What is serum allergy test

Pneumococcal antisera from SSI Diagnostica are intended forin vitro diagnostic testing in clinical microbiological laboratories, in reference laboratories, and in the pharmaceutical industry for the quality control of vaccines. Every antisera are polyclonal and produced by immunising rabbits with well-defined reference strains. The specific pool, group and type antisera are absorbed free of cross-reactions. Factor antisera are absorbed free of cross-reactions within the group.


Special InstructionsLibrary of PDFs including pertinent information and forms related to the test

Assessing sensitization to various inhalant allergens commonly found in sub-tropic Florida, which is south of Orlando

Immunoglobulin E (IgE) is one of the 5 classes of immunoglobulins, and is defined by the presence of the epsilon heavy chain.

It is the most recently described immunoglobulin, having first been identified in 1966. IgE exists as a monomer, and is present in circulation at extremely low concentrations, approximately 300-fold lower than that of IgG. The physiologic role of IgE is not well characterized, although it is thought to be involved in defense against parasites, specifically helminthes.

The function of IgE is also distinct from other immunoglobulins in that it induces activation of mast cells and basophils through the cell-surface receptor Fc epsilon RI. Fc epsilon RI is a high-affinity receptor specific for IgE present at a high density on tissue-resident mast cells and basophils.

Because of this high-affinity interaction, almost every IgE produced by B cells is bound to mast cells or basophils, which explains the low concentration present in circulation. Cross-linking of the Fc epsilon RI -bound IgE leads to cellular activation, resulting in immediate release of preformed granular components (histamine and tryptase) and subsequent production of lipid mediators (prostaglandins and leukotrienes) and cytokines (interleukin-4 and interleukin-5).

Elevated concentrations of IgE may happen in the context of allergic disease. However, increases in the quantity of circulating IgE can also be found in various other diseases, including primary immunodeficiencies, infections, inflammatory diseases, and malignancies.

Entire IgE measurements own limited utility for diagnostic evaluation of patients with suspected allergic disease. In this scenario, testing for the presence of allergen-specific IgEs may provide more information.

Clinical manifestations of allergic disease result from activation of mast cells and basophils, which occurs when Fc epsilon RI -bound IgE antibodies interact with allergen.

In vitro serum testing for specific IgE antibodies may provide an indication of the immune response to an allergen that may be associated with allergic disease.

The allergens chosen for testing often depend upon the age of the patient, history of allergen exposure, season of the year, and clinical manifestations.

Sensitization to inhalant allergens (dust mite, mold, and pollen inhalants) primarily occurs in older children, adolescents, and adults, and generally manifests as respiratory disease (rhinitis and asthma).

Specific IgE:

Class

IgE kU/L

Interpretation

0

<0.35

Negative

1

0.35-0.69

Equivocal

2

0.70-3.49

Positive

3

3.50-17.4

Positive

4

17.5-49.9

Strongly positive

5

50.0-99.9

Strongly positive

6

> or =100

Strongly positive

Reference values apply to every ages.

Total IgE:

Results Reported in kU/L

Age

Reference interval

0-5 months

< or =13

6-11 months

< or =34

1 and 2 years

< or =97

3 years

< or =199

4-6 years

< or =307

7 and 8 years

< or =403

9-12 years

< or =696

13-15 years

< or =629

16 and 17 years

< or =537

18 years and older

< or =214

Elevated concentrations of entire IgE may be found in a variety of clinical diseases, including allergic disease, certain primary immunodeficiencies, infections, inflammatory diseases, and malignancies.

Detection of allergen-specific IgE antibodies in serum (Class 1 or greater) indicates an increased likelihood of allergic disease as opposed to other etiologies and defines the allergens that may be responsible for eliciting signs and symptoms.

An elevated concentration of entire IgE is not diagnostic for allergic disease, and must be interpreted in the clinical context of the patient, including age, gender, travel history, potential allergen exposure, and family history.

