of allergens. However, 165 (41.98%) showed no reaction to the tested panel of allergens can be due to various factors like reduced skin sensitivity, antihistaminic medications, etc. Conclusion Skin prick test accurate test for determining offending allergens in allergic conditions. House dust mites (41%) were the most common offending aeroallergen among patients with allergic rhinitis and/or bronchial asthma residing in Bangalore. The identification of offending aeroallergens have helped patients in avoiding unnecessary medications, take appropriate preventive measures or plan appropriate immunotherapy.
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Affiliation(s)
| | - Himanshu Swami
- Senior Advisor & Head (ENT), Army Hospital (R&R), Delhi Cantt, India
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Ansotegui IJ, Melioli G, Canonica GW, Caraballo L, Villa E, Ebisawa M, Passalacqua G, Savi E, Ebo D, Gómez RM, Luengo Sánchez O, Oppenheimer JJ, Jensen-Jarolim E, Fischer DA, Haahtela T, Antila M, Bousquet JJ, Cardona V, Chiang WC, Demoly PM, DuBuske LM, Ferrer Puga M, Gerth van Wijk R, González Díaz SN, Gonzalez-Estrada A, Jares E, Kalpaklioğlu AF, Kase Tanno L, Kowalski ML, Ledford DK, Monge Ortega OP, Morais Almeida M, Pfaar O, Poulsen LK, Pawankar R, Renz HE, Romano AG, Rosário Filho NA, Rosenwasser L, Sánchez Borges MA, Scala E, Senna GE, Sisul JC, Tang ML, Thong BYH, Valenta R, Wood RA, Zuberbier T. IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper. World Allergy Organ J 2020; 13:100080. [PMID: 32128023 PMCID: PMC7044795 DOI: 10.1016/j.waojou.2019.100080] [Citation(s) in RCA: 195] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/08/2019] [Indexed: 02/06/2023] Open
Abstract
Currently, testing for immunoglobulin E (IgE) sensitization is the cornerstone of diagnostic evaluation in suspected allergic conditions. This review provides a thorough and updated critical appraisal of the most frequently used diagnostic tests, both in vivo and in vitro. It discusses skin tests, challenges, and serological and cellular in vitro tests, and provides an overview of indications, advantages and disadvantages of each in conditions such as respiratory, food, venom, drug, and occupational allergy. Skin prick testing remains the first line approach in most instances; the added value of serum specific IgE to whole allergen extracts or components, as well as the role of basophil activation tests, is evaluated. Unproven, non-validated, diagnostic tests are also discussed. Throughout the review, the reader must bear in mind the relevance of differentiating between sensitization and allergy; the latter entails not only allergic sensitization, but also clinically relevant symptoms triggered by the culprit allergen.
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Key Words
- AAAAI, American Academy of Allergy Asthma and Immunology
- ABA, Allergen Bead Array
- ACAAI, American College of Allergy Asthma and Immunology
- AEC, Allergen Exposure Chambers
- AIT, allergen immunotherapy
- AP, Alkaline Phosphatase
- AU/mL, Allergenic Units milliLiter
- Allergy
- Anti-IgE, Antibody against IgE
- BAT, Basophil Activation Test
- BAU/mL, Biologic Allergenic Units milliLiter
- CBA, Cytometric Bead Array
- CCD, Cross-reactive Carbohydrate Determinants
- CDER, Center for Drug Evaluation and Research (USA)
- CL, Chemiluminescence
- CaFE, Calibrated Fluorescence Enhancement
- DBPCFC, Double-Blind Placebo-Controlled Food Challenge
- Diagnostic strategies
- EAACI, European Academy of Allergy and Immunology
- EIA, Enzyme Immune Assay
- ELISA, Enzyme Linked Immuno Sorbent Analysis
- EMEA, European MEdicine Agencies
- ENPP-3, EctoNucleotide Pyrophosphatase/Phosphodiesterase 3
- FACS, Fluorescence-Activated Cell Sorting
- FDA, Food and Drug Administration (U.S. Department of Health and Human Services)
- FEIA, Fluorescent Enzyme Immunoassays
- FcεRI, High affinity IgE receptor
- H1, Histamine 1 receptor
- H2, Histamine 2 receptor
- HPO, Horseradish Peroxidase
- IDT, Intradermal Test
- ISAC, Immuno-Solid phase Allergen Chip
- IUIS, International Union of Immunological Societies
- IVD, in vitro diagnostic tool
- IgE
- IgE, immunoglobulin E
- In vitro tests
- LAMP-3, Lysosomal-Associated Membrane Protein
- MBAD, Molecule Based Allergy Diagnostics
- MRGPRX2, Mas-related G protein receptor 2
- NIH, National Institutes of Health (USA)
- NMBAs, NeuroMuscular Blocking Agents
- NPA, Negative Percent Agreement
- NSAIDs, Non-Steroidal Anti-Inflammatory Drugs
- PPA, Positive Percent Agreement
- PPT, Prick-Prick Test
- RAST, Radio Allergo Sorbent Test
- SCAR, severe cutaneous adverse drug reactions
- SPT, Skin prick test
- Skin tests
- kUA/L, kilo Units of Allergen/Liter for allergen-specific IgE antibody assays
- mAb, Monoclonal Antibody
- pNPP, p-Nitrophenylphosphate
- sIgE, specific IgE
- w/v, weight /volume
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Affiliation(s)
| | - Giovanni Melioli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | - Elisa Villa
