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Heron M, Schreurs MWJ, Haagen IA, China B, Faria AP, Vanhanen AR, Thelen M, Weykamp CW. Allergy: Evaluation of 16 years (2007-2022) results of the shared external quality assessment program in Belgium, Finland, Portugal and The Netherlands. Clin Chem Lab Med 2024; 62:1853-1862. [PMID: 38008748 DOI: 10.1515/cclm-2023-0862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/03/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVES This paper evaluates 16 year results of the Allergy EQA program shared by EQA organisers in Belgium, Finland, Portugal, and The Netherlands. METHODS The performance of Thermo Fisher and Siemens user groups (in terms of concordance between both groups, between laboratory CV, prevalence of clinically significant errors) and suitability of samples (stability and validity of dilution of patient samples) are evaluated using data of 192 samples in the EQA programs from 2007 to 2022. Measurands covered are total IgE, screens and mixes, specific IgE extracts and allergen components. RESULTS There is perfect (53 %), acceptable (40 %) and poor (6 %) concordance between both method groups. In case of poor concordance the best fit with clinical data is seen for Thermo Fisher (56 %) and Siemens (26 %) respectively. The between laboratory CV evolves from 7.8 to 6.6 % (Thermo Fisher) and 7.3 to 7.7 % (Siemens). The prevalence of blunders by individual laboratories is stable for Siemens (0.4 %) and drops from 0.4 to 0.2 % for Thermo Fisher users. For IgE, the between year CV of the mean of both user groups is 1 %, and a fifteen-fold dilution of a patient sample has an impact of 2 and 4 % on the recovery of Thermo Fisher and Siemens user groups. CONCLUSIONS The analytical performance of Thermo Fisher is slightly better than that of Siemens users but the clinical impact of this difference is limited. Stability of the sample and the low impact of dilution on the recovery of measurands demonstrates the suitability for purpose of the EQA program.
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Affiliation(s)
- Michiel Heron
- Medical Microbiology and Immunology, Diakonessenhuis, Utrecht, The Netherlands
| | - Marco W J Schreurs
- Microvida Laboratory of Medical Microbiology and Immunology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Inez-Anne Haagen
- Department of Hematology and Clinical Chemistry Laboratory, OLVG Lab, Amsterdam, The Netherlands
| | - Bernard China
- Department of Quality of Laboratories, Sciensano, Brussel, Belgium
| | - Ana Paula Faria
- Department of Epidemiology, External Quality Assessment Unit Nacional Institute of Health, Doctor Ricardo Jorge, Lisbon, Portugal
| | | | - Marc Thelen
- Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Foundation for Quality Assurance in Laboratory Medicine (SKML), Nijmegen, The Netherlands
| | - Cas W Weykamp
- Department of Clinical Chemistry, Queen Beatrix Hospital, Winterswijk, The Netherlands
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2
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Chong Neto HJ. [RAST, Inmunoblot, Immunocap and ISAC in food allergy]. REVISTA ALERGIA MÉXICO 2023; 70:245-249. [PMID: 38506866 DOI: 10.29262/ram.v70i4.1335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/29/2023] [Indexed: 03/21/2024] Open
Abstract
skin tests; Sensitization; IgE-mediated allergy; allergenic extract. After the discovery of IgE, technological advances have provided new laboratory tools for the quantification of allergen-specific IgE antibodies in serum and on the surface of basophils-mast cells. In vitro testing offers numerous advantages: accurate quantitation, lack of drug interference, safety, and long-term storage of samples. Quantitative immunoassays for IgE antibodies can be an adjunct to skin testing. The allergen reagent in solid phase (allergosorbent) or liquid is the main component of the assay that confers specificity to the IgE antibody test. It is the most complex and highly variable reagent in IgE antibody assays. The choice to use diagnostic recombinants on a single rather than multiple platforms is made on a case-by-case basis (considering prior history and clinical profile) and in an allergen-dependent manner. Although most food allergies are limited to a small number of possible triggers, these foods are very complex when evaluating their allergenic potential. The possibility of fractionating the allergen and understanding some of its components as potentially important to define the risk of clinical reaction, cross-reactivity, or persistence of allergy, opened a new era in the field of allergy, called molecular allergy. The identification of the allergenic component responsible for the reactions is an important tool to confirm the information and severity of the symptoms, natural history of the disease, possibility of cross-reactivity and clinical symptoms (allergy markers).
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Affiliation(s)
- Herberto J Chong Neto
- Especialista en Alergia y Inmunología, Profesor Asociado de Pediatría, Universidad Federal de Paraná,
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3
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Aagaard JB, Fischer M, Lober J, Neumann FB, Allahverdi D, Sivelle C, Miehe M, Spillner E. Extract-Shaped Immune Repertoires as Source for Nanobody-Based Human IgE in Grass Pollen Allergy. Mol Biotechnol 2023; 65:1518-1527. [PMID: 36696011 DOI: 10.1007/s12033-023-00664-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
The presence of allergen-specific IgE in serum is a biomarker for allergic disease. Specific IgE antibodies for research and diagnostics, however, remain scarce. In contrast to prototypic antibodies, camelid species have evolved single domains as moiety for antigen recognition. These so-called nanobodies represent a versatile platform for the development of diagnostic and therapeutic approaches. In this study, we aimed for generating nanobodies and derived IgE formats from an extract-shaped immune repertoire. Timothy grass pollen represents a complex, but well-defined mixture of individual allergens. Therefore, a repertoire library from a timothy grass pollen extract immunised llama was established. The selection by phage display yielded 3 nanobodies with immunoreactivity to the extract. IgE-like nanobody-based human IgE (nb-hIgE) antibodies were produced in mammalian cells and assessed in different immunoassays and commercial platforms. Immunoblotting and diagnostic ImmunoCap analysis of single timothy grass pollen allergens identified the major allergens Phl p 6 and Phl p 4 as targets. Assessment of immunoreactivity further documented significant molecular cross-reactivity with pollen extract of different grass species and variant presence of allergens within extracts of Pooideae grasses. In summary, our study shows that extract-based immunisation enables the generation of allergen-specific nanobodies and derived nb-hIgE formats linking nanobody technologies with allergological applications.
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Affiliation(s)
- Josephine Baunvig Aagaard
- Immunological Biotechnology, Department of Biological and Chemical Engineering, Aarhus University, Gustav Wieds Vej 10, 8000, Aarhus C, Denmark
| | - Michaela Fischer
- Immunological Biotechnology, Department of Biological and Chemical Engineering, Aarhus University, Gustav Wieds Vej 10, 8000, Aarhus C, Denmark
| | - Julia Lober
- Immunological Biotechnology, Department of Biological and Chemical Engineering, Aarhus University, Gustav Wieds Vej 10, 8000, Aarhus C, Denmark
| | - Frederikke Bolbro Neumann
- Immunological Biotechnology, Department of Biological and Chemical Engineering, Aarhus University, Gustav Wieds Vej 10, 8000, Aarhus C, Denmark
| | - Dena Allahverdi
- Immunological Biotechnology, Department of Biological and Chemical Engineering, Aarhus University, Gustav Wieds Vej 10, 8000, Aarhus C, Denmark
| | - Coline Sivelle
- Immunological Biotechnology, Department of Biological and Chemical Engineering, Aarhus University, Gustav Wieds Vej 10, 8000, Aarhus C, Denmark
| | - Michaela Miehe
- Immunological Biotechnology, Department of Biological and Chemical Engineering, Aarhus University, Gustav Wieds Vej 10, 8000, Aarhus C, Denmark
| | - Edzard Spillner
- Immunological Biotechnology, Department of Biological and Chemical Engineering, Aarhus University, Gustav Wieds Vej 10, 8000, Aarhus C, Denmark.
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4
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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 JOURNAL OF ALLERGY, ASTHMA AND IMMUNOLOGY 2023. [DOI: 10.4103/0972-6691.367373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Ito K, Tagami K. Distinct differences in analytical performance of two commercially available assays for specific IgE to egg white and house dust mite allergens. Clin Mol Allergy 2021; 19:13. [PMID: 34340696 PMCID: PMC8330041 DOI: 10.1186/s12948-021-00151-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background Measurements of allergen-specific IgE antibodies with different manufacturers’ assays show modest or poor agreement. This study compares analytical performance of specific IgE tests for whole allergen extracts and individual allergen components of two assay systems, IMMULITE and ImmunoCAP, using human sera as well as monoclonal antibodies. Methods Comparisons were performed for specific IgE to house dust mite (HDM, n = 44), egg white (EW, n = 36) and the allergen components rDer p 1, rDer p 2, nGal d 1, nGal d 2 and nGal d 4 in human sera and with monoclonal mouse/human chimeric IgE antibodies specific for the same allergen components. Competitive interference with IgE measurement was investigated using allergen-specific monoclonal IgG and IgG4 antibodies. Results Measurements of IgE to HDM and EW in serial dilutions of human sera revealed weaker dilution linearity with IMMULITE than with ImmunoCAP. Analysis of five different monoclonal IgE antibodies with total and specific IgE assays, expected to return similar levels, gave an average specific/total IgE ratio of 0.96 (range 0.71–1.14) with ImmunoCAP and 1.89 (range 0.76–2.85) with IMMULITE, indicating overestimation of specific IgE by IMMULITE. With the EW IgE tests of both assay systems, measurements of a chimeric anti-Gal d 2 IgE antibody were unaffected by a competing mouse IgG antibody. While the same was true for measurement of a chimeric anti-Der p 1 IgE antibody using the HDM test in ImmunoCAP, a suppression of measured concentrations by up to 42% was observed in IMMULITE. Similarly, measurement of HDM-specific IgE in human sera by ImmunoCAP was unaffected by a competing monoclonal anti-Der p 2 IgG4 antibody while IMMULITE displayed a reduction of HDM-specific IgE values by up to 30%. Conclusions In this evaluation of analytical performance of two widely used assay systems, ImmunoCAP showed higher accuracy in quantitation of specific IgE and greater resistance against competing allergen-specific non-IgE antibodies which may arise through natural or dietary exposure, or as a result of allergen immunotherapy treatment.
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Affiliation(s)
- Komei Ito
- Allergy and Immunology Center, Aichi Children's Health and Medical Center, Obu, Aichi, Japan.
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Al Hawi Y, Nagao M, Furuya K, Sato Y, Ito S, Hori H, Hirayama M, Fujisawa T. Agreement Between Predictive, Allergen-Specific IgE Values Assessed by ImmunoCAP and IMMULITE 2000 3gAllergy™ Assay Systems for Milk and Wheat Allergies. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2021; 13:141-153. [PMID: 33191682 PMCID: PMC7680830 DOI: 10.4168/aair.2021.13.1.141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/29/2020] [Accepted: 06/16/2020] [Indexed: 12/05/2022]
Abstract
Purpose ImmunoCAP® (ImmunoCAP) and IMMULITE® 2000 3gAllergy™ (3gAllergy) systems are major quantitative allergen-specific immunoglobulin E (sIgE) assay methods. Due to the heterogeneous nature of allergenic extracts and differences in the assay format, quantitation of allergen-sIgEs is not expected to correlate well between different methods. However, we have recently reported good agreement between the methods in the diagnosis of egg allergy. This study aimed to determine and correlate the predictive values of sIgE by the two systems in the diagnosis of milk and wheat allergies. Methods Children who had undergone oral food challenge (OFC) for the diagnosis of milk and wheat allergies were enrolled. The OFCs were performed to diagnose either true allergy in the 1-year-old group (A) or tolerance in the 2- to 6-year-old group (B). Milk, casein and β-lactoglobulin, and wheat and ω-5 gliadin sIgE values were measured using the 2 systems. The predictive accuracy of each sIgE for the OFC outcome was assessed using receiver operating characteristic (ROC) curves. The probability of a positive OFC outcome was estimated by logistic regression analysis. Results A total of 395 patients were recruited from 7 primary care clinics and 19 hospitals in Japan. Milk and wheat OFCs were performed for 87 and 102 group A patients, and 124 and 82 group B patients, respectively. ROC analysis yielded similar areas under the curve for the 2 assays (0.7–0.9). The log-transformed sIgE data showed a strong linear correlation with the estimated probabilities (R > 0.9). Conclusions The 2 systems may be interchangeable for diagnosis of milk and wheat allergies in young children.
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Affiliation(s)
- Yasmeen Al Hawi
- Allergy Center and Institute for Clinical Research, National Hospital Organization Mie National Hospital, Tsu, Japan.,Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan.,Cairo University School of Medicine, Cairo, Egypt
| | - Mizuho Nagao
- Allergy Center and Institute for Clinical Research, National Hospital Organization Mie National Hospital, Tsu, Japan.,Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kanae Furuya
- Allergy Center and Institute for Clinical Research, National Hospital Organization Mie National Hospital, Tsu, Japan.,Aichi Konan College, Konan, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Setsuko Ito
- Department of Food Science and Nutrition, Faculty of Human Life and Science, Doshisha Women's College of Liberal Arts, Kyoto, Japan
| | - Hiroki Hori
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masahiro Hirayama
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Takao Fujisawa
- Allergy Center and Institute for Clinical Research, National Hospital Organization Mie National Hospital, Tsu, Japan.,Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan.
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Casas ML, Esteban Á, González-Muñoz M, Labrador-Horrillo M, Pascal M, Teniente-Serra A. Proyecto VALIDA: Validation of ALlergy In vitro Diagnostics Assays (Herramientas y recomendaciones para la valoración de las pruebas in vitro en el diagnóstico de la alergia). ADVANCES IN LABORATORY MEDICINE 2020; 1:20200022. [PMCID: PMC10197503 DOI: 10.1515/almed-2020-0022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/05/2020] [Indexed: 08/29/2023]
Abstract
En la evaluación del paciente con sospecha de alergia las pruebas de detección y cuantificación de la inmunoglobulina E (IgE) específica in vitro se usan de manera habitual en los laboratorios clínicos para ayudar en el diagnóstico de la alergia. Actualmente existen diferentes alternativas comerciales para realizar estos ensayos, pero los resultados obtenidos por cada uno de ellos pueden variar, lo que condiciona el diagnóstico y el tratamiento que se le proporcionará al paciente. Con el fin de dar respuesta a los retos planteados por las diferencias entre las distintas técnicas para la determinación in vitro de la IgE específica, un grupo de expertos ha recogido en un documento una serie de recomendaciones sobre las implicaciones que puede tener el uso de una determinada técnica in vitro y el impacto en el manejo del paciente alérgico que suponen las diferencias entre las distintas técnicas. La lectura y el análisis de este documento de consenso ayudarán a entender las implicaciones que tiene el cambio de método de diagnóstico in vitro en el manejo del paciente con alergia, en su calidad de vida y en los costes socioeconómicos asociados a la enfermedad.
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Affiliation(s)
- María L. Casas
- Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, España
- Servicio de Análisis Clínicos, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Ángel Esteban
- Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, España
- Servicio de Análisis Clínicos, Hospital General Universitario de Alicante, Alicante, España
| | - Miguel González-Muñoz
- Sociedad Española de Inmunología (SEI), Barcelona, España
- Servicio de Inmunología, Hospital Universitario La Paz, Madrid, España
| | - Moisés Labrador-Horrillo
- Sociedad Española de Alergología e Inmunología Clínica (SEAIC), Madrid, España
- Servicio de Alergología, Hospital Universitari Vall d’Hebron, Barcelona, España
| | - Mariona Pascal
- Servicio de Alergología, Hospital Universitari Vall d’Hebron, Barcelona, España
- Servicio de Inmunología, CDB, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, España
- Red de Investigación ARADyAL, Instituto Carlos III, Madrid, España
| | - Aina Teniente-Serra
- Sociedad Española de Inmunología (SEI), Barcelona, España
- Servicio de Inmunología, LCMN, Hospital Universitari Germans Trias i Pujol, Badalona, España
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8
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Casas ML, Esteban Á, González-Muñoz M, Labrador-Horrillo M, Pascal M, Teniente-Serra A. VALIDA project: Validation of allergy in vitro diagnostics assays (Tools and recommendations for the assessment of in vitro tests in the diagnosis of allergy). ADVANCES IN LABORATORY MEDICINE 2020; 1:20200051. [PMID: 37360620 PMCID: PMC10197418 DOI: 10.1515/almed-2020-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/05/2020] [Indexed: 06/28/2023]
Abstract
In vitro allergen-specific immunoglobulin E (IgE) detection and quantification tests are routinely performed in clinical laboratories to diagnose patients with a suspected allergy. Numerous commercial assays are available to test for allergies, but the results can vary widely, thereby influencing both diagnosis and treatment. Given the challenges posed by differences in the various assays for in vitro determination of specific IgE, a group of experts has compiled in a document a series of recommendations on the implications that the use of a certain in vitro technique may have and the impact on the management of the allergic patient that the differences between the various techniques represent. The reading and analysis of this consensus document will help to understand the implications of the change of in vitro diagnostic method in the management of the patient with allergy, in the quality of life and in the socioeconomic costs associated with the disease.
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Affiliation(s)
- María L. Casas
- Clinical Analysis Service, Fundación Alcorcón University Hospital, Alcorcón, Madrid, Spain
- Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain
| | - Ángel Esteban
- Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain
- Clinical Analysis Service, University General Hospital of Alicante, Alicante, Spain
| | - Miguel González-Muñoz
- Immunology Service, La Paz University Hospital, Madrid, Spain
- Spanish Society of Immunology (SEI), Barcelona, Spain
| | - Moisés Labrador-Horrillo
- Allergology Service, Vall d’Hebron University Hospital, Barcelona, Spain
- Spanish Society of Allergology and Clinical Immunology (SEAIC), Madrid, Spain
| | - Mariona Pascal
- Spanish Society of Immunology (SEI), Barcelona, Spain
- Spanish Society of Allergology and Clinical Immunology (SEAIC), Madrid, Spain
- Immunology Service, CBD, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- ARADyAL Research Network, Carlos III Institute, Madrid, Spain
| | - Aina Teniente-Serra
- Spanish Society of Immunology (SEI), Barcelona, Spain
- Immunology Service, LCMN, Germans Trias i Pujol University Hospital, Badalona, Spain
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Hamilton RG, Hemmer W, Nopp A, Kleine-Tebbe J. Advances in IgE Testing for Diagnosis of Allergic Disease. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2495-2504. [PMID: 32717438 DOI: 10.1016/j.jaip.2020.07.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 01/10/2023]
Abstract
Since its discovery in 1967, IgE antibody detection in skin and blood has identified a state of allergic sensitization and served as a necessary but not sufficient risk factor that requires objective symptoms to make the definitive diagnosis of human allergic disease. More recently, quantitative IgE antibody levels in serum against allergenic extracts, molecules, and epitopes have pushed its application into more accurately identifying the specificity of the allergic response for targeting immunotherapy, predicting allergic symptom severity after allergen exposure, and attempting to distinguish tolerance from food allergy. This review examines new in vivo and in vitro developments in the design, performance, interference, and application of the methods used to identify allergic sensitization. The increasing accepted applications of molecular allergen and allergen epitope-based IgE antibody measurements, especially as applied to food allergy diagnosis and management, are highlighted as state-of-the-art advances. Despite these major advances in allergic sensitization documentation, their ultimate value requires integration by the clinician with the patient's history and pretest probability of disease.
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Affiliation(s)
- Robert G Hamilton
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
| | | | - Anna Nopp
- Department of Clinical Science and Education, Karolinska Institutet, Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Jörg Kleine-Tebbe
- Allergy & Asthma Center Westend, Outpatient Clinic Hanf, Ackermann & Kleine-Tebbe, Berlin, Germany
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Blank S, Bazon ML, Grosch J, Schmidt-Weber CB, Brochetto-Braga MR, Bilò MB, Jakob T. Antigen 5 Allergens of Hymenoptera Venoms and Their Role in Diagnosis and Therapy of Venom Allergy. Curr Allergy Asthma Rep 2020; 20:58. [PMID: 32647993 PMCID: PMC7347709 DOI: 10.1007/s11882-020-00954-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Stings of Hymenoptera of the superfamily Vespoidea such as yellow jackets, paper wasps or stinging ants are common triggers for severe and even fatal allergic reactions. Antigen 5 allergens are potent allergens in the majority of these venoms with major importance for diagnosis and therapy. Reviewed here are the characteristics of antigen 5 allergens, their role in component-resolved diagnostics as well as current limitations of the available diagnostics for proper therapeutic decisions. RECENT FINDINGS Antigens 5 are proteins of unknown function in Hymenoptera venoms with high allergenic potency. They represent key elements in component-resolved diagnosis to discriminate between honeybee and vespid venom allergy. However, due to their pronounced cross-reactivity, there are remaining diagnostic and therapeutic challenges that have to be addressed. Antigens 5 are highly relevant venom allergens of the Vespoidea superfamily. Although their use in component-resolved diagnosis facilitates dissection of cross-reactivity and primary allergy in double sensitization to honeybee and vespid venom, new diagnostic concepts are needed to discriminate between allergies to different vespid species.
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Affiliation(s)
- Simon Blank
- Center of Allergy and Environment (ZAUM), School of Medicine and Helmholtz Center Munich, German Research Center for Environmental Health, Member of the German Center of Lung Research (DZL), Technical University of Munich, Ingolstädter Landstraße 1, 85764, Munich, Germany.
| | - Murilo Luiz Bazon
- Center of Allergy and Environment (ZAUM), School of Medicine and Helmholtz Center Munich, German Research Center for Environmental Health, Member of the German Center of Lung Research (DZL), Technical University of Munich, Ingolstädter Landstraße 1, 85764, Munich, Germany
- Department of General and Applied Biology, Biosciences Institute, Sao Paulo State University, Rio Claro, São Paulo, Brazil
| | - Johannes Grosch
- Center of Allergy and Environment (ZAUM), School of Medicine and Helmholtz Center Munich, German Research Center for Environmental Health, Member of the German Center of Lung Research (DZL), Technical University of Munich, Ingolstädter Landstraße 1, 85764, Munich, Germany
| | - Carsten B Schmidt-Weber
- Center of Allergy and Environment (ZAUM), School of Medicine and Helmholtz Center Munich, German Research Center for Environmental Health, Member of the German Center of Lung Research (DZL), Technical University of Munich, Ingolstädter Landstraße 1, 85764, Munich, Germany
| | - Márcia Regina Brochetto-Braga
- Department of General and Applied Biology, Biosciences Institute, Sao Paulo State University, Rio Claro, São Paulo, Brazil
| | - Maria Beatrice Bilò
- Department of Clinical and Molecular Sciences, Ancona and Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Polytechnic University of Marche, Ancona, Italy
| | - Thilo Jakob
- Experimental Dermatology and Allergy Research Group, Department of Dermatology and Allergology, Justus-Liebig-University Gießen, Giessen, Germany
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Nakayama M, Fukuda H, Ando Y, Miyamoto M, Kato M, Yoshihara S. Two commercial Gal d1 specific IgE assays show major differences in performance. Pediatr Allergy Immunol 2020; 31:424-426. [PMID: 31943358 DOI: 10.1111/pai.13210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/02/2019] [Accepted: 12/24/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Motoko Nakayama
- Department of Pediatrics, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Hironobu Fukuda
- Department of Pediatrics, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Yusuke Ando
- Department of Pediatrics, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Manabu Miyamoto
- Department of Pediatrics, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Masaya Kato
- Department of Pediatrics, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Shigemi Yoshihara
- Department of Pediatrics, Dokkyo Medical University Hospital, Tochigi, Japan
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12
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Third-party verification of total and specific immunoglobulin E on analyzer Immulite® 2000XPi. Clin Chim Acta 2020; 500:28-33. [DOI: 10.1016/j.cca.2019.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 09/12/2019] [Accepted: 09/29/2019] [Indexed: 12/27/2022]
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13
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Baur X, Akdis CA, Budnik LT, Cruz MJ, Fischer A, Förster‐Ruhrmann U, Göen T, Goksel O, Heutelbeck AR, Jones M, Lux H, Maestrelli P, Munoz X, Nemery B, Schlünssen V, Sigsgaard T, Traidl‐Hoffmann C, Siegel P. Immunological methods for diagnosis and monitoring of IgE-mediated allergy caused by industrial sensitizing agents (IMExAllergy). Allergy 2019; 74:1885-1897. [PMID: 30953599 PMCID: PMC6851709 DOI: 10.1111/all.13809] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/20/2019] [Accepted: 03/26/2019] [Indexed: 02/06/2023]
Abstract
Industrial sensitizing agents (allergens) in living and working environments play an important role in eliciting type 1 allergic disorders including asthma and allergic rhinitis. Successful management of allergic diseases necessitates identifying their specific causes (ie, identify the causative agent(s) and the route of contact to allergen: airborne, or skin contact) to avoid further exposure. Identification of sensitization by a sensitive and validated measurement of specific IgE is an important step in the diagnosis. However, only a limited number of environmental and occupational allergens are available on the market for use in sIgE testing. Accordingly, specific in‐house testing by individual diagnostic and laboratory centers is often required. Currently, different immunological tests are in use at various diagnostic centers that often produce considerably divergent results, mostly due to lack of standardized allergen preparation and standardized procedures as well as inadequate quality control. Our review and meta‐analysis exhibited satisfactory performance of sIgE detection test for most high molecular weight (HMW) allergens with a pooled sensitivity of 0.74 and specificity of 0.71. However, for low molecular weight (LMW) allergens, pooled sensitivity is generally lower (0.28) and specificity higher (0.89) than for HMW tests. Major recommendations based on the presented data include diagnostic use of sIgE to HMW allergens. A negative sIgE result for LMW agents does not exclude sensitization. In addition, the requirements for full transparency of the content of allergen preparations with details on standardization and quality control are underlined. Development of standard operating procedures for in‐house sIgE assays, and clinical validation, centralized quality control and audits are emphasized. There is also a need for specialized laboratories to provide a custom service for the development of tests for the measurement of putative novel occupational allergens that are not commercially available.
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Affiliation(s)
- Xaver Baur
- European Society for Environmental and Occupational Medicine Berlin Germany
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research, UZH Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
| | - Lygia Therese Budnik
- Translational Toxicology and Immunology Unit, Institute for Occupational and Maritime Medicine University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | | | - Axel Fischer
- Clinical Research Unit of Allergy Charité–Universitätsmedizin Berlin Berlin Germany
| | | | - Thomas Göen
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine Friedrich‐Alexander‐University Erlangen‐Nurnberg Erlangen Germany
| | - Ozlem Goksel
- Pulmonary, Immunology and Allergy, Laboratory of Occupational & Environmental Respiratory Diseases and Asthma EGE University Izmir Turkey
| | - Astrid R. Heutelbeck
- Institute for Occupational, Environmental and Social Medicine Friedrich Schiller University Jena Jena Germany
| | - Meinir Jones
- Imperial College London National Heart and Lung Institute London UK
| | - Harald Lux
- Institute for Occupational, Environmental and Social Medicine Friedrich Schiller University Jena Jena Germany
- Charité Comprehensive Allergy Center, Institute of Occupational Medicine Charité–Universitätsmedizin Berlin Berlin Germany
| | - Piero Maestrelli
- Department of Cardiologic, Thoracic and Vascular Sciences University of Padova Padova Italy
| | - Xavier Munoz
- Pneumology Department Vall d'Hebron Hospital Barcelona Spain
| | - Benoit Nemery
- Department of Public Health and Primary Care, KU Leuven Centre for Environment and Health Leuven Belgium
| | - Vivi Schlünssen
- National Research Center for the Working Environment Copenhagen Denmark
- Department of Public Health, Environment, Occupation & Health, & Danish Ramazzini Centre Aarhus University Aarhus Denmark
| | - Torben Sigsgaard
- Department of Public Health, Environment, Occupation & Health, & Danish Ramazzini Centre Aarhus University Aarhus Denmark
| | - Claudia Traidl‐Hoffmann
- Swiss Institute of Allergy and Asthma Research, UZH Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
- The Christine Kühne Center for Allergy Research and Education (CK‐CARE) Augsburg Germany
- UNIKA Technical University Munich Munich Germany
| | - Paul Siegel
- Division Morgantown, Health Effects Laboratory, Centers for Disease Control and Prevention National Institute for Occupational Safety and Health Morgantown West Virginia
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14
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Prevalence of Hymenoptera venom allergy and sensitization in the population-representative German KORA cohort. ALLERGO JOURNAL 2019. [DOI: 10.1007/s15007-019-1916-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Prevalence of Hymenoptera venom allergy and sensitization in the population-representative German KORA cohort. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s40629-018-0089-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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16
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Popescu FD, Vieru M. Precision medicine allergy immunoassay methods for assessing immunoglobulin E sensitization to aeroallergen molecules. World J Methodol 2018; 8:17-36. [PMID: 30519536 PMCID: PMC6275558 DOI: 10.5662/wjm.v8.i3.17] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/17/2018] [Accepted: 10/09/2018] [Indexed: 02/06/2023] Open
Abstract
Molecular-based allergy diagnosis for the in vitro assessment of a patient immunoglobulin E (IgE) sensitization profile at the molecular level uses allergen molecules (also referred to as allergen components), which may be well-defined, highly purified, natural allergen components or recombinant allergens. Modern immunoassay methods used for the detection of specific IgE against aeroallergen components are either singleplex (such as the fluorescence enzyme immunoassay with capsulated cellulose polymer solid-phase coupled allergens, the enzyme-enhanced chemiluminescence immunoassay and the reversed enzyme allergosorbent test, with liquid-phase allergens), multiparameter (such as the line blot immunoassay for defined partial allergen diagnostics with allergen components coating membrane strips) or multiplex (such as the microarray-based immunoassay on immuno solid-phase allergen chip, and the two new multiplex nanotechnology-based immunoassays: the patient-friendly allergen nano-bead array, and the macroarray nanotechnology-based immunoassay used as a molecular allergy explorer). The precision medicine diagnostic work-up may be organized as an integrated “U-shape” approach, with a “top-down” approach (from symptoms to molecules) and a “bottom-up” approach (from molecules to clinical implications), as needed in selected patients. The comprehensive and accurate IgE sensitization molecular profiling, with identification of the relevant allergens, is indicated within the framework of a detailed patient’s clinical history to distinguish genuine IgE sensitization from sensitization due to cross-reactivity (especially in polysensitized patients), to assess unclear symptoms and unsatisfactory response to treatment, to reveal unexpected sensitizations, and to improve assessment of severity and risk aspects in some patients. Practical approaches, such as anamnesis molecular thinking, laboratory molecular thinking and postmolecular anamnesis, are sometimes applied. The component-resolved diagnosis of the specific IgE repertoire has a key impact on optimal decisions making for prophylactic and specific immunotherapeutic strategies tailored for the individual patient.
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Affiliation(s)
- Florin-Dan Popescu
- Department of Allergology, “Carol Davila” University of Medicine and Pharmacy, Bucharest 022441, Romania
- Department of Allergology and Clinical Immunology, “Nicolae Malaxa” Clinical Hospital, Bucharest 022441, Romania
| | - Mariana Vieru
- Department of Allergology, “Carol Davila” University of Medicine and Pharmacy, Bucharest 022441, Romania
- Department of Allergology and Clinical Immunology, “Nicolae Malaxa” Clinical Hospital, Bucharest 022441, Romania
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17
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Yang J, Lee H, Choi AR, Park KH, Ryu JH, Oh EJ. Comparison of allergen-specific IgE levels between Immulite 2000 and ImmunoCAP systems against six inhalant allergens and ten food allergens. Scandinavian Journal of Clinical and Laboratory Investigation 2018; 78:606-612. [PMID: 30375892 DOI: 10.1080/00365513.2018.1528506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In vitro allergen-specific immunoglobulin E (sIgE) measurement has been used as an important diagnostic tool for allergic diseases. Currently, quantitative sIgE levels are detected mainly by using ImmunoCAP and Immulite 2000 assay system. These two systems have the same calibration scale at 0-100 kUA/L, but they differ in used allergens, detection methods and automation systems. We compared 1600 paired sIgE results for 204 allergic patients, including 100 paired sIgE assay results for each of 16 allergens (Alternaria alternata, birch-alder mix, cat dander, D. farinae, D. pteronyssinus, dog dander, buckwheat, crab, egg white, mackerel, milk, peach, peanut, shrimp, soybean and wheat flour). Inter-method comparison was performed for qualitative data with a cutoff of 0.35 kUA/L and a detection limit of 0.1 kUA/L, semi-quantitative class results and quantitative data. In qualitative comparisons, the overall concordance rate ranged from 81.0% to 99.0% (k: 0.599-0.949) with the cutoff value of 0.35 kUA/L. It also ranged from 80.0% to 99.0% (k: 0.521-0.951) with the detection limit of 0.1 kUA/L. The class results from these two assays showed good agreements for all allergens. For quantitative sIgE results, these two assays showed moderate positive correlations for Dog dander (r = 0.683) and Mackerel (r = 0.573) but high to very high correlations for the other 14 allergens (r = 0.734-0.972). Immulite 2000 and ImmunoCAP assays demonstrated good concordance and correlation for 16 common allergens, but international standards against each specific allergen for calibration and harmonization of sIgE tests are still needed.
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Affiliation(s)
- Jinyoung Yang
- a Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine , The Catholic University of Korea , Seoul , Korea
| | - Hyeyoung Lee
- b Department of Laboratory Medicine, International St. Mary's Hospital, College of Medicine , Catholic Kwandong University , Incheon , Korea
| | - Ae Ran Choi
- a Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine , The Catholic University of Korea , Seoul , Korea
| | - Ki Hyun Park
- a Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine , The Catholic University of Korea , Seoul , Korea.,c Department of Biomedicine & Health Sciences College of Medicine , The Catholic University of Korea , Seoul , Korea
| | - Ji Hyeong Ryu
- a Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine , The Catholic University of Korea , Seoul , Korea.,c Department of Biomedicine & Health Sciences College of Medicine , The Catholic University of Korea , Seoul , Korea
| | - Eun-Jee Oh
- a Department of Laboratory Medicine, Seoul St. Mary's Hospital, College of Medicine , The Catholic University of Korea , Seoul , Korea
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18
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Wojtalewicz N, Kabrodt K, Goseberg S, Schellenberg I. Evaluation of the manufacturer-dependent differences in specific immunoglobulin E results for indoor allergens. Ann Allergy Asthma Immunol 2018; 121:490-495. [PMID: 30025909 DOI: 10.1016/j.anai.2018.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Even though allergies are an important health issue, the detected amount of allergen-specific IgE (sIgE) has differed widely between manufacturers in the past, and even as recently as this year. These discrepancies hinder diagnostics and can even impact allergen immunotherapy. OBJECTIVE The aim of this study was to evaluate the development and status quo of the quality of in vitro diagnostic testing for house dust mites (HDM) and cat epithelium, 2 important indoor allergen sources. METHODS We analyzed data on the allergen sources European HDM, American HDM, and cat epithelium, which were collected by the Society for Promoting Quality Assurance in Medical Laboratories (INSTAND e.V.) during 7 years as part of External Quality Assessment schemes (EQAs). A pseudoanonymized comparison was made of the semiquantitative data and allergen-class results of the 4 main suppliers of in vitro diagnostic sIgE tests. Coefficients of variation (CV) were determined in order to evaluate interlaboratory comparability. RESULTS In vitro allergy diagnostic testing for the major allergen sources HDM and cat epithelium still reveals manufacturer-dependent differences. Despite this, a cautious trend was found towards an alignment of the results and interlaboratory comparability, with the exception of 1 supplier. CONCLUSION Even though these results are promising, future EQAs have to be closely monitored to ensure this positive trend is not just a snapshot.
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Affiliation(s)
- Nathalie Wojtalewicz
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Düsseldorf, Germany
| | - Kathrin Kabrodt
- Institute of Bioanalytical Sciences (IBAS), Center of Life Sciences, Anhalt University of Applied Sciences, Bernburg, Germany
| | - Sabine Goseberg
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Düsseldorf, Germany
| | - Ingo Schellenberg
- INSTAND e.V., Society for Promoting Quality Assurance in Medical Laboratories, Düsseldorf, Germany; Institute of Bioanalytical Sciences (IBAS), Center of Life Sciences, Anhalt University of Applied Sciences, Bernburg, Germany.
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19
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Abstract
Allergy testing is commonly used when symptoms of allergic rhinitis are refractory to symptoms and there is potential for treatment with institution of avoidance measures or immunotherapy. Once the decision for testing has been made, the method of testing by either in vivo skin testing by prick/puncture or intradermal testing or in vitro testing of serum-specific IgE is dictated by factors in the clinical history and an informed decision by the patient. Because there is no perfect testing method, understanding the benefits and limitations of each method is important in selecting the best testing option for each patient.
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Affiliation(s)
- Michael P Platt
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, Boston, MA 02118, USA.
| | - Jacqueline A Wulu
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, Boston, MA 02118, USA
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20
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Abstract
Purpose of review Component-resolved diagnostics makes use of defined allergen molecules to analyse IgE-mediated sensitizations at a molecular level. Here, we review recent studies on the use of component-resolved diagnostics in the field of Hymenoptera venom allergy (HVA) and discuss its benefits and limitations. Recent findings Component resolution in HVA has moved from single molecules to panels of allergens. Detection of specific immunoglobulin E (sIgE) to marker and cross-reactive venom allergens has been reported to facilitate the discrimination between primary sensitization and cross-reactivity and thus, to provide a better rationale for prescribing venom immunotherapy (VIT), particularly in patients sensitized to both honeybee and vespid venom. Characterization of IgE reactivity to a broad panel of venom allergens has allowed the identification of different sensitization profiles that in honeybee venom allergy were associated with increased risks for side effects or treatment failure of VIT. In contrast, component resolution so far has failed to provide reliable markers for the discrimination of sensitizations to venoms of different members of Vespidae. Summary Component-resolved diagnostics allows a better understanding of the complexity of sensitization and cross-reactivities in HVA. In addition, the enhanced resolution and precision may allow identification of biomarkers, which can be used for risk stratification in VIT. Knowledge about the molecular composition of different therapeutic preparations may enable the selection of appropriate preparations for VIT according to individual sensitization profiles, an approach consistent with the goals of personalized medicine.
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21
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Zeng G, Hu H, Zheng P, Wu G, Wei N, Liang X, Sun B, Zhang X. The practical benefit of Phadiatop test as the first-line in vitro allergen-specific immunoglobulin E (sIgE) screening of aeroallergens among Chinese asthmatics: a validation study. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:151. [PMID: 29862240 DOI: 10.21037/atm.2018.04.06] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Phadiatop test is a variant of ImmunoCAP assay that covers a mixture of common aeroallergens. Its diagnostic efficiency in Chinese population remains so far inadequate. We validated Phadiatop testing with ImmunoCAP assays in a Chinese cohort. Methods Phadiatop test was performed for serum samples from 290 asthmatics and 92 healthy controls previously tested with "classic" ImmunoCAP for house dust mix (hx2), molds and yeasts mix (mx2), tree pollen mix (tx4) and weed mix (wx5). Results Phadiatop positivity was shown in 46.2% of 290 asthmatic patients. Using ImmunoCAP as the gold standard, the concordance rate was 91.7%; negative predictive value, 92.9%; and positive predictive value, 90.2%. The sensitivity of Phadiatop test was high for hx2 (98.2%), tx4 (100%) and wx5 (95.5%), but not for mx2 (78.4%). Yet the mx2 allergen-specific immunoglobulin E (sIgE) level in all missed cases was relatively low (0.35 to 0.90 kUA/L). The total Phadiatop sIgE level was correlated with the ImmunoCAP sIgE levels for all allergen mixes combined (rs =0.941, P<0.001) or each allergen mix, particularly the hx2 (rs =0.924) (all P<0.001), 0.53 kUA/L used as a cut-off would optimize the diagnostic performance of Phadiatop testing, yielding 89.4% sensitivity and 97.5% specificity in indentifying serums positive to any of these allergen mixes. Conclusions Overall, Phadiatop test may efficiently detect sensitization to common aeroallergen mixes. In light of the currently rigorous administration on crude extracts for skin tests in China, using Phadiatop as the first-line test for suspected atopy can be cost-effective.
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Affiliation(s)
- Guangqiao Zeng
- State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center of Respiratory Disease, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Haisheng Hu
- State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center of Respiratory Disease, Guangzhou 510120, China
| | - Peiyan Zheng
- State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center of Respiratory Disease, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,Department of Allergy and Clinical Immunology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Sino-French Hoffmann Institute, Guangzhou Medical University, Guangzhou 510120, China
| | - Ge Wu
- State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center of Respiratory Disease, Guangzhou 510120, China
| | - Nili Wei
- State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center of Respiratory Disease, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,Department of Allergy and Clinical Immunology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Sino-French Hoffmann Institute, Guangzhou Medical University, Guangzhou 510120, China
| | - Xueqing Liang
- State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center of Respiratory Disease, Guangzhou 510120, China
| | - Baoqing Sun
- State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center of Respiratory Disease, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,Department of Allergy and Clinical Immunology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,Sino-French Hoffmann Institute, Guangzhou Medical University, Guangzhou 510120, China
| | - Xiaowen Zhang
- State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.,National Clinical Research Center of Respiratory Disease, Guangzhou 510120, China.,Guangzhou Institute of Respiratory Health, Guangzhou 510120, China.,Department of Otolaryngology-Head and Neck Surgery, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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22
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Blank S, Bilò MB, Ollert M. Component-resolved diagnostics to direct in venom immunotherapy: Important steps towards precision medicine. Clin Exp Allergy 2018; 48:354-364. [PMID: 29331065 DOI: 10.1111/cea.13090] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Stings of Hymenoptera can induce IgE-mediated systemic and even fatal allergic reactions. Venom-specific immunotherapy (VIT) is the only disease-modifying and curative treatment of venom allergy. However, choosing the correct venom for VIT represents a necessary prerequisite for efficient protection against further anaphylactic sting reactions after VIT. In the past, therapeutic decisions based on the measurement of specific IgE (sIgE) levels to whole venom extracts were not always straightforward, especially when the patient was not able to identify the culprit insect. In the last years, the increasing knowledge about the molecular structure and relevance of important venom allergens and their availability as recombinant allergens, devoid of cross-reactive carbohydrate determinants, resulted in the development of an advanced component-resolved diagnostics (CRD) approach in venom allergy. Already to date, CRD has increased the sensitivity of sIgE detection and enabled the discrimination between primary sensitization and cross-reactivity, particularly in patients with sensitization to both honeybee and vespid venom. Hence, CRD in many patients improves the selection of the appropriate immunotherapeutic intervention. Moreover, the detailed knowledge about sensitization profiles on a molecular level might open new options to identify patients who are at increased risk of side-effects or not to respond to immunotherapy. Therefore, increasing potential of CRD becomes evident, to direct therapeutic decisions in a personalized and patient-tailored manner. Reviewed here are the state of the art options, recent developments and future perspectives of CRD of Hymenoptera venom allergy.
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Affiliation(s)
- S Blank
- Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, Munich, Germany
| | - M B Bilò
- Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Ancona, Italy
| | - M Ollert
- Department of Infection and Immunity, Luxembourg Institute of Health (LIH), Esch-sur-Alzette, Luxembourg.,Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
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23
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Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, Azar A, Baroody FM, Bachert C, Canonica GW, Chacko T, Cingi C, Ciprandi G, Corey J, Cox LS, Creticos PS, Custovic A, Damask C, DeConde A, DelGaudio JM, Ebert CS, Eloy JA, Flanagan CE, Fokkens WJ, Franzese C, Gosepath J, Halderman A, Hamilton RG, Hoffman HJ, Hohlfeld JM, Houser SM, Hwang PH, Incorvaia C, Jarvis D, Khalid AN, Kilpeläinen M, Kingdom TT, Krouse H, Larenas-Linnemann D, Laury AM, Lee SE, Levy JM, Luong AU, Marple BF, McCoul ED, McMains KC, Melén E, Mims JW, Moscato G, Mullol J, Nelson HS, Patadia M, Pawankar R, Pfaar O, Platt MP, Reisacher W, Rondón C, Rudmik L, Ryan M, Sastre J, Schlosser RJ, Settipane RA, Sharma HP, Sheikh A, Smith TL, Tantilipikorn P, Tversky JR, Veling MC, Wang DY, Westman M, Wickman M, Zacharek M. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol 2018; 8:108-352. [PMID: 29438602 PMCID: PMC7286723 DOI: 10.1002/alr.22073] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). METHODS Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. CONCLUSION This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.
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Affiliation(s)
| | | | | | | | - Cezmi A. Akdis
- Allergy/Asthma, Swiss Institute of Allergy and Asthma Research, Switzerland
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, USA
| | | | | | | | | | - Cemal Cingi
- Otolaryngology, Eskisehir Osmangazi University, Turkey
| | | | | | | | | | | | | | - Adam DeConde
- Otolaryngology, University of California San Diego, USA
| | | | | | | | | | | | | | - Jan Gosepath
- Otorhinolaryngology, Helios Kliniken Wiesbaden, Germany
| | | | | | | | - Jens M. Hohlfeld
- Respiratory Medicine, Hannover Medical School, Airway Research Fraunhofer Institute for Toxicology and Experimental Medicine, German Center for Lung Research, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amber U. Luong
- Otolaryngology, McGovern Medical School at the University of Texas Health Science Center Houston, USA
| | | | | | | | - Erik Melén
- Pediatric Allergy, Karolinska Institutet, Sweden
| | | | | | - Joaquim Mullol
- Otolaryngology, Universitat de Barcelona, Hospital Clinic, IDIBAPS, Spain
| | | | | | | | - Oliver Pfaar
- Rhinology/Allergy, Medical Faculty Mannheim, Heidelberg University, Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | | | - Carmen Rondón
- Allergy, Regional University Hospital of Málaga, Spain
| | - Luke Rudmik
- Otolaryngology, University of Calgary, Canada
| | - Matthew Ryan
- Otolaryngology, University of Texas Southwestern, USA
| | - Joaquin Sastre
- Allergology, Hospital Universitario Fundacion Jiminez Diaz, Spain
| | | | | | - Hemant P. Sharma
- Allergy/Immunology, Children's National Health System, George Washington University School of Medicine, USA
| | | | | | | | | | | | - De Yun Wang
- Otolaryngology, National University of Singapore, Singapore
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24
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Park KH, Lee J, Sim DW, Lee SC. Comparison of Singleplex Specific IgE Detection Immunoassays: ImmunoCAP Phadia 250 and Immulite 2000 3gAllergy. Ann Lab Med 2018; 38:23-31. [PMID: 29071815 PMCID: PMC5700143 DOI: 10.3343/alm.2018.38.1.23] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/17/2017] [Accepted: 09/15/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The identification of clinically meaningful specific immunoglobulin E (sIgE) is important for the diagnosis and management of allergic diseases. Various in vitro sIgE detection methods are available worldwide. Depending on the number of antigens that can be tested simultaneously, there are two representative methods: singleplex and multiplex. Singleplex sIgE detection is mainly provided by Thermo Fisher (ImmunoCAP) and Siemens (Immulite). This study aimed to compare the diagnostic agreement of two singleplex sIgE detection assays. METHODS Sera from 209 Korean patients with allergic disease were used to compare the ImmunoCAP and Immulite assays with respect to the following allergens: inhalant allergens (Dermatophagoides farinae, cat and dog dander, oak, rye grass, mugwort, Alternaria, German cockroach) and food allergens (hen's egg white, cow's milk, wheat, peanut, soybean, and shrimp). Data from 902 paired comparison tests were included for comparisons. Qualitative, semi-quantitative, and quantitative comparisons were performed using statistical analyses. RESULTS In qualitative comparisons, the positivity and negativity agreements ranged from 75% (wheat, shrimp) to 96% (Alternaria). Class consistency (classes 0-6) was well matched. Spearman's rank correlation coefficients for all allergens except shrimp were over 0.7. In quantitative comparisons, all allergens excluding shrimp showed >0.7 intra-class correlation coefficients. CONCLUSIONS The ImmunoCAP and Immulite systems showed similar performances. However, clinicians should consider fundamental methodological differences between the assays.
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Affiliation(s)
- Kyung Hee Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea.
| | - Jongsun Lee
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
| | - Da Woon Sim
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Division of Allergy, Asthma, and Clinical Immunology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Chul Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Allergy, Yonsei University College of Medicine, Seoul, Korea
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Chauveau A, Dalphin ML, Mauny F, Kaulek V, Schmausser-Hechfellner E, Renz H, Riedler J, Pekkanen J, Karvonen AM, Lauener R, Roduit C, Vuitton DA, von Mutius E, Dalphin JC. Skin prick tests and specific IgE in 10-year-old children: Agreement and association with allergic diseases. Allergy 2017; 72:1365-1373. [PMID: 28235151 DOI: 10.1111/all.13148] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Accurate assessment of atopic sensitization is pivotal to clinical practice and research. Skin prick test (SPT) and specific IgE (sIgE) are often used interchangeably. Some studies have suggested a disagreement between these two methods, and little is known about their association with allergic diseases. The aims of our study were to evaluate agreement between SPT and sIgE, and to compare their association with allergic diseases in 10-year-old children. METHODS Skin prick test, sIgE measurements, and assessment of allergic diseases were performed in children aged 10 years in the Protection against Allergy: STUdy in Rural Environments (PASTURE) cohort. The agreement between SPT and sIgE was assessed by Cohen's kappa coefficient with different cutoff values. RESULTS Skin prick tests and sIgE were performed in 529 children. The highest agreement (κ=.44) was found with a cutoff value of 3 and 5 mm for SPT, and 3.5 IU/mL for sIgE. The area under the curve (AUC) obtained with SPT was not significantly different from that obtained with sIgE. For asthma and hay fever, SPT (cutoff value at 3 mm) had a significantly higher specificity (P<.0001) than sIgE (cutoff value at 0.35 IU/mL) and the specificity was not different between both tests (P=.1088). CONCLUSION Skin prick test and sIgE display moderate agreement, but have a similar AUC for allergic diseases. At the cutoff value of 3 mm for SPT and 0.35 IU/mL for sIgE, SPT has a higher specificity for asthma and hay fever than sIgE without difference for sensitivity.
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Affiliation(s)
- A. Chauveau
- Pediatrics Department; University Hospital of Besançon; Besançon France
- Pediatric Allergy Department; University Hospital of Nancy; Nancy France
- UMR 6249 Chrono-Environment; CNRS and University of Franche-Comté; Besançon France
| | - M.-L. Dalphin
- Pediatrics Department; University Hospital of Besançon; Besançon France
| | - F. Mauny
- UMR 6249 Chrono-Environment; CNRS and University of Franche-Comté; Besançon France
- Clinical Methodology Center; University Hospital of Besançon; Besançon France
| | - V. Kaulek
- UMR 6249 Chrono-Environment; CNRS and University of Franche-Comté; Besançon France
- Respiratory Diseases Department; University Hospital of Besançon; Besançon France
| | | | - H. Renz
- Institute for Laboratory Medicine, Pathobiochemistry and Molecular Diagnostics; Philipps University of Marburg; Marburg Germany
| | - J. Riedler
- Children's Hospital Schwarzach; Salzburg Austria
| | - J. Pekkanen
- Department of Health Protection; National Institute for Health and Welfare; Kuopio Finland
- Department of Public Health; University of Helsinki; Helsinki Finland
| | - A. M. Karvonen
- Department of Health Protection; National Institute for Health and Welfare; Kuopio Finland
| | - R. Lauener
- Christine Kühne Center for Allergy Research and Education (CK-CARE); Davos Switzerland
- Children's Hospital of Eastern Switzerland; St. Gallen Switzerland
| | - C. Roduit
- Christine Kühne Center for Allergy Research and Education (CK-CARE); Davos Switzerland
- University Children's Hospital Zurich; Zurich Switzerland
| | - D. A. Vuitton
- EA 3181; University of Franche-Comté; Besançon France
| | - E. von Mutius
- Dr. von Hauner Children's Hospital; Ludwig Maximilians University Munich; Munich Germany
- CPC-M; Member of the German Center for Lung Research; Giessen Germany
| | - J.-C. Dalphin
- UMR 6249 Chrono-Environment; CNRS and University of Franche-Comté; Besançon France
- Respiratory Diseases Department; University Hospital of Besançon; Besançon France
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Luo W, Pan G, Huang H, Zheng P, Wei N, Zhang Y, Zeng G, Sun B. A Component-resolved Diagnostic Approach for a Study on Grass Pollen Allergens in Chinese Southerners with Allergic Rhinitis and/or Asthma. J Vis Exp 2017. [PMID: 28605372 DOI: 10.3791/55723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Sensitization to grass pollen imposes a global risk for allergic airway diseases. Although prevention relies on local investigation of the pollen allergens, data on this topic are limited in southern China. Any available data were obtained by self-report questionnaires, skin prick tests, and total or specific IgE tests using crude extracts. For many reasons, these methods are unreliable. Serum sIgE reactivity to Bermuda grass, Timothy grass, and Humulus scandens allergens in a cohort of patients from Greater Guangzhou (southern China's largest city and its outskirts) with allergic rhinitis and/or asthma were examined using a fully-automated immunoassay analyzer as a component-resolved diagnostics (CRD) tool. For the first time, a considerably high prevalence of Bermuda grass sIgE positivity was demonstrated in Chinese southerners with allergic rhinitis and/or asthma. In these patients, a subtle prevalence of sensitization to Timothy grass and Humulus scandens was also noted, which may arise from cross-reactivity, as the latter two are not common in the region. This was also supported by the detection of allergen components. Fully-automated immunoassay analyzers may offer satisfactory consistency between regions, laboratories, and institutions and over time. The automaticity of the instrument may enable a standardized detection that would not have been readily revealed before the advent of CRD. This is a study that uses a CRD approach to investigate sensitization to grass pollen allergens in southern China. It adds to current evidence in the literature. Future studies are needed to validate these findings. However, although CRD is a useful tool, the findings made with the fully-automated immunoassay analyzer should not substitute for other laboratory investigations, clinical evaluations, and physician expertise.
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Affiliation(s)
- Wenting Luo
- State Key Laboratory of Respiratory Disease; National Clinical Research Center of Respiratory Disease; Guangzhou Institute of Respiratory Diseases; Department of Allergy and Clinical Immunology, First Affiliated Hospital of Guangzhou Medical University
| | - Guichang Pan
- Department of Respiratory Medicine, Sixth Affiliated Hospital of Guangzhou Medical University
| | - Huimin Huang
- State Key Laboratory of Respiratory Disease; National Clinical Research Center of Respiratory Disease; Guangzhou Institute of Respiratory Diseases; Department of Allergy and Clinical Immunology, First Affiliated Hospital of Guangzhou Medical University
| | - Peiyan Zheng
- State Key Laboratory of Respiratory Disease; National Clinical Research Center of Respiratory Disease; Guangzhou Institute of Respiratory Diseases; Department of Allergy and Clinical Immunology, First Affiliated Hospital of Guangzhou Medical University
| | - Nili Wei
- State Key Laboratory of Respiratory Disease; National Clinical Research Center of Respiratory Disease; Guangzhou Institute of Respiratory Diseases; Department of Allergy and Clinical Immunology, First Affiliated Hospital of Guangzhou Medical University
| | - Yifei Zhang
- Department of Respiratory Medicine, Sixth Affiliated Hospital of Guangzhou Medical University
| | - Guangqiao Zeng
- State Key Laboratory of Respiratory Disease; National Clinical Research Center of Respiratory Disease; Guangzhou Institute of Respiratory Diseases; Department of Allergy and Clinical Immunology, First Affiliated Hospital of Guangzhou Medical University;
| | - Baoqing Sun
- State Key Laboratory of Respiratory Disease; National Clinical Research Center of Respiratory Disease; Guangzhou Institute of Respiratory Diseases; Department of Allergy and Clinical Immunology, First Affiliated Hospital of Guangzhou Medical University;
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Bulat Lokas S, Plavec D, Rikić Pišković J, Živković J, Nogalo B, Turkalj M. Allergen-Specific IgE Measurement: Intermethod Comparison of Two Assay Systems in Diagnosing Clinical Allergy. J Clin Lab Anal 2017; 31:e22047. [PMID: 27604174 PMCID: PMC6816900 DOI: 10.1002/jcla.22047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/11/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Our aim was to examine the performance of IMMULITE 2000 assay for specific IgE (sIgE) by comparing it with ImmunoCAP technology in light of a clinical background. METHODS Measurements of sIgE were done in a selected patient group (N = 569; varied sample size for each allergen) and in a random sample group (N = 100; 8 allergens). sIgE results were correlated with skin-prick test results (selected patients) and medical history (nonselected patients). RESULTS We have detected fair to excellent correlation and agreement between the results of both assays, despite their methodological differences, both in selected and nonselected patient group (ρc = 0.431-0.976; ρc = 0.390-0.972, respectively). Associations of sIgE levels with skin-prick test (SPT) levels and medical history have shown significant correlation for both assays for majority of tested allergens, where applicable (D. pteronyssinus, cat dander, egg white, milk, peanut, orchard grass, Alternaria tenuis, and common ragweed in selected patients; birch, cat dander, common ragweed, D. pteronyssinus, and orchard grass in nonselected; P < 0.05 for all). CONCLUSIONS Laboratory testing for sIgE can be successfully accomplished by IMMULITE 2000 immunoanalyzer at a diagnostic accuracy relative to SPT, comparable to the results acquired by CAP technology but not fully comparable on the level of an individual patient.
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Affiliation(s)
| | - Davor Plavec
- Children's Hospital SrebrnjakZagrebCroatia
- Faculty of MedicineJosip Juraj Strossmayer University OsijekOsijekCroatia
| | | | | | - Boro Nogalo
- Children's Hospital SrebrnjakZagrebCroatia
- Faculty of MedicineJosip Juraj Strossmayer University OsijekOsijekCroatia
| | - Mirjana Turkalj
- Children's Hospital SrebrnjakZagrebCroatia
- Faculty of MedicineJosip Juraj Strossmayer University OsijekOsijekCroatia
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Diagnostik der Hymenopterengiftallergie: aktuelle Konzepte und Entwicklungen mit besonderem Fokus auf die molekulare Allergiediagnostik. ALLERGO JOURNAL 2017. [DOI: 10.1007/s15007-017-1315-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Diagnostics in Hymenoptera venom allergy: current concepts and developments with special focus on molecular allergy diagnostics. ACTA ACUST UNITED AC 2017; 26:93-105. [PMID: 28503403 PMCID: PMC5406443 DOI: 10.1007/s40629-017-0014-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/06/2017] [Indexed: 11/05/2022]
Abstract
Background The high rate of asymptomatic sensitization to Hymenoptera venom, difficulty in correctly identifying Hymenoptera and loss of sensitization over time make an accurate diagnosis of Hymenoptera venom allergy challenging. Although routine diagnostic tests encompassing skin tests and the detection of venom-specific IgE antibodies with whole venom preparations are reliable, they offer insufficient precision in the case of double sensitized patients or in those with a history of sting anaphylaxis, in whom sensitization cannot be proven or only to the presumably wrong venom. Methods Systematic literature research and review of current concepts of diagnostic testing in Hymenoptera venom allergy. Results and discussion Improvements in diagnostic accuracy over recent years have mainly been due to the increasing use of molecular allergy diagnostics. Detection of specific IgE antibodies to marker and cross-reactive venom allergens improves the discrimination between genuine sensitization and cross-reactivity, and this provides a better rationale for prescribing venom immunotherapy. The basophil activation test has also increased diagnostic accuracy by reducing the number of Hymenoptera venom sensitizations overlooked with routine tests. This paper reviews current concepts of diagnostic testing in Hymenoptera venom allergy and suggests fields for further development.
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Sato S, Ogura K, Takahashi K, Sato Y, Yanagida N, Ebisawa M. Usefulness of antigen-specific IgE probability curves derived from the 3gAllergy assay in diagnosing egg, cow's milk, and wheat allergies. Allergol Int 2017; 66:296-301. [PMID: 27523600 DOI: 10.1016/j.alit.2016.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/21/2016] [Accepted: 06/28/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Specific IgE (sIgE) antibody detection using the Siemens IMMULITE® 3gAllergy™ (3gAllergy) assay have not been sufficiently examined for the diagnosis of food allergy. The aim of this study was to evaluate the utility of measuring sIgE levels using the 3gAllergy assay to diagnose allergic reactions to egg, milk, and wheat. METHODS This retrospective study was conducted on patients with diagnosed or suspected allergies to egg, milk and wheat. Patients were divided into two groups according to their clinical reactivity to these allergens based on oral food challenge outcomes and/or convincing histories of immediate reaction to causative food(s). The sIgE levels were measured using 3gAllergy and ImmunoCAP. Predicted probability curves were estimated using logistic regression analysis. RESULTS We analyzed 1561 patients, ages 0-19 y (egg = 436, milk = 499, wheat = 626). The sIgE levels determined using 3gAllergy correlated with those of ImmunoCAP, classifying 355 patients as symptomatic: egg = 149, milk = 123, wheat = 83. 3gAllergy sIgE levels were significantly higher in symptomatic than in asymptomatic patients (P < 0.0001). Predictive probability for positive food allergy was significantly increased and correlated with increased sIgE levels. The cut-offs for allergic reaction with 95% predictive probability as determined by the 3gAllergy probability curves were different from those of ImmunoCAP. CONCLUSIONS Measurements of sIgE against egg, milk, and wheat as determined by 3gAllergy may be used as a tool to facilitate the diagnosis of food allergy in subjects with suspected food allergies. However, these probability curves should not be applied interchangeably between different assays.
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Affiliation(s)
- Sakura Sato
- Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan.
| | - Kiyotake Ogura
- Department of Pediatrics, Sagamihara National Hospital, Kanagawa, Japan
| | - Kyohei Takahashi
- Department of Pediatrics, Sagamihara National Hospital, Kanagawa, Japan
| | - Yasunori Sato
- Department of Biostatistics, Clinical Research Center, Chiba University, Chiba, Japan
| | - Noriyuki Yanagida
- Department of Pediatrics, Sagamihara National Hospital, Kanagawa, Japan
| | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
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Wojtalewicz N, Goseberg S, Kabrodt K, Schellenberg I. Six years of INSTAND e. V. sIgE proficiency testing: an evaluation of in vitro allergy diagnostics. ALLERGO JOURNAL 2017. [DOI: 10.1007/s15007-017-1297-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sturm GJ, Schrautzer C, Arzt L, Aberer W. Reply. J Allergy Clin Immunol 2017; 139:1067-1068. [DOI: 10.1016/j.jaci.2016.09.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 09/09/2016] [Indexed: 11/25/2022]
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Wojtalewicz N, Goseberg S, Kabrodt K, Schellenberg I. Six years of INSTAND e. V. sIgE proficiency testing: An evaluation of in vitro allergy diagnostics. ACTA ACUST UNITED AC 2017; 26:43-52. [PMID: 28344920 PMCID: PMC5346112 DOI: 10.1007/s40629-016-0005-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/23/2016] [Indexed: 11/24/2022]
Abstract
Background Even though allergies are an important health issue, wide manufacturer-dependent differences in the detected
amounts of allergen-specific IgE (sIgE) have repeatedly been found. These discrepancies hinder diagnostics and
research into clinically significant cutoff points for life-threatening symptoms. Methods To evaluate whether the reported differences have led to changes in diagnostic testing, we analyzed data from six years of round robin testing (RRT, also known as proficiency testing) at the Gesellschaft zur Förderung der Qualitätssicherung in medizinischen Laboratorien e.V. (Society for Promoting Quality Assurance in medical Laboratories) for the important allergen sources bee venom, wasp venom, and birch pollen. The results of the four main suppliers of in vitro diagnostic sIgE testing were compared in a pseudo-anonymized form using overlay images of box plot graphs for the semiquantitative data and allergen class results. Coefficients of variation (CV) were obtained to study the development of interlaboratory comparability. Results We found that the large differences between the manufacturer collectives remained constant between January 2010
and April 2015 without any real improvement. The CVs were good for two of the four analyzed suppliers, one was
marginal and one above the quality level of 20%. Conclusion The numerous publications that have found discrepancies in the sIgE results of the different suppliers did not change the status quo within the last six years. Unfortunately, this is unlikely to change until there is a characterized standard material with known values of sIgE.
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Affiliation(s)
- N Wojtalewicz
- Center of Life Sciences, AG IBAS, Hochschule Anhalt, Stenzfelder Allee 28, 06406 Bernburg (Saale), Germany
| | | | - K Kabrodt
- Center of Life Sciences, AG IBAS, Hochschule Anhalt, Stenzfelder Allee 28, 06406 Bernburg (Saale), Germany
| | - I Schellenberg
- Center of Life Sciences, AG IBAS, Hochschule Anhalt, Stenzfelder Allee 28, 06406 Bernburg (Saale), Germany
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Jakob T, Spillner E. Comparing sensitivity of Hymenoptera allergen components on different diagnostic assay systems: Comparing apples and oranges? J Allergy Clin Immunol 2017; 139:1066-1067. [PMID: 28062118 DOI: 10.1016/j.jaci.2016.09.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/09/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Thilo Jakob
- Department of Dermatology and Allergology, University Medical Center Gieβen and Marburg, Camous Gieβen, Justus Liebig University Gieβen, Germany; Allergy Research Group, Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany.
| | - Edzard Spillner
- Immunological Engineering, Department of Engineering, Aarhus University, Aarhus, Denmark
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Furuya K, Nagao M, Sato Y, Ito S, Fujisawa T. Predictive values of egg-specific IgE by two commonly used assay systems for the diagnosis of egg allergy in young children: a prospective multicenter study. Allergy 2016; 71:1435-43. [PMID: 27061295 PMCID: PMC5129468 DOI: 10.1111/all.12912] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2016] [Indexed: 11/29/2022]
Abstract
Background Specific IgE (sIgE) is often used to predict oral food challenge (OFC) outcomes in food allergy, but interpretation of the results may vary depending on the assay method employed and the patient population tested. The aim of this study was to use two commercial assay systems to determine egg‐sIgE values predictive of allergy within the most common populations treated at pediatric clinics. Methods In a multicenter prospective study, 433 children with suspected or confirmed egg allergy underwent oral challenge (OFC) using cooked egg (CE) and raw egg (RE) powders to diagnose either true allergy in 1‐year‐old (group A, n = 220) or tolerance in 2‐ to 6‐year‐old (group B, n = 213). Egg white (EW)‐ and ovomucoid (OM)‐sIgE values were measured using the ImmunoCAP®sIgE (ImmunoCAP) and the IMMULITE® 2000 3 gAllergy™ (3gAllergy) systems. Children were recruited from six primary care clinics and 18 hospitals in Japan. Results Receiver‐operating characteristic (ROC) curve analysis yielded similar areas under the curve (AUC) for the two assays (0.7–0.8). The optimal cutoff values and the probability curves (PCs) of the sIgE by the two assays to predict CE and RE OFC outcomes were determined for both groups. Values for 3gAllergy were higher than for ImmunoCAP; however, correlation of sIgE and predicted probability calculated by PCs were strong between the two methods. Conclusions Cutoff values and PCs for egg‐sIgE established using both ImmunoCAP and 3gAllergy may be useful for predicting egg allergy in early childhood patient populations.
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Affiliation(s)
- K. Furuya
- Allergy Center and Institute for Clinical Research; Mie National Hospital; Tsu Japan
| | - M. Nagao
- Allergy Center and Institute for Clinical Research; Mie National Hospital; Tsu Japan
| | - Y. Sato
- Department of Global Clinical Research; Graduate School of Medicine; Chiba University; Chiba Japan
| | - S. Ito
- Department of Food Science and Nutrition; Faculty of Human Life and Science; Doshisha Women's College of Liberal Arts; Kyoto Japan
| | - T. Fujisawa
- Allergy Center and Institute for Clinical Research; Mie National Hospital; Tsu Japan
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Adkinson NF, Hamilton RG. Clinical History-Driven Diagnosis of Allergic Diseases: Utilizing in vitro IgE Testing. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 3:871-6; quiz 877-8. [PMID: 26553614 DOI: 10.1016/j.jaip.2015.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/06/2015] [Accepted: 08/10/2015] [Indexed: 02/06/2023]
Abstract
This case illustrates the importance of a thorough clinical history in providing an interpretation of previously collected IgE antibody serology as part of a workup for allergic disease. Although a yellow-jacket sting was the allergenic insult that led the patient to the emergency department, nonindicated IgE antibody serology tests were ordered that subsequently required interpretation. This report systematically evaluates the relative significance of previously measured IgE antibody serology responses to 4 major allergen groups (inhalants [aeroallergens], foods, venoms, and drugs) within the context of the patient's history. An algorithm that takes into account the pretest likelihood of disease and diagnostic sensitivity and specificity of the available IgE antibody tests is proposed for decisions about further IgE testing. This case study concludes that selection of testing methods, extract and molecular allergen specificities, and the final interpretation of the results from tests of sensitization such as serological (in vitro) IgE antibody assays requires knowledge of test parameters and clinical judgments based largely on a carefully collected clinical history and physical examination.
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Affiliation(s)
- N Franklin Adkinson
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Robert G Hamilton
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
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Chauveau A, Dalphin ML, Kaulek V, Roduit C, Pugin A, von Mutius E, Vuitton DA, Dalphin JC. Disagreement between Skin Prick Tests and Specific IgE in Early Childhood. Int Arch Allergy Immunol 2016; 170:69-74. [DOI: 10.1159/000446776] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 05/03/2016] [Indexed: 11/19/2022] Open
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Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Hilger C, Hofmaier S, Aalberse RC, Agache I, Asero R, Ballmer-Weber B, Barber D, Beyer K, Biedermann T, Bilò MB, Blank S, Bohle B, Bosshard PP, Breiteneder H, Brough HA, Caraballo L, Caubet JC, Crameri R, Davies JM, Douladiris N, Ebisawa M, EIgenmann PA, Fernandez-Rivas M, Ferreira F, Gadermaier G, Glatz M, Hamilton RG, Hawranek T, Hellings P, Hoffmann-Sommergruber K, Jakob T, Jappe U, Jutel M, Kamath SD, Knol EF, Korosec P, Kuehn A, Lack G, Lopata AL, Mäkelä M, Morisset M, Niederberger V, Nowak-Węgrzyn AH, Papadopoulos NG, Pastorello EA, Pauli G, Platts-Mills T, Posa D, Poulsen LK, Raulf M, Sastre J, Scala E, Schmid JM, Schmid-Grendelmeier P, van Hage M, van Ree R, Vieths S, Weber R, Wickman M, Muraro A, Ollert M. EAACI Molecular Allergology User's Guide. Pediatr Allergy Immunol 2016; 27 Suppl 23:1-250. [PMID: 27288833 DOI: 10.1111/pai.12563] [Citation(s) in RCA: 515] [Impact Index Per Article: 64.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The availability of allergen molecules ('components') from several protein families has advanced our understanding of immunoglobulin E (IgE)-mediated responses and enabled 'component-resolved diagnosis' (CRD). The European Academy of Allergy and Clinical Immunology (EAACI) Molecular Allergology User's Guide (MAUG) provides comprehensive information on important allergens and describes the diagnostic options using CRD. Part A of the EAACI MAUG introduces allergen molecules, families, composition of extracts, databases, and diagnostic IgE, skin, and basophil tests. Singleplex and multiplex IgE assays with components improve both sensitivity for low-abundance allergens and analytical specificity; IgE to individual allergens can yield information on clinical risks and distinguish cross-reactivity from true primary sensitization. Part B discusses the clinical and molecular aspects of IgE-mediated allergies to foods (including nuts, seeds, legumes, fruits, vegetables, cereal grains, milk, egg, meat, fish, and shellfish), inhalants (pollen, mold spores, mites, and animal dander), and Hymenoptera venom. Diagnostic algorithms and short case histories provide useful information for the clinical workup of allergic individuals targeted for CRD. Part C covers protein families containing ubiquitous, highly cross-reactive panallergens from plant (lipid transfer proteins, polcalcins, PR-10, profilins) and animal sources (lipocalins, parvalbumins, serum albumins, tropomyosins) and explains their diagnostic and clinical utility. Part D lists 100 important allergen molecules. In conclusion, IgE-mediated reactions and allergic diseases, including allergic rhinoconjunctivitis, asthma, food reactions, and insect sting reactions, are discussed from a novel molecular perspective. The EAACI MAUG documents the rapid progression of molecular allergology from basic research to its integration into clinical practice, a quantum leap in the management of allergic patients.
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Affiliation(s)
- P M Matricardi
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - J Kleine-Tebbe
- Allergy & Asthma Center Westend, Outpatient Clinic Ackermann, Hanf, & Kleine-Tebbe, Berlin, Germany
| | - H J Hoffmann
- Department of Respiratory Diseases and Allergy, Institute of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - R Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - C Hilger
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - S Hofmaier
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - R C Aalberse
- Sanquin Research, Department of Immunopathology, Amsterdam, The Netherlands
- Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - I Agache
- Department of Allergy and Clinical Immunology, Faculty of Medicine, Transylvania University of Brasov, Brasov, Romania
| | - R Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - B Ballmer-Weber
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - D Barber
- IMMA-School of Medicine, University CEU San Pablo, Madrid, Spain
| | - K Beyer
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - T Biedermann
- Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
| | - M B Bilò
- Allergy Unit, Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy
| | - S Blank
- Center of Allergy and Environment (ZAUM), Helmholtz Center Munich, Technical University of Munich, Munich, Germany
| | - B Bohle
- Division of Experimental Allergology, Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology & Immunology, Medical University of Vienna, Vienna, Austria
| | - P P Bosshard
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - H Breiteneder
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - H A Brough
- Paediatric Allergy, Department of Asthma, Allergy and Respiratory Science, King's College London, Guys' Hospital, London, UK
| | - L Caraballo
- Institute for Immunological Research, The University of Cartagena, Cartagena de Indias, Colombia
| | - J C Caubet
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - R Crameri
- Swiss Institute of Allergy and Asthma Research, University of Zürich, Davos, Switzerland
| | - J M Davies
- School of Biomedical Sciences, Institute of Biomedical Innovation, Queensland University of Technology, Brisbane, Qld, Australia
| | - N Douladiris
- Allergy Unit, 2nd Paediatric Clinic, National & Kapodistrian University, Athens, Greece
| | - M Ebisawa
- Department of Allergy, Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan
| | - P A EIgenmann
- Pediatric Allergy Unit, Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
| | - M Fernandez-Rivas
- Allergy Department, Hospital Clinico San Carlos IdISSC, Madrid, Spain
| | - F Ferreira
- Division of Allergy and Immunology, Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - G Gadermaier
- Division of Allergy and Immunology, Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - M Glatz
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - R G Hamilton
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - T Hawranek
- Department of Dermatology, Paracelsus Private Medical University, Salzburg, Austria
| | - P Hellings
- Department of Otorhinolaryngology, Academic Medical Center (AMC), Amsterdam, The Netherlands
- Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium
| | - K Hoffmann-Sommergruber
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - T Jakob
- Department of Dermatology and Allergology, University Medical Center Giessen and Marburg, Justus Liebig University Giessen, Giessen, Germany
| | - U Jappe
- Division of Clinical and Molecular Allergology, Research Centre Borstel, Airway Research Centre North (ARCN), Member of the German Centre for Lung Research (DZL), Borstel, Germany
- Interdisciplinary Allergy Division, Department of Pneumology, University of Lübeck, Lübeck, Germany
| | - M Jutel
- Department of Clinical Immunology, 'ALL-MED' Medical Research Institute, Wrocław Medical University, Wrocław, Poland
| | - S D Kamath
- Molecular Allergy Research Laboratory, Centre for Biodiscovery and Molecular Development of Therapeutics, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville City, Qld, Australia
| | - E F Knol
- Departments of Immunology and Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Korosec
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - A Kuehn
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - G Lack
- King's College London, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
- Division of Asthma, Allergy and Lung Biology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A L Lopata
- Department of Clinical Immunology, 'ALL-MED' Medical Research Institute, Wrocław Medical University, Wrocław, Poland
| | - M Mäkelä
- Skin and Allergy Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - M Morisset
- National Service of Immuno-Allergology, Centre Hospitalier Luxembourg (CHL), Luxembourg, UK
| | - V Niederberger
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - A H Nowak-Węgrzyn
- Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N G Papadopoulos
- Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
| | - E A Pastorello
- Unit of Allergology and Immunology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - G Pauli
- Service de Pneumologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - T Platts-Mills
- Department of Microbiology & Immunology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - D Posa
- Paediatric Pneumology and Immunology, Charitè Medical University, Berlin, Germany
| | - L K Poulsen
- Allergy Clinic, Copenhagen University Hospital, Copenhagen, Denmark
| | - M Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Ruhr-University Bochum (IPA), Bochum, Germany
| | - J Sastre
- Allergy Division, Fundación Jimenez Díaz, Madrid, Spain
| | - E Scala
- Experimental Allergy Unit, IDI-IRCCS, Rome, Italy
| | - J M Schmid
- Department of Respiratory Diseases and Allergy, Institute of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - P Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
- Christine Kühne Center for Allergy Research and Education CK-CARE, Davos, Switzerland
| | - M van Hage
- Department of Medicine Solna, Clinical Immunology and Allergy Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - R van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - S Vieths
- Department of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - R Weber
- School of Medicine, University of Colorado, Denver, CO, USA
- Department of Medicine, National Jewish Health Service, Denver, CO, USA
| | - M Wickman
- Sachs' Children's Hospital, Karolinska Institutet, Stockholm, Sweden
| | - A Muraro
- The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, Department of Mother and Child Health, University of Padua, Padua, Italy
| | - M Ollert
- Department of Infection & Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
- Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark
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Smoldovskaya O, Feyzkhanova G, Arefieva A, Voloshin S, Ivashkina O, Reznikov Y, Rubina A. Allergen extracts and recombinant proteins: comparison of efficiency of in vitro allergy diagnostics using multiplex assay on a biological microchip. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2016. [PMID: 26973700 DOI: 10.1186/s13223-016-0117-1.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Immunological test systems for diagnostics of type I hypersensitivity involve the following types of antigens: whole allergen extracts, individual highly purified proteins and their recombinant analogues. The goal of this study was to compare the results obtained with whole allergen extracts (birch pollen, cat dander, and timothy grass pollen) and their respective recombinant proteins in biochip-based immunoassay. METHODS Multiplex fluorescent immunoassay of 139 patients' blood serum samples was carried out using biological microchips (biochips). sIgE concentrations for the chosen allergens and their recombinant components were measured. ROC analysis was used for comparison of the results and determination of diagnostic accuracy. RESULTS The results for the birch pollen extract and its recombinant allergens have shown that the diagnostic accuracy of the methods utilizing the whole allergen extract, its major component Bet v 1 and the combination of major and minor components (Bet v 1 and Bet v 2) was the same. Values for diagnostic accuracy for the cat dander extract and its major recombinant component Fel d 1 were equal. In contrast with birch pollen and cat dander allergens, using of recombinant components of timothy grass pollen (Phl p 1, Phl p 5, Phl p 7 and Phl p 12) did not allow reaching the diagnostic accuracy of using natural extract. CONCLUSIONS Multiplex analysis of samples obtained from patients with allergy to birch pollen and cat dander using biological microchips has shown that comparable accuracy was observed for the assay with natural extracts and recombinant allergens. In the case of timothy grass allergen, using the recombinant components may be insufficient.
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Affiliation(s)
- Olga Smoldovskaya
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences (EIMB RAS), 119991 Vavilova str.,32, Moscow, Russia
| | - Guzel Feyzkhanova
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences (EIMB RAS), 119991 Vavilova str.,32, Moscow, Russia
| | - Alla Arefieva
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences (EIMB RAS), 119991 Vavilova str.,32, Moscow, Russia
| | - Sergei Voloshin
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences (EIMB RAS), 119991 Vavilova str.,32, Moscow, Russia
| | - Olