UK NEQAS survey of allergen component testing across the United Kingdom and other European countries

Abstract

SummaryThe clinical utility of molecular diagnostic approaches in allergy investigation is increasingly being recognized to play a significant role in the management of allergic patients. Determining the sensitisation pattern, which is best achieved through the use of component resolved diagnostics (CRD), allows effective risk stratification, appropriate treatment and patient selection for immunotherapy.In order to assess the diagnostic service provisions for in vitro allergy testing across Europe, a survey was carried out via the total IgE and Specific IgE external quality assurance schemes run by UK NEQAS Immunology, Immunochemistry & Allergy.This survey assessed allergy testing and in particular allergen-components offered by the laboratories and found a wide variability in service provision, particularly between the UK and EU. Furthermore, there was lack of standardisation for acquisition of clinical information to aid allergen (and component) selection, gating strategy, testing algorithms and clinical interpretation. Interestingly, a significant proportion of laboratories (the majority from EU) stated that they 'used' the results for peanut components for risk stratification. However, vast majority of participants were unaware of guidelines relating to the use of allergen component testing and agreed further education would assist in reaching a common platform.

Component-resolved diagnostics in the clinical and laboratory investigation of allergy

“…Following a recent survey into the use of CRD within allergy testing across the UK and Europe, 1 it was apparent that use of CRD was becoming increasingly incorporated into routine diagnostics. Its clinical utility however was potentially being compromised due to limited understanding and interpretive guidance for requesting clinicians.…”

“…Following a recent survey into the use of CRD within allergy testing across the UK and Europe (1), it was apparent that use of CRD was becoming increasingly incorporated into routine diagnostics; however its clinical utility was potentially being compromised due to limited understanding and interpretive guidance for requesting clinicians. With wider implementation, the immunology laboratory must consider the practical aspects for CRD, both methodological and interpretative, prior to the introduction of these specialised tests.…”

Advances and novel developments in mechanisms of allergic inflammation

“…Conventional allergy tests such as SPT and slgE to allergen extracts are unable to differentiate sensitization from clinical allergy, resulting in overdiagnosis. More advanced antigenbased tests such as component-resolved diagnostics (CRD) may lead to a more accurate diagnosis and selection of therapeutic intervention,90,91 and becoming increasingly incorporated into routine diagnostics 92. A recent systemic review suggested that sIgE The reports on passive sensitization strategies using the mast cell lines12 or mast cell precursors13 showed promising po-…”