- Azienda Sanitaria Locale di Vercelli, S.C. Pneumologia, Vercelli, Italia
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | | | - Didier Ebo
- Department of Immunology - Allergology - Rheumatology, Antwerp University Hospital, Antwerp University, Department Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
| | | | - Olga Luengo Sánchez
- Allergy Section, Department of Internal Medicine, Vall d’Hebron University Hospital, Barcelona, Spain
| | | | - Erika Jensen-Jarolim
- Institute for Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, The Interuniversity Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University Vienna, Vienna, Austria
| | - David A. Fischer
- Fischer Medicine Professional Corporation, Barrie, Ontario, Canada
| | - Tari Haahtela
- Skin and Allergy Hospital, University of Helsinki, Helsinki, Finland
| | | | - Jean J. Bousquet
- MACVIA-France, Montpellier, France
- INSERM, Villejuif, France
- Université Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France
- Euforea, Brussels, Belgium
- CHU Montpellier, France
| | - Victoria Cardona
- Universitat Autónoma de Barcelona, Hospital Universitario Vall d'Hebron, Servicio de Medicina Interna, Sección de Alergología, Barcelona, Spain
| | - Wen Chin Chiang
- Mount Elizabeth Medical Centre, Chiang Children's Allergy & Asthma Clinic, Singapore, Singapore
| | - Pascal M. Demoly
- University Hospital Montpellier, Montpellier, France
- Sorbonne Université, Paris, France
| | | | - Marta Ferrer Puga
- The Unidad de Educación Médica, Department of Medical Education, School of Medicine, Clinica Universitad de Navarra, Navarra, Spain
| | | | | | | | | | | | | | - Marek L. Kowalski
- Faculty of Medicine, Department of Clinical Immunology & Allergy, Medical University of Łódź, Łódź, Poland
| | | | | | | | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Lars K. Poulsen
- Gentofte University Hospital, Lab for Allergology, Allergy Clinic, Hellerup, Denmark
| | - Ruby Pawankar
- Nippon Medical School, Dept. of Otolaryngology, Tokyo, Japan
| | - Harald E. Renz
- University Hospital GI & MR GmbH, Institute of Laboratory Medicine & Pathology, Standort Marburg, Marburg, Germany
| | | | | | - Lanny Rosenwasser
- University of Missouri at Kansas City, School of Medicine, Kansas City, MO, USA
| | | | - Enrico Scala
- Experimental Allergy Unit, Istituto Dermopatico dell'Immacolata, Rome, Italy
| | | | | | - Mimi L.K. Tang
- Royal Children's Hospital, Department of Allergy & Immunology, Parkville, Victoria, Australia
| | - Bernard Yu-Hor Thong
- Tan Tock Seng Hospital, Deptartment of Rheumatology, Allergy & Immunology, Singapore, Singapore
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
- NRC Institute of Immunology FMBA of Russia, Moscow, Russia
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Robert A. Wood
- Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Torsten Zuberbier
- Campus Charite Mitte, Klinik fur Dermatologie & Allergologie, Berlin, Germany
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Baarnes CB, Thuesen BH, Linneberg A, Ulrik CS. Determinants of airflow limitation in Danish adults - findings from the Health2006 cohort. Int J Chron Obstruct Pulmon Dis 2019; 14:713-718. [PMID: 30988605 PMCID: PMC6440446 DOI: 10.2147/copd.s173815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and aim Airflow limitation may be found in patients with both asthma and COPD and is often associated with more symptoms and poorer outcome. We aimed to identify factors associated with airflow limitation in a well-characterized, population-based sample of adults. Methods From the Health2006 cohort, we selected participants aged ≥35 years at enrolment (n=2,959). Airflow limitation was defined as FEV1/FVC < lower limit of normal. Participants with (cases) and without (controls) airflow limitation were compared with regard to self-reported symptoms, medical history, atopy, lung function and exhaled nitric oxide. Between-group differences were analyzed using Chi-square and Mann–Whitney U tests, and effect size was estimated by logistic regression (reported as OR and 95% CI). Results We identified 313 cases, majority of which were female, reported poor overall health, physically inactivity and experienced respiratory symptoms within the previous year. The presence of airflow limitation was associated with BMI (OR 3.1 for overweight, P<0.001, CI 1.97–4.78), age (OR 2.3, P<0.001 for age 55+, CI 1.7–3.2), tobacco exposure (OR 1.6, P=0.01, CI 1.1–2.32, and OR 1.76, P=0.019, CI 1.2–2.3 for former and current smokers, respectively), sex (OR 1.6 for being female, P=0.002, CI 1.2–2.2), presence of specific IgE to common aeroallergen(s) (OR 1.4, P=0.041, CI 1.2–2.0), and ever being diagnosed with asthma (OR 1.6, P=0.003, CI 1.3–2.0). Conclusion Apart from tobacco exposure and age, the presence of airflow limitation was associated with being overweight, female, sensitized to common aeroallergens or ever having a diagnosis of asthma.
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Affiliation(s)
| | - Betina H Thuesen
- Center for Clinical Research and Disease Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Disease Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark, .,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,
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Nevis IF, Binkley K, Kabali C. Diagnostic accuracy of skin-prick testing for allergic rhinitis: a systematic review and meta-analysis. Allergy Asthma Clin Immunol 2016; 12:20. [PMID: 27127526 PMCID: PMC4848807 DOI: 10.1186/s13223-016-0126-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 04/01/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Allergic rhinitis is the most common form of allergy worldwide. The accuracy of skin testing for allergic rhinitis is still debated. Our primary objective was to evaluate the diagnostic accuracy of skin-prick testing for allergic rhinitis using the nasal provocation as the reference standard. We also evaluated the diagnostic accuracy of intradermal testing as a secondary objective. METHODS We searched EBM Reviews from 2005 to March 2015; Embase from 1980 to March 2015; and Ovid MEDLINE(R) from 1946 to until March 2015. We included any study with at least 10 subjects including children. We excluded non-English studies. We performed data extraction and quality assessment using the QUADAS-2 tool. RESULTS We meta-analysed seven studies assessing the accuracy of skin-prick testing using the bivariate random-effects model, including a total of 430 patients. The pooled estimate for sensitivity and specificity for skin-prick testing was 85 and 77 % respectively. We did not pool results for intradermal testing due to few number of studies (n = 4), each with very small sample size. Of these, two evaluated the accuracy of intradermal testing in confirming skin-prick testing results, with sensitivity ranging from 27 to 50 % and specificity ranging from 60 to 100 %. The other two evaluated the accuracy of intradermal testing as a stand-alone test for diagnosing allergic rhinitis with sensitivity ranging from 60 to 79 % and specificity ranging from 68 to 69 %. CONCLUSIONS Findings from this review suggest that skin-prick testing is accurate in discriminating subjects with or without allergic rhinitis.
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Affiliation(s)
| | - Karen Binkley
- />Department of Medicine, University of Toronto, Toronto, ON Canada
| | - Conrad Kabali
- />Health Quality Ontario, 130 Bloor Street West, Toronto, ON M5S 1N5 Canada
- />Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
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Ballabio C, Peñas E, Uberti F, Fiocchi A, Duranti M, Magni C, Restani P. Characterization of the sensitization profile to lupin in peanut-allergic children and assessment of cross-reactivity risk. Pediatr Allergy Immunol 2013; 24:270-5. [PMID: 23551124 DOI: 10.1111/pai.12054] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Case reports of allergy to lupin, due to primary sensitization or cross-reactions with other legumes, are increasing as a consequence of the augmented use of lupin flour in bakery, pasta formulations and other food items. The main allergens that have been associated with the sensitization to lupin are α- and β-conglutins and, to a lesser extent, γ- and δ-conglutin, but no conclusive data are available so far. The aim of this study was to characterize the sensitization pattern to lupin in a group of 12 Italian children allergic to peanut and identify the specific lupin proteins involved in the cross-reactivity with peanut. METHODS The immunochemical cross-reactivity among peanut and lupin was evaluated by both in vitro immunoblotting and in vivo fresh food skin prick test (FFSPT). RESULTS The results showed that β-conglutin was recognized by cutaneous IgEs from 7/12 peanut-allergic children in FFSPT and serum IgEs from 5/12 in immunoblotting, while 4/12 and 8/12 patients tested positive to γ-conglutin in FFSPT and immunoblotting, respectively. No significant immunoreactive responses were observed to α- and δ-conglutins under non-reducing conditions, but they were bound in FFSPT by the sera of 5/12 and 3/12 patients, respectively. CONCLUSION In this group of allergic children, β-conglutin has been identified as the major lupin allergen involved both in vitro and in vivo cross-reactivity with peanut proteins. The role of γ-conglutin in the cross-reactivity between lupin and peanut proteins was also relevant and clear, despite the observed unspecificity of the immunoblotting responses.