A normal concentration of entire IgE does not eliminate the possibility of allergic disease.

In patients with a high index of suspicion for allergic disease, testing for allergen-specific IgEs may be warranted.

Testing for allergen-specific IgE antibodies is not useful in patients previously treated with immunotherapy to determine if residual clinical sensitivity exists, or in patients in whom the medical management does not depend upon identification of allergen specificity.

Some individuals with clinically insignificant sensitivity to allergens may own measurable levels of IgE antibodies in serum, and results must be interpreted in the clinical context.

False-positive results for IgE antibodies may happen in patients with markedly elevated serum IgE (>2,500 kU/L) due to nonspecific binding to allergen solid phases.

1.

Homburger HA: Allergic diseases. In Clinical Diagnosis and Management by Laboratory Methods. 21st edition. New York, WB Saunders Company, 2007, pp 961-971

2. Bernstein IL, Li JT, Bernstein DI, et al: Allergy diagnostic testing: An updated practice parameter. Ann Allergy Asthma Immunol 2008 Mar;100(3 Suppl 3):S1-148

Allergy Diagnostic Testing

Updated: July 2014
Originally posted: November 2007

Dr. John Oppenheimer
Director of Clinical Research,
Pulmonary and Allergy Associates
Denville, NJ, USA

Prof.

Stephen Durham
Department Allergy and Respiratory Medicine,
Imperial College, London, UK

Dr. Harold Nelson
National Jewish Medical and Research Center
Denver, CO, USA

Dr. Ole D. Wolthers
Clinical Institute, Health, Aarhus University
Asthma and Allergy Clinic, Children’s Clinic Randers
Randers, Denmark

Credit for the first skin testing goes to Charles H. Blackley, who in 1865 abraded a quarter-inch area of his skin with a lancet, applied grass pollen on a piece of wet lint, and covered the scarified area with an occlusive bandage.

This resulted in intense itching and a extremely large cutaneous response.

Percutaneous skin test ranks first in confirming the presence of IgE-mediated sensitization in the allergist's office. This should come as no surprise, as it has numerous advantages.

What is serum allergy test

Skin testing is minimally invasive, and when it is performed correctly it has excellent reproducibility, is easily quantified, and allows the evaluation of multiple allergens at one session. The results correlates within vivochallenges.in vitrotesting is an alternative, generally a back up tool for diagnosing allergic illness. Skin testing alone or in combination within vitrotesting is relied upon for the evaluation of allergic rhinitis, asthma, eczema, food allergy, insect sting allergy, drug allergy (especially beta-lactam and local anesthetic allergy), occupational disease and anaphylaxis.

However, the reliability of these tests depends on a number of factors. In the case of skin testing, it is significant that the technician performing the skin tests and the clinician ordering or interpreting these tests are aware of the advantages and pitfalls of the type of skin testing, the device used, the location of the tests on the body, the extracts used and the potential for suppression of the skin response by medications used to treat allergies or depression. These issues own been reviewed elsewhere in greater detail.1Forin vitrotesting, it is imperative that quality standards be met.

These include calibration of the assay, training and experience of the technician and the use of quality allergens in the solid phase.2As in any diagnostic test, it is of paramount importance that the clinician consider the positive and negative predictive worth of the tests performed. These tests should always be considered as adjuncts to the medical history and physical exam in formulating the diagnosis in each individual case, bearing in mind that both test types can yield untrue positive or, less commonly, untrue negative results.

Skin Testing Devices

Whereas intradermal skin tests are always performed using a hypodermic syringe and needle, percutaneous tests may be performed with a variety of devices.

Comparisons of percutaneous devices own been reviewed elsewhere in greater detail.5 Some devices own a single stylus with one or several points, whereas others own multiple heads and permit up to 10 tests to be accomplished with one application. The degree of skin trauma created by these devices for percutaneous testing varies and so may result in differences in the size of positive reactions, and the likelihood of producing a reaction at the site of the negative control. Thus, they require diverse criteria for what constitutes a positive reaction (see Table 1).

Table 1. Wheal size indicating a positive response to skin tests using various devices.a

a Positive response is defined as a wheal greater than 99% of wheals generated by the istration of saline to the subject's back by the same operator.

Adapted from ref. 14.
b HS = Hollister Steir, Greer = Greer laboratories, Lincoln = Lincoln Diagnostics, ALK = ALK America, ALO = Labs of Ohio

Methods of Skin Testing

Skin testing may be performed using either the prick/puncture (percutaneous) or intradermal (intracutaneous) technique. Intradermal testing is far more sensitive than prick/puncture testing, which means that it requires about 1000-fold less concentrated extracts than those used for prick/puncture testing to achieve a similar response. Although direct comparisons indicate that intradermal testing is more reproducible than percutaneous testing, there are numerous factors that favor the routine use of percutaneous allergy tests.

These include economy of time, patient comfort and patient safety. Percutaneous testing allows the use of extract in 50% glycerin, which provides greater extract stability. Intradermal testing cannot use this diluent, as it may incite a false-positive irritant response. However, the most significant consideration is that results of percutaneous testing correlate better with clinical allergy. The higher sensitivity of intradermal skin tests does not generally offer added benefit, since the results of skin prick tests performed with potent extracts are of sufficient sensitivity for use in clinical practice.

Two studies reinforce this concept.3,4Each study compared intradermal with skin prick tests by correlating their results with patients' responses to natural exposure to allergen as well as by allergen challenge testing.

In the first study, three groups of patients with seasonal rhinitis were compared. These subjects were classified into 3 groups based on their degree of sensitization to Timothy grass pollen. They were either skin prick test positive, only intradermal test positive, or were negative by both skin prick and intradermal testing. Both nasal allergen provocation testing and symptom scores during the pollen season correlated best with a positive skin prick test (>60% of subjects with positive skin prick tests had symptoms on allergen exposure).

The frequency of positive nasal provocation (11%) and symptom scores (21%) in subjects with positive intradermal testing alone were not diverse from subjects who were skin prick test and intradermal test negative. The authors conclude that under the conditions of this study, the presence of a positive intradermal skin test response to Timothy grass in the presence of a negative skin prick test did not indicate the presence of clinically significant sensitivity to this grass.

In the second study, patients were challenged with cat exposure for one hour.4Both positive skin prick tests andin vitrotests to cat were highly predictive of the development of symptoms upon allergen exposure in the cat challenge room.4Subjects with a negative skin prick test were just as likely to own a positive challenge result if they had a negative intradermal skin test (31%) as subjects with a positive intradermal skin test (24%).

The authors conclude that, at least with regard to cat allergy, major therapeutic decisions, such as environmental control or immunotherapy, should never be based on a positive intradermal skin test alone.

Both of these studies were performed in adults and both relied upon skin testing with relatively potent allergens (Timothy grass and cat). The clinical applicability of these results to less potent allergens, such as dog, or to younger patients (especially infants) is a matter of clinical judgment, because no specific evidence is available for these groups.

Recording and Scoring of Skin Test Results

Skin test results are often reported by clinicians in semi-quantitative terms.

They may record results only as positive or negative, or express them on a 0 to 4+ scale without any indication of the size of the reactions that these numbers represent. However, allergy patients may own to change their allergist for numerous reasons, and it is significant that records of prior allergy testing be interpretable by the receiving physician. At the extremely least, a record of skin testing should contain sufficient information to permit another physician to interpret the results and avoid the need to repeat skin testing. Standardized forms own been developed and are available through the American Academy of Allergy Asthma and Immunology website (for an exampleAAAAI's Skin Test and Immunotherapy Forms).

Although the area of the wheal and erythema are the most precise measurements, the longest diameter or two diameters at correct angles to each other correlate with area (r > 0.9).8The importance of performing such measurements is exemplified by the study of McCann and Ownby in which allergists were asked to interpret photographs of skin test reactions.

The scoring and interpretation of the skin test results varied greatly.9The authors of this study reinforce the thought that the most dependable method of reporting a skin test reaction is to measure and record the reaction size. At the extremely minimum, skin test results should be graded 0 to 4+, and the criteria for each grade of reaction clearly stated along with the skin test results.

Various investigators propose diverse criteria for interpreting a skin test response as positive. To assess the reliability of diverse means of interpreting the results of skin prick testing, Vanto and colleagues studied a group of 202 children sensitive to dogs.10A determination of sensitivity to dog was based on a composite score derived from the history, RAST, and bronchial or conjunctival allergen challenges.

Although in this study the overall efficacy was greatest with the histamine reference method (in which the allergy skin test response is compared to a histamine control, with a positive response considered to be a response at least as grand as that of the histamine control), maximal sensitivity was achieved when using a cutoff of a wheal 3 mm. If a clinician wishes to maximize sensitivity, the latter criterion would be most useful; however, adjustment must be made for the device used. Therefore, the criteria for a positive test should be: 1) the larger of a 3 mm mean wheal diameter or 2) equal to or greater than the 99th percentile reaction with that device at negative control sites (see Table 1).

Proficiency Testing

Like every other laboratory tests, it is imperative that quality assurance standards be met to ensure that the testing technique produces precise results.

To confirm such standards, it is recommended that every technicians performing skin testing undergo evaluation of their technique.11 Certainly, it would be comforting to know that skin test technicians achieve some degree of consistency in skin test performance. Although there are no formal standards available for skin test proficiency testing, several publications propose some possible criteria. European publications propose a coefficient of variation of less than 20% following repeated skin test control applications, and the Childhood Asthma Management Program study requires that a coefficient of variation of less than 30% be attained with repeated testing with histamine and consistently negative reactions to saline to confirm proficiency in skin testing.

The National Committee for Clinical Laboratory Standards recommends quality control procedures for daily performance ofin vitroallergy testing, with a recommended coefficient of variation of less than or equal to 15%.2Even with such calibration and the increased use of automation,in vitroassays still own flaws.

Williams and colleagues examined the performance of 6 large commercial laboratories on tests of blinded samples of the same sera, both diluted and non-diluted.12They found that only two of the laboratories demonstrated acceptable precision and accuracy.

Comparing in vivo to in vitro Testing:

The preponderance of comparative studies protest skin tests to be more sensitive thanin vitrotests. However, the majority of these studies were performed with earlier generationin vitrotests.

The newerin vitrotests produce higher test sensitivity and specificity13by using a matrix capsule containing antigen bound to a hydrophilic carrier to produce enhanced specific IgE binding with lower nonspecific IgE binding.2Levels of specific IgE measured by diverse commercial assays are not equivalent, as each assay differs in the composition of allergen reagents, methods of measurement and standardization procedures.

The advantages ofin vitrotesting are largely related to use in patients with extensive dermatoses (e.g., atopic dermatitis), resulting in an inability to act out tests on unaffected skin, or in patients who are unable to discontinue medicines that block the histamine response, i.e., antihistamines or tricyclic antidepressants.

The disadvantages ofin vitrotesting include a potential decrease in sensitivity, added cost, and lack of immediate and visible response. Performing bothin vitroandin vivotests may yield improved sensitivity.15

"Gold Standard" Confirmation of Allergy

Although there are challenge protocols available in the research setting to confirm allergic rhinitis and asthma, the standard tool available to the clinician is a careful history and physical exam. Skin testing correlates with results of nasal challenge and with bronchial challenges when allowance is made for nonspecific airway responsiveness.

When evaluating potential food allergy, the clinical history is the initial screening, with skin testing orin vitrotests used to corroborate the history.

Oral food challenges represent the "gold standard" for the confirmation of food allergy. These can be performed as open challenges or in a single- or double-blind fashion. Food challenges are not without risk and thus require that appropriate supportive care be available. Several studies protest that the magnitude of thein vitrotest or the skin test reaction size may be useful in determining the utility of performing a food challenge.16,17One additional advantage of skin testing for food allergies is the ability to act out skin testing with the unused food, "prick-prick" test.

Several reports protest that unused foods provide greater sensitivity for certain foods.18, 19This is particularly significant in assessing allergy to fruit; however, useful results own also been demonstrated for other foods, including seafood, peanut, tree nuts, vegetables, milk and eggs.

Molecular-based allergy diagnostic

It is hoped that the predictive worth of allergy diagnostic testing can be improved with the use of molecular-based allergy diagnostics. This methodology is used to map the allergen sensitization of a patient at the epitope level, using purified natural or recombinant allergenic molecules (components) 20,21Molecular-based allergy diagnostics is available either using singleplex platforms which utilize panels of single allergens together with the corresponding allergen extract or can also be performed using multiplex technology to measure serum IgE antibodies against multiple allergens in a single assay 20-22 The technique allows for the testing of a large number of allergens using a little quantity of serum (as little as 20 µL; conventional specific IgE tests use 50 µL per allergen).

Currently one multiplex platform is available on the market (the Immuno-Solid phase Allergen Chip (ISAC) platform) 23,24 Though a higher degree of variability in low IgE levels own been found, ISAC results own been similar to those obtained from singleplex platforms 25,26 At low serum IgE levels singleplex platforms may be more sensitive than ISAC and thus this should be considered when interpreting testing using the ISAC. Although more than 130 epitopes own been identified, the clinical relevance of numerous of these is not known. Evidence, however, has been provided for use of several epitopes in clinical practice, such as peanut.

In numerous cases of peanut sensitization detected solely by prick skin testing or by whole allergen specific IgE it is hard to decide whether true allergy exists versus sensitization with no clinical symptoms as a manifestation of cross reactivity to pollen.

In such cases there is excellent evidence for analyzing IgE to the epitopes Ara h 2 (genuine IgE mediated allergy) and Ara h 8 (Bet v 1 (birch pollen) homologue; a marker of cross-reactivity) 27,28 IgE sensitization to Ara h 2 often correlates with positive IgE against Ara h 1 and Ara h 3. If there were IgE antibodies in serum to Ara h 2 and/or Ara h 1/Ara h 3, more than 95% of patients own reported symptoms when ingesting peanuts 29 If there was IgE only to Ara h 2 and not to Ara h 1, 3 or 8, 87% reported symptoms. Whether there may be a threshold level of serum IgE to Ara h 2 above which peanut allergy may be diagnosed with a sufficient sensitivity and specificity which may forsake the need for oral provocation remains to be prospectively evaluated 30If there was only IgE to Ara h 8 and not to Ara h 1, 2 or 3 only around 18% of patients own reported symptoms, and these were generally extremely mild 29 More serious symptoms cannot be ruled out, however, in Ara h 8 sensitized patients.

In the event of itching and swelling in the mouth and throat both Ara h 2 and Ara h 8 should be sure, and, at the same time, assessment of sensitization to birch pollen should be made by analyzing IgE to Bet v 1.

Bet v 1, PR-10 protein is the major allergen in birch pollen and approximately 95% of birch pollen sensitized patients own specific IgE antibodies to Bet v 1 31 Specific IgE to Bet v 1 may also be found in patients with primary sensitization to other tree pollens (e.g. elm: Aln g 1; hazel pollen: Cor a 1) as well as to foods (hazelnut, apple, soy, peanut (Ara h 8), kiwi, celery). IgE antibodies to Bet v 2 (profilin) and/or Bet v 4 (calcium-binding protein) are markers of cross-reactivity 31 and as opposed to Bet v 1 if increased are indicators that the patient is primarily sensitized to another pollen.

IgE to Bet v 2 is a marker of cross-reactivity with numerous pollens and vegetable foods 32 while IgE to Bet v 4 is a marker of cross-reactivity only with other pollen allergens 33

IgE antibodies to Phl p 1 and Phl p 5 are specific markers for sensitization to Phleum pratense (Timothy grass). Phl p 7 (calcium-binding protein) and Phl p 12 (profilin) are markers of cross-reactivity with fruits and vegetables. Increased IgE to these components and not to Phl p 1 and/or Phl p 5 indicates primary sensitization to a diverse species of grass pollen than Phleum pratense 34 It has been suggested that if relevant symptoms are present in addition to elevated IgE Phl p 1 and p 5 levels immunotherapy with phleum pratense extract would likely be clinically effective because phleum pratense extracts contain mainly Phl p5 and p6 24,35

Molecular-based allergy diagnostics are also likely to be of utility when considering immunotherapy for dust mite allergy.

Der p 1 and Der p 2 are the most significant component markers for sensitization to home dust mites 36as more than 80-90% of patients allergic to home dust mites own IgE antibodies to these epitopes. Approximately 10% of patients allergic to home dust mites, however, own increased IgE levels to Der p 10 37 These patients will not benefit from specific immunotherapy since home mite extracts contain mainly Der p 1 and Der p 2 and variable or low amounts of Der p 10. Whether molecular-based allergy diagnostics may increase the effect ratio of immunotherapy of Phleum pratense and houst dust mite allergic patients has not, however, been tested in prospectively planned trials.

Positive IgE to both bee and wasp venom is often due to cross-reactivity between cross-reactive carbohydrate-determining reagents (CCD) 38 shared in these two species.

In the frequently occurring clinical situation of an uncertain history and positive IgE to both allergens, determination of specific molecular epitopes may be of aid. An increase in both Api m 1 and Ves v 5 would indicate a true double sensitization and immunotherapy with both bee and wasp extracts would be indicated 38,39

Understanding the paucity of data, a recent consensus document concluded that molecular-based allergy diagnosis may be considered for investigation of 20

  1. Williams, PB ; Barnes, J; Szeinbach, S; Sullivan, T Analytic precision and accuracy of commercial immunoassays for specific IgE: Establishing a standard J Every Clin Immunol 2000;105:1221-30
  2. Yunginger, J.

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  3. Vanto T. Efficacy of diverse skin test methods in diagnosis of allergy to dogs. Ann Every 1982:49:340
  4. patients and triggering allergens for specific immunotherapy, specifically
    — grass, (Phl p1, p5, p12)
    — home dust mites, (Der p1, p2, p10)
    — hymenoptera venom (Api m1; Ves v5).
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    Clin Exp Allergy 2003;33:956-61.

  7. Flinterman AE, van Hoffen E, den Hartog Jager CF et al. Children with peanut allergy recognize predominantly Ara h 2 and Ara h 6, which remains stable over time. Clin Exp Allergy 2007;37:1221-8.
  8. Liebermann JA, Glaumann S, Batelson S, Borres MP, Sampson HA, Nilsson C. The utility of peanut components in the diagnosis of IgE-mediated peanut allergy among distinct populations. J Allergy Clin Immunol Pract 2013; Jan;1(1):75-82. doi: 10.1016/j.jaip.2012.11.002.

    Epub 2012 Dec 27.

  9. selected cases of suspected peanut allergy, birch pollen allergy and associated cross-reactivity (Ara h2, h8 (h1, h3) (Bet v1, v2, v4).
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  11. Meliol G, Bonifazi F, Bonni S, et al. The ImmunoCAP ISAC molecular allergologyappraoch in adult multi-sensitized Italian parents with respiratory symptoms. Clin Biochem 2011; 44:1005-1011.
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    Allergy 2009;64:1030-7.

  13. Yoon I-K, Martin BL, Carr WW.

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    A comparison of two single-headed and two multi-headed allergen skin test devices. Allergy Asthma Proc 2006;27:473-8.

  14. Gadisseur R, Chapelle JP, Cavalier E: A new tool in the field of in-vitro diagnosis of allergy: preliminary results in the comparison of ImmunoCAP© with the ImmucoCAP© ISAC. Clin Chem Lab Med 2011;49:277-280.
  15. Bilo BM, Rueff F, Mobech H, Bonifazi F, Oude-Elberink JN. Diagnosis of hymenoptera venom allergy. Allergy 2005;60:1339-49.
  16. Sporik, R0, Hill DJ, Hosking, CS0 Specificity of allergen skin testing in predicting positive open food challenges to milk, egg and peanut in children.

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  32. patients with insect allergy (Api m1; Ves v5).
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    J Allergy Clin Immunol 2011:127:684-5.

  40. Eller E, Bindslev-Jensen C. Clinical worth of component-resolved diagnostics in peanut-allergic patients. Allergy. 2013 Feb;68(2):190-4. doi: 10.1111/all.12075. Epub 2012 Dec 14.
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Rather than classic testing, alternative molecular-based allergy diagnostics should be seen as an adjunct to the traditional whole allergen specific IgE tests.

It is significant to remember that numerous patients can still be sufficiently assessed using conventional prick skin testing or specific IgE to whole allergens in the blood in addition to a thorough history and clinical examination 20 The clinical significance of sensitization detected via molecular-based allergy diagnostics should only be used in relation to the clinical history and physical signs. ISAC testing is likely to be most useful in poly-sensitized patients for evaluation of sensitization to cross-reacting food and airborne allergens. Prospectively planned studies should be undertaken to determine to what extent such extensive panel screening may be helpful in clinical practice.

Robust evidence has not yet been provided to prove that molecular-based allergy diagnostics can be utilized in lieu of oral challenge testing in food allergy.

ConclusionDiagnostic testing remains an essential tool for the evaluation of the allergic patient. Several variables should be controlled to produce more dependable skin test results and improve the predictive values of allergy skin testing. It is also imperative that allergists ensure that the results of skin testing are dependable by conducting proficiency testing. In addition, the results must be properly documented to make them easily understandable by others.

Similar standards must be applied toin vitrotesting; as in the case of skin testing, it is imperative that the ordering physician be familiar with the operating characteristics that thein vitrolab employs. Lastly, it is likely that in the future, molecular based allergy diagnostics will frolic a bigger role in the evaluation of allergic patients.

References

  • Oppenheimer J, Nelson HS. Skin Testing. Ann Every Asthma Immunol.

    2006;96:S6-12.

  • Wood RA, Phipatanakul W, Hamilton RG, Eggleston PA. A comparison of skin prick tests, intradermal skin tests, and RASTs in the diagnosis of cat allergy. J Allergy Clin Immunol 103:773-9, 1999.
  • Williams, PB ; Barnes, J; Szeinbach, S; Sullivan, T Analytic precision and accuracy of commercial immunoassays for specific IgE: Establishing a standard J Every Clin Immunol 2000;105:1221-30
  • Nelson HS, Oppenheimer JJ, Buchmeier A, et al. An assessment of the role of intradermal skin testing in the diagnosis of clinically relevant allergy to timothy grass.

    J Allergy Clin Immunol 97:1193-1201, 1996.

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SSI Diagnostica offers a wide range of pneumococcus antisera

SSI Diagnostica offers a wide range of pneumococcus antisera


Clinical relevance

Serotyping of pneumococci is used for surveillance of serotype distribution in connection with pneumococcal vaccination of both children and adults.

Following the introduction of the various vaccines, an increased incidence of serotypes which were not previously so dominant has been observed.



Part Descriptions

LP17040-4 Parietaria judaica
Parietaria judaica (spreading pellitory) is a species of plant in the family Urticaceae, commonly nicknamed sticky-weed. The plant’s pollen is highly allergenic. In Australia it is also known as asthma weed, due to the high incidence of allergy.

It is unrelated to the herb pellitory (Anacyclus pyrethrum). It is easily confused with the extremely similar species Parietaria officinalis. Copyright Text is available under the Creative Commons Attribution/Share-Alike License. See http://creativecommons.org/licenses/by-sa/3.0/ for details.Source: Wikipedia, Wikipedia

LP17040-4 Parietaria judaica
Wall pellitory is a common weed around the Mediterranean and along the West coast of Europe as far north as central England.

It is found in Spain, Greece, Italy and Israel, and has been introduced in other parts of Western Europe and in Australia and Argentina. Two closely related species are found in the US and one in Brazil.

The genus Parietaria has about 10 species, which are highly cross-reactive to each other. Parietaria pollen allergens (officinalis, judaica, lusitanica, creatica) are one of the most common causes of pollinosis in areas where the plants grow. A shut correlation exists between the species P. judaica and P. officinalis.

In some geographical areas one species may dominate, and IgE antibodies to only one of the species can be found in sensitised individuals.

Wall pellitory pollen has been recognised as an significant allergen, causing symptoms of asthma, allergic rhinitis and allergic conjunctivitis. Rhinoconjunctivitis and bronchial asthma, alone or in association, represent the most common clinical manifestations of this allergy. Copyright Copyright © 2006 Phadia AB.Source: ImmunoCap, ImmunoCap

Testing for IgE antibodies may be useful to establish the diagnosis of an allergic disease and to define the allergens responsible for eliciting signs and symptoms.

Testing also may be useful to identify allergens which may be responsible for allergic disease and/or anaphylactic episode, to confirm sensitization to specific allergens prior to beginning immunotherapy, and to investigate the specificity of allergic reactions to insect venom allergens, drugs, or chemical allergens.

Clinical manifestations of immediate hypersensitivity (allergic) diseases are caused by the release of proinflammatory mediators (histamine, leukotrienes, and prostaglandins) from immunoglobulin E (IgE)-sensitized effector cells (mast cells and basophils) when cell-bound IgE antibodies interact with allergen.

In vitro serum testing for IgE antibodies provides an indication of the immune response to allergen(s) that may be associated with allergic disease.

The allergens chosen for testing often depend upon the age of the patient, history of allergen exposure, season of the year, and clinical manifestations.

In individuals predisposed to develop allergic disease(s), the sequence of sensitization and clinical manifestations proceed as follows: eczema and respiratory disease (rhinitis and bronchospasm) in infants and children less than 5 years due to food sensitivity (milk, egg, soy, and wheat proteins) followed by respiratory disease (rhinitis and asthma) in older children and adults due to sensitivity to inhalant allergens (dust mite, mold, and pollen inhalants).

Detection of IgE antibodies in serum (Class 1 or greater) indicates an increased likelihood of allergic disease as opposed to other etiologies and defines the allergens that may be responsible for eliciting signs and symptoms.

The level of IgE antibodies in serum varies directly with the concentration of IgE antibodies expressed as a class score or kU/L.

Testing for IgE antibodies is not useful in patients previously treated with immunotherapy to determine if residual clinical sensitivity exists, or in patients in whom the medical management does not depend upon identification of allergen specificity.

Some individuals with clinically insignificant sensitivity to allergens may own measurable levels of IgE antibodies in serum, and results must be interpreted in the clinical context.

False-positive results for IgE antibodies may happen in patients with markedly elevated serum IgE (>2,500 kU/L) due to nonspecific binding to allergen solid phases.

Homburger HA: Chapter 53: Allergic diseases.

In Clinical Diagnosis and Management by Laboratory Methods. 21st edition. Edited by RA McPherson, MR Pincus. WB Saunders Company, New York, 2007, Part VI, pp 961-971


Competence

Thanks to our numerous years of experience producing and serotyping pneumococci, we are capable to offer dependable advice and serotyping.


Quality

SSI Diagnostica’s antisera are high quality, CE-marked and produced in accordance with DS/EN ISO 13485. The shelf life is 4 years from the date of production, and a minimum of 2 years from delivery.


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