The relationship of allergen-specific IgE levels and oral food challenge outcome

Perry, Tamara T.; Matsui, Elizabeth C.; Conover-Walker, Mary Kay; Wood, Robert A.

doi:10.1016/j.jaci.2004.04.009

Cited by 305 publications

(232 citation statements)

References 18 publications

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“…In a large infant population with mild to moderate AD, 15.9% of patients developed food allergy during the study. Serum immunoglobulin E decision points had low positive predictive values, indicating that they are of limited use in this population.…”

Section: What This Study Addsmentioning

confidence: 99%

Food Allergy in Infants With Atopic Dermatitis: Limitations of Food-Specific IgE Measurements

et al. 2015

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BACKGROUND AND OBJECTIVES: Children with atopic dermatitis (AD) have a higher risk for development of food allergies. The objective of this study was to examine incidence of food allergy development in infants with AD and the predictive value of food-antigen-specific immunoglobulin E measurements.METHODS: This trial examined the long-term safety and efficacy of pimecrolimus cream 1% in .1000 infants (3-18 months) with mild-to-severe AD without a history of food allergy. Food allergy development was followed throughout a 36-month randomized double-blind phase followed by an open-label (OL) phase up to 33 months. Additionally, sIgE for cow's milk, egg white, peanut, wheat, seafood mix, and soybean was measured by ImmunoCAP at baseline, end of the double-blind phase, and end of OL phase.RESULTS: By the end of the OL phase, 15.9% of infants with AD developed at least 1 food allergy; allergy to peanut was most common (6.6%), followed by cow's milk (4.3%) and egg white (3.9%). Seafood, soybean, and wheat allergies were rare. Levels of sIgE for milk, egg, and peanut increased with severity of AD, as determined by Investigator's Global Assessment score. We assigned sIgE decision points for the 6 foods and tested their ability to predict definite food allergy in this population. Positive predictive values for published and newly developed sIgE decision points were low (,0.6 for all values tested). CONCLUSIONS:In a large cohort of infants at risk for development of food allergy, sIgE levels were not clinically useful for predicting food allergy development. WHAT'S KNOWN ON THIS SUBJECT:Food allergies are often thought to be a common trigger in atopic dermatitis (AD). Serum immunoglobulin E is frequently used to assess food sensitization and clinical allergy, but few studies have assessed it longitudinally in infants and children with AD. WHAT THIS STUDY ADDS:In a large infant population with mild to moderate AD, 15.9% of patients developed food allergy during the study. Serum immunoglobulin E decision points had low positive predictive values, indicating that they are of limited use in this population.

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Section: What This Study Addsmentioning

confidence: 99%

Food Allergy in Infants With Atopic Dermatitis: Limitations of Food-Specific IgE Measurements

et al. 2015

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“…Even though there is a correlation between SPT result or sIgE and likelihood of a clinical reaction, sensitisation level does not always correlate with allergic manifestations. [77][78][79] One study points to between 7.5 % and 19 % asymptomatic sensitisations among Finnish schoolchildren. 80 Skin test reactivity to inhalant allergens is reduced in asymptomatic sensitisations when compared with symptomatic patients.…”

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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“…[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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The relationship of allergen-specific IgE levels and oral food challenge outcome

Cited by 305 publications

References 18 publications

Food Allergy in Infants With Atopic Dermatitis: Limitations of Food-Specific IgE Measurements

Food Allergy in Infants With Atopic Dermatitis: Limitations of Food-Specific IgE Measurements

Skin prick tests and allergy diagnosis

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

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