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Affiliation(s)
- Cinzia Ballabio
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy
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Magnusson AL, Svensson RE, Leirvik C, Gunnarsson RK. The Effect of Acupuncture on Allergic Rhinitis: A Randomized Controlled Clinical Trial. Am J Chin Med 2012; 32:105-15. [PMID: 15154290 DOI: 10.1142/s0192415x04001813] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Allergic rhinitis is a common health problem usually treated with drug therapy. Some patients experience side effects of drug therapy while others fear the use of drugs. Acupuncture is an interesting alternative to traditional treatment. The few studies evaluating acupuncture indicate a possible clinical effect on allergic rhinitis. This study compared active versus sham acupuncture in 40 consecutive patients with a history of allergic rhinitis and a positive skin test. Patients were randomized and assessed prior to treatment and then reassessed after 12 months. Improvements in symptoms using visual analogue scales, reduction in skin test reactions and levels of specific immunoglobin E (IgE) were used to compare the effect of treatment. For one allergen, mugwort, a greater reduction in levels of specific IgE ( p =0.019, 0.039) and skin test reaction ( p =0.004) was seen in the group receiving active acupuncture compared to the group receiving sham acupuncture. However, this finding might be an artifact. No differences in clinical symptoms were seen between active versus sham acupuncture, thus the conclusion being that the effect of acupuncture on allergic rhinitis should be further evaluated in larger randomized studies.
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Ballabio C, Magni C, Restani P, Mottini M, Fiocchi A, Tedeschi G, Duranti M. IgE-mediated cross-reactivity among leguminous seed proteins in peanut allergic children. Plant Foods Hum Nutr 2010; 65:396-402. [PMID: 21080075 DOI: 10.1007/s11130-010-0199-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The immunological cross-reactivity among major protein- and oil-crops, including lupin, lentil, pea, peanut, kidney bean and soybean, has been studied by a combination of in vitro and in vivo experimental approaches: SDS-PAGE separations of legume protein extracts and immuno-blot revelations with 12 peanut-sensitive subjects' sera, Immuno-CAP and Skin Prick tests on the same subjects. The immuno-blotting data showed a wide range of IgE-binding responses both displayed by one subject towards different plant extracts and among subjects. Differences were both quantitative and qualitative. The prevalent responses of most subjects' sera were seen with peanut polypeptides, as expected, as well as with various polypeptides of the other legumes, the most recurrent of which were the basic subunits of the 11S globulins. The distribution of in vivo responses generally paralleled those obtained by in vitro approaches with strong responses elicited by peanut, lentil and pea protein extracts, especially by most sensitive subjects, thus providing a consistent overall set of results. In this work, the comparison of various approaches has allowed us to get an overall broad picture of the immunological cross-reactivities among proteins of widely used different seed species and to hypothesize the role of most conserved specific polypeptides.
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Affiliation(s)
- Cinzia Ballabio
- Department of Pharmacological Sciences, Università degli Studi di Milano, via Balzaretti 9, 20133, Milan, Italy
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Abstract
PURPOSE To evaluate the diagnostic accuracy of the atopy patch test (APT) in detection of delayed-type sensitization to different food allergens, in children with digestive symptoms and with/or without cow's milk allergy. MATERIAL AND METHODS 28 children suspected of food allergy-related gastrointestinal symptoms were underwent diagnostic procedures as skin prick test (SPT), specific immunoglobulin E (sIgE), APT, oral food challenge and then divided into two groups according to the results of oral food challenge: A - 17 children with cow's milk allergy, B - 11 children without cow's milk allergy. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of APT were calculated. RESULTS A positive challenge response to milk was found in 60,7% of examined children. No statistical difference in the prevalence of positive SPT and sIgE to milk has been found between the groups. The prevalence of positive APT to other food allergens was significantly higher in children with allergy to milk (p<0,005). No statistical difference of positive APT to other food allergens has been found in children with/or without cow's milk allergy. APT sensitivity and specificity in children with cow's milk allergy obtained on 77%/73%; where PPV obtained on 71%. CONCLUSIONS High sensitivity and specificity of APT confirm its accuracy in diagnostics of delayed-type reactions in children with gastrointestinal symptoms. Combined atopy patch test and oral food challenge is essential for avoidance of unnecessary elimination diet. Delayed-type sensitization to other food allergens is common in children with cow's milk allergy.
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Tripodi S, Di Rienzo Businco A, Alessandri C, Panetta V, Restani P, Matricardi PM. Predicting the outcome of oral food challenges with hen's egg through skin test end-point titration. Clin Exp Allergy 2009; 39:1225-33. [DOI: 10.1111/j.1365-2222.2009.03250.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fiocchi A, Sarratud P, Terracciano L, Vacca E, Bernardini R, Fuggetta D, Ballabio C, Duranti M, Magni C, Restani P. Assessment of the tolerance to lupine-enriched pasta in peanut-allergic children. Clin Exp Allergy 2009; 39:1045-51. [DOI: 10.1111/j.1365-2222.2009.03199.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Skin prick test (SPT) is usually considered to be a safe procedure, but recently there have been occasional case reports of generalized allergic reactions. This study was performed to delineate the prevalence of, and evaluate possible risk factors for, adverse reactions to SPT in a prospective study. Altogether 5,908 patients aged < or =18 yr from 11 different pediatric settings were included. The adverse reactions were classified into two groups: (1) Generalized allergic reactions (GAR), (2) Vasovagal reactions (VVR). Adverse reactions were observed in 14 out of 5,908 children examined with SPT. Seven of the adverse reactions were GARs and required medication, yielding a 0.12% risk for GAR. Seven of 14 were VVRs, giving the same risk, 0.12%. Identified risk factors for GAR were low age (<1 yr) (RR 6.28) and active eczema (RR 16.98). For VVR, the risk factors were female sex (RR 7.32) and multiple skin pricks performed on a single patient (p < 0.05). We conclude that GARs do occur, albeit rarely, so the need for proper emergency handling should always be acknowledged. The risk factors suggested may help to identify patients who need extra attention.
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Affiliation(s)
- Gunilla Norrman
- Pediatric Clinic, Hudiksvall Hospital, Hudiksvall S-824 81, Sweden.
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Esposito S, Gasparini C, Martelli A, Zenga A, Tremolati E, Varin E, Marseglia GL, Fiocchi A, Principi N. Safe administration of an inactivated virosomal adjuvanted influenza vaccine in asthmatic children with egg allergy. Vaccine 2008; 26:4664-8. [PMID: 18639601 DOI: 10.1016/j.vaccine.2008.06.095] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2008] [Revised: 06/11/2008] [Accepted: 06/29/2008] [Indexed: 10/21/2022]
Abstract
In order to evaluate whether the virosomal adjuvanted influenza vaccine that has been shown to have the lowest egg protein content (Inflexal V, Berna Biotech) could be administered to children with even severe egg allergy without any risk of allergic reactions, we used epicutaneous skin testing with the undiluted vaccine in 88 asthmatic children (44 with and 44 without egg allergy), none of whom had a positive response. They were then vaccinated with the whole dose of Inflexal V intramuscularly in a one-dose protocol, and the occurrence of any immediate or delayed adverse events were actively monitored for 28 days. The results showed the safety of the administration, and demonstrated that Inflexal V can be safely given without performing a vaccine skin test in children with any kind of egg allergy.
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Affiliation(s)
- Susanna Esposito
- Institute of Pediatrics, University of Milan, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via Commenda 9, 20122 Milan, Italy
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Abstract
BACKGROUND Allergy to heat stable potato proteins can cause severe allergic disease in children. OBJECTIVE To study diagnostic criteria for allergy to cooked potatoes and to describe its clinical characteristics and natural history. METHODS Thirty-six children, aged 4-36 months, with atopic symptoms and having a positive potato-CAP and/or skin prick test (SPT) were included. Potato allergy was documented by means of provocation, or elimination and reintroduction or an unequivocal clinical history. Potato-CAP and SPT with a commercial extract were evaluated for diagnostic performance. RESULTS Presenting symptoms in children with proven potato allergy (n = 17) were eczema (16 of 17), gastrointestinal complaints (eight of 17), urticaria and/or angioedema (five of 17), wheezing/rhinitis (three of 17) and anaphylaxis (two of 17). Fifteen children had previously diagnosed cow's milk protein allergy and were egg-sensitized. Potato-CAP at cut-off >2 kU/l provided a 100% sensitivity and a 62.5% specificity for diagnosis of potato allergy, while a SPT score >/= 3 had a 100% sensitivity and a score >/= 4 had a 100% specificity. Tolerance to cooked potato was achieved in 80% of subjects at age 16-102 months. Of 12 subjects having reached the age of 3 years during the study, 10 were re-evaluated at age 3-6 years: seven of 10 subjects had developed clinical pollen allergy, compared with four of 18 atopic controls (P < 0.05). CONCLUSIONS Potato-CAP and SPT at specific cut-off are valuable tools in the diagnosis of allergy to cooked potato. Most children with potato allergy develop tolerance at mean age of 4 years. Allergy to cooked potatoes is a risk factor for the development of pollen allergy.
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Affiliation(s)
- L F A De Swert
- Pediatric Allergy, Department of Pediatrics, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
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Skjold T, Nielsen SC, Adolf K, Hoffmann HJ, Dahl R, Sigsgaard T. Allergy in bakers’ apprentices and factors associated to non-participation in a cohort study of allergic sensitization. Int Arch Occup Environ Health 2006; 80:458-64. [PMID: 17021842 DOI: 10.1007/s00420-006-0151-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Accepted: 09/04/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the prevalence of atopy and respiratory symptoms among baker apprentices at the start of the education and factors associated with non-participation in the study. METHODS A total of 346 students, 22.1(0.6) years of age, mean (SD), from the food production programme of technical colleges in Denmark were invited to participate in a 3 year study. Of the students, 187 agreed to participate and filled in a physician-administered questionnaire. The presence of atopy was determined by skin prick test (SPT) and serum allergen specific IgE (SpIgE). Bronchial hyper responsiveness to methacholine (PD(20) <or= 1,440 microg) was determined. RESULTS Prevalence of atopy was 32%. The prevalence of symptoms from the lungs and nose was 19.8 and 25.5%, respectively. Significantly, more SPT reactions were seen in males compared to females (39 vs. 22%, P < 0.05). Sensitization towards flour was significantly more frequent if determined as SpIgE (7.3%) compared to SPT (0.5%). We found a positive association between atopy and lung symptoms OR 6.1 (2.8-13.2 SD) and nasal symptoms OR 3.7 (1.8-7.5 SD). The major reason for non-participation was fear of blood sampling (25.5%). CONCLUSION The prevalence of atopy in bakers' apprentices was of the same magnitude in the general Danish population. Significantly, more male bakers' apprentices had atopy. This finding has major impact on the diagnostic procedures of occupational allergy in bakery workers emphasizing the need for standardization of the clinical tests. The main reasons for non-participation were, fear of blood-sampling (57%) and the 3 years commitment to the follow-up study (39%).
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Affiliation(s)
- Tina Skjold
- Department of Respiratory Medicine, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark.
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van Ree R, Vieths S, Poulsen LK. Allergen-specific IgE testing in the diagnosis of food allergy and the event of a positive match in the bioinformatics search. Mol Nutr Food Res 2006; 50:645-54. [PMID: 16764014 DOI: 10.1002/mnfr.200500268] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Current documents on risk assessment of genetically modified foods recommend including IgE-binding tests on sera from allergic patients. However, there is no generally accepted recommendation on technical aspects of the testing procedures or on the interpretation of the results, despite that fact that both false positive and false-negative results may be caused by variability of the test procedures. The present article discusses the state-of-the-art of serological test procedures for qualitative and quantitative determination of specific IgE and interpretation of test results. It is emphasized that the use of sera from clinically well-characterized subjects is of high importance. In the case of a positive test result, the biological activity of the detected IgE antibodies, i. e., the potential to trigger mediator release from basophils or mast cells in an allergen-specific manner, should be taken into account. However, present data also indicate that validation of such mediator release tests is required, both in terms of experimental protocols and with respect to correlation of the test results with the clinical situation. Further studies are also required to prove the usefulness of targeted serum screening, i. e., the testing of gene products from organisms not known to be allergenic with sera from subjects allergic to related species.
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Fiocchi A, Restani P, Bernardini R, Lucarelli S, Lombardi G, Magazzù G, Marseglia GL, Pittschieler K, Tripodi S, Troncone R, Ranzini C. A hydrolysed rice-based formula is tolerated by children with cow's milk allergy: a multi-centre study. Clin Exp Allergy 2006; 36:311-6. [PMID: 16499641 DOI: 10.1111/j.1365-2222.2006.02428.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children allergic to cow's milk are fed a soy- or a hydrolysed cow's milk-based substitute. Neither can rule out a sensitization risk. Previous studies have shown that hydrolysed rice is tolerated by animals and children with multiple food hypersensitivities. OBJECTIVE A prospective clinical assessment of tolerance to a rice-based hydrolysed formula was carried out in children allergic to cow's milk. Patients and methods One hundred children (42 girls and 58 boys, mean age 3.17+/-2.93 years, median 2.20, range 0.18-14.6 years) with a history of immediate reactions to cow's milk and confirmed at double-blind, placebo-controlled food challenge (DBPCFC) when not contraindicated were assessed for clinical tolerance to cow's milk proteins. Their allergy work-up included skin prick tests with whole milk, alpha-lactalbumin (ALA), beta-lactoglobulin (BLG) and total caseins, and specific IgE determinations using CAP technology were performed against whole milk, ALA, BLG and casein. Sensitization to rice and rice-based hydrolysed formula was similarly investigated. Patients' sera were evaluated at immunoblotting for specific IgE to cow's milk proteins, rice and rice-based hydrolysed formula. DBPCFC was carried out with increasing doses of a rice-based hydrolysed formula. RESULTS All patients were sensitized to cow's milk and/or at least one cow's milk protein fraction. Eighty-seven out of 99 were positive to cow's milk and/or a cow's milk protein fraction at skin prick test. Positive (>0.35 kUA/L) specific IgE determinations were found for cow's milk and/or milk fractions (92/95), rice (21/91) and hydrolysed rice infant formula (4/91). At immunoblotting, sera from 96 children were positive to alpha-casein (n=54), beta-casein (n=38), ALA (n=57), BLG (n=37) and bovine serum albumin (n=61). Similarly, although patients' sera often contained specific IgE against rice proteins at CAP (21/91) and immunoblotting (70/96), only six very weakly positive responses were observed against rice-based hydrolysed formula. All DBPCFC with rice-based hydrolysed formula were negative. CONCLUSIONS Rice-based hydrolysed formula is a possible alternative not only for children with multiple allergies, but also for children with cow's milk allergy.
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Abstract
AIM To evaluate common methods of investigation and treatment in children younger than 2 y of age with eczema, with or without sensitization to food allergens. METHODS One hundred and twenty-three children younger than 2 y of age with eczema and suspected food allergy were included in this prospective study. The children underwent skin-prick test with cow's milk, fresh hen's egg white and wheat. Specific IgE to milk and egg white was analysed. The eczema extent and severity was estimated with SCORAD before and after treatment. Children with a positive skin-prick test were instructed to exclude that food item from their diet. All children were treated with emollients and topical steroids when needed. RESULTS Sixty-two of the children were skin-prick positive to at least one of the allergens; 62% had mild, 30% moderate and 8% severe eczema at their first visit. After treatment, 90% had mild, 10% moderate and 0% severe eczema. Forty-six per cent of the children had circulating IgE antibodies to milk or egg white. Ten per cent had specific IgE but negative skin-prick test to the same allergen. This subgroup improved their eczema significantly without elimination diet. CONCLUSION The conventional treatments for children with eczema, i.e. skin care and food elimination, are effective. The beneficial effect of skin care as the first step should not be neglected, and it may not be necessary to eliminate food allergens to relieve skin symptoms in all food-sensitized children with eczema.
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Affiliation(s)
- Gunilla Norrman
- Department of Molecular and Clinical Medicine, Division of Paediatrics, Linköping University, Sweden.
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Muraro A, Dreborg S, Halken S, Høst A, Niggemann B, Aalberse R, Arshad SH, von Berg A, Carlsen KH, Duschén K, Eigenmann P, Hill D, Jones C, Mellon M, Oldeus G, Oranje A, Pascual C, Prescott S, Sampson H, Svartengren M, Vandenplas Y, Wahn U, Warner JA, Warner JO, Wickman M, Zeiger RS. Dietary prevention of allergic diseases in infants and small children. Part II. Evaluation of methods in allergy prevention studies and sensitization markers. Definitions and diagnostic criteria of allergic diseases. Pediatr Allergy Immunol 2004; 15:196-205. [PMID: 15209950 DOI: 10.1111/j.1399-3038.2004.00128.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The role of primary prevention of allergic disease has been a matter of debate for the last 40 years. In order to shed some light into this issue a group of experts of the Section of Pediatrics EAACI critically reviewed the existing literature on the subject. The design of observational and interventional studies was evaluated with relevance to the important factors influencing outcome of studies on allergy development/prevention. in this analysis the statements of evidence as defined by WHO were applied. Best evidence of recommendations are those fulfilling the criteria for statements category 1 and 2 and grade of recommendations A and B as proposed by WHO. This survey include target group for dietary prevention and methods and diagnostic criteria of atopic dermatitis, asthma and food allergy for prevention studies.
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Muraro A, Dreborg S, Halken S, Høst A, Niggemann B, Aalberse R, Arshad SH, Berg Av AV, Carlsen KHK, Duschén K, Eigenmann P, Hill D, Jones C, Mellon M, Oldeus G, Oranje A, Pascual C, Prescott S, Sampson H, Svartengren M, Vandenplas Y, Wahn U, Warner JA, Warner JO, Wickman M, Zeiger RS. Dietary prevention of allergic diseases in infants and small children. Part I: immunologic background and criteria for hypoallergenicity. Pediatr Allergy Immunol 2004; 15:103-11. [PMID: 15059185 DOI: 10.1046/j.1399-3038.2003.00129.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The role of primary prevention of allergic diseases has been a matter of debate for the last 40 years. In order to shed some light into this issue, a group of experts of the Section of Pediatrics EAACI critically reviewed the existing literature on the subject. In this paper, the immunology of the fetus and newborn is reviewed as well as the post-natal development of the immune system. The influence of post-natal environment and breastfeeding on tolerance induction and sensitization are examined. Allergic diseases result from a strong relationship between genetic and environmental factors. Sensitization to food allergens occurs in the first year of life and cow's milk allergy is the first food allergy to appear in the susceptible infants. Hypoallergenicity of food formulas to be used is a critical issue both for treatment of cow's milk-allergic children and for prevention. Methods to document hypoallergenicity are discussed and evaluated in the preclinical and clinical steps.
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Calvani M, Alessandri C, Sopo SM, Panetta V, Tripodi S, Torre A, Pingitore G, Frediani T, Volterrani A. Infectious and uterus related complications during pregnancy and development of atopic and nonatopic asthma in children. Allergy 2004; 59:99-106. [PMID: 14674941 DOI: 10.1046/j.1398-9995.2003.00338.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND It has been suggested that environmental factors early in life, particularly related to hygiene and infections, seem to be involved in the increase of asthma and allergic disease observed recently in developed countries. The possible effect of these factors also in utero have yet to be completely clarified. The aim of this study was to investigate the association between infective and uterus related complications during pregnancy, as well as related drug factors, with atopic and nonatopic asthma in children. METHODS This was a case-controlled study enrolling 338 children with asthma and 467 controls, who had never suffered from wheeze or asthma. Fever episodes, flu episodes, threatened abortions and related drug factors were retrospectively assessed by parental report via a standardized questionnaire. Atopy was determined by skin-prick tests to 10 prevalent allergens at the time of examination. RESULTS Flu episodes during pregnancy were significantly associated with development of asthma in children [adjusted odds ratio (aOR) 1.91; 95% confidence interval (95% CI) 1.1-3.2], mainly with nonatopic asthma. Fever episodes showed similar results (aOR 2.16; 95% CI 1.2-3.9), but were associated with both atopic and nonatopic asthma. The effect seems mainly due to flu and fever episodes contracted in the third trimester. Exposure to isoxsuprine was significantly associated with asthma (aOR 1.54; 95% CI 1.08-2.19) while threatened abortions were more frequent in the asthma group than in controls, although the difference was statistically significant only when such events occurred in the second trimester (aOR 2.06; 95% CI 1.07-3.94). Both threatened abortions and exposure to isoxsuprine were associated only with nonatopic asthma. CONCLUSIONS This study confirms that prenatal infective complications may contribute to the development of asthma in children and show a possible role for a new risk factor for asthma, that is exposure to isoxsuprine. Therefore, larger prospective studies, capable of separating atopic and nonatopic asthma, would serve to confirm these results and to explain the possible mechanism through which these factors may act.
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Affiliation(s)
- M Calvani
- Department of Pediatrics, San Camillo de Lellis Hospital, Rome, Italy
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Høst A, Andrae S, Charkin S, Diaz-Vázquez C, Dreborg S, Eigenmann PA, Friedrichs F, Grinsted P, Lack G, Meylan G, Miglioranzi P, Muraro A, Nieto A, Niggemann B, Pascual C, Pouech MG, Rancé F, Rietschel E, Wickman M. Allergy testing in children: why, who, when and how? Allergy 2003; 58:559-69. [PMID: 12823111 DOI: 10.1034/j.1398-9995.2003.00238.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ricci G, Capelli M, Miniero R, Menna G, Zannarini L, Dillon P, Masi M. A comparison of different allergometric tests, skin prick test, Pharmacia UniCAP and ADVIA Centaur, for diagnosis of allergic diseases in children. Allergy 2003; 58:38-45. [PMID: 12580805 DOI: 10.1034/j.1398-9995.2003.23761.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The diagnosis of allergic disease is performed by skin prick tests (SPT) or through the demonstration of specific IgE in a blood sample via an in vitro test. The measurement of IgE concentration against allergens provides critical information in clinical allergy. Standardized and reproducible methods contribute to the quality of diagnosis and treatment of allergic disease. METHODS In this study we evaluated the performance of a new specific IgE method, developed by ALK-Abellò for Bayer Diagnostics to run on their ADVIA Centaur immunoassay system. One hundred and fifty-one children with allergic diseases (both food and inhalant allergies) were tested for specific IgE (sIgE) via SPT and in vitro tests (UniCAP system, Pharmacia, and ADVIA Centaur immunoassay system, Bayer Diagnostics) and the test results were correlated with the clinical data. RESULTS Statistical analysis revealed no significant difference between the two in vitro tests compared with clinical history. The sensitivities and specificities are similar, but the UniCAP system method has higher sensitivity. In the children with cow's milk allergy, the UniCAP system has sensitivity of 91% and specificity of 70%; the ADVIA Centaur immunoassay has sensitivity of 82% and specificity of 74%. In hen's egg allergy, UniCAP system has 94% sensitivity and 64% specificity, and the ADVIA Centaur system has 88% sensitivity and 52% specificity. In inhalant allergies, the two methods show statistically similar performances for both grass pollen allergies (UniCAP sensitivity 100%, specificity 73%; ADVIA Centaur sensitivity 95%, specificity 79%) and in the dust mites allergies (UniCAP sensitivity 91%, specificity 62%; ADVIA Centaur sensitivity 86%, specificity 64%). In cat allergies, the systems showed equivalent results (UniCAP sensitivity 100%, specificity 71%; ADVIA Centaur sensitivity 100%, specificity 70%). Using the UniCAP system, the geometric mean of sIgE values in children with clinical allergy is significantly higher than in sensitized ones. The ADVIA Centaur system shows a similar trend with the exclusion of cow's milk and Dermatophagoides farinae allergens. With this last method the mean value of sIgE is higher in sensitized than in symptomatic children. CONCLUSION The new ADVIA Centaur method compares favorably with the results obtained on the UniCAP system. If other studies continue to confirm this data, then the advantages are numerous: the use of only a small quantity of serum (25 micro l per allergen), rapid turnaround time, minimal hands-on time, and no interference from IgG.
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Affiliation(s)
- G Ricci
- Department of Paediatrics, University of Bologna, Italy
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