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A new framework for the interpretation of IgE sensitization tests

A new framework for the interpretation of IgE sensitization tests
A new framework for the interpretation of IgE sensitization tests
IgE sensitization tests, such as skin prick testing and serum-specific IgE, have been used to diagnose IgE-mediated clinical allergy for many years. Their prime drawback is that they detect sensitization which is only loosely related to clinical allergy. Many patients therefore require provocation tests to make a definitive diagnosis; these are often expensive and potentially associated with severe reactions. The likelihood of clinical allergy can be semi-quantified from an IgE sensitization test results. This relationship varies though according to the patients' age, ethnicity, nature of the putative allergic reaction and coexisting clinical diseases such as eczema. The likelihood of clinical allergy can be more precisely estimated from an IgE sensitization test result, by taking into account the patient's presenting features (pretest probability). The presence of each of these patient-specific factors may mean that a patient is more or less likely to have clinical allergy with a given test result (post-test probability). We present two approaches to include pretest probabilities in the interpretation of results. These approaches are currently limited by a lack of data to allow us to derive pretest probabilities for diverse setting, regions and allergens. Also, cofactors, such as exercise, may be necessary for exposure to an allergen to result in an allergic reaction in specific IgE-positive patients. The diagnosis of IgE-mediated allergy is now being aided by the introduction of allergen component testing which may identify clinically relevant sensitization. Other approaches are in development with basophil activation testing being closest to clinical application.
0105-4538
1540-1551
Roberts, Graham
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Ollert, Markus
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Aalberse, R.
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Austin, M.
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Custovic, A.
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Dunngalvin, A.
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Eigenmann, P.A.
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Fassio, Filippo
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Grattan, C.
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Hellings, Peter
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Hourihane, J.
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Knol, E.
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Muraro, A.
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Papadopoulos, N.
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Santos, A.F.
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Schnadt, S.
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Tzeli, K.
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Roberts, Graham
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Ollert, Markus
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Aalberse, R.
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Austin, M.
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Custovic, A.
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Dunngalvin, A.
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Eigenmann, P.A.
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Fassio, Filippo
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Grattan, C.
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Hellings, Peter
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Hourihane, J.
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Knol, E.
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Muraro, A.
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Papadopoulos, N.
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Santos, A.F.
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Schnadt, S.
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Tzeli, K.
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Roberts, Graham, Ollert, Markus, Aalberse, R., Austin, M., Custovic, A., Dunngalvin, A., Eigenmann, P.A., Fassio, Filippo, Grattan, C., Hellings, Peter, Hourihane, J., Knol, E., Muraro, A., Papadopoulos, N., Santos, A.F., Schnadt, S. and Tzeli, K. (2016) A new framework for the interpretation of IgE sensitization tests. Allergy, 71, 1540-1551. (doi:10.1111/all.12939).

Record type: Article

Abstract

IgE sensitization tests, such as skin prick testing and serum-specific IgE, have been used to diagnose IgE-mediated clinical allergy for many years. Their prime drawback is that they detect sensitization which is only loosely related to clinical allergy. Many patients therefore require provocation tests to make a definitive diagnosis; these are often expensive and potentially associated with severe reactions. The likelihood of clinical allergy can be semi-quantified from an IgE sensitization test results. This relationship varies though according to the patients' age, ethnicity, nature of the putative allergic reaction and coexisting clinical diseases such as eczema. The likelihood of clinical allergy can be more precisely estimated from an IgE sensitization test result, by taking into account the patient's presenting features (pretest probability). The presence of each of these patient-specific factors may mean that a patient is more or less likely to have clinical allergy with a given test result (post-test probability). We present two approaches to include pretest probabilities in the interpretation of results. These approaches are currently limited by a lack of data to allow us to derive pretest probabilities for diverse setting, regions and allergens. Also, cofactors, such as exercise, may be necessary for exposure to an allergen to result in an allergic reaction in specific IgE-positive patients. The diagnosis of IgE-mediated allergy is now being aided by the introduction of allergen component testing which may identify clinically relevant sensitization. Other approaches are in development with basophil activation testing being closest to clinical application.

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Roberts_et_al-2016-Allergy New diagnostic framework position paper
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Accepted/In Press date: 23 May 2016
e-pub ahead of print date: 15 August 2016
Published date: 1 November 2016

Identifiers

Local EPrints ID: 413453
URI: http://eprints.soton.ac.uk/id/eprint/413453
ISSN: 0105-4538
PURE UUID: af5df374-d173-41c6-8684-042b585e2f47
ORCID for Graham Roberts: ORCID iD orcid.org/0000-0003-2252-1248

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Date deposited: 24 Aug 2017 16:30
Last modified: 18 Feb 2021 17:04

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Contributors

Author: Graham Roberts ORCID iD
Author: Markus Ollert
Author: R. Aalberse
Author: M. Austin
Author: A. Custovic
Author: A. Dunngalvin
Author: P.A. Eigenmann
Author: Filippo Fassio
Author: C. Grattan
Author: Peter Hellings
Author: J. Hourihane
Author: E. Knol
Author: A. Muraro
Author: N. Papadopoulos
Author: A.F. Santos
Author: S. Schnadt
Author: K. Tzeli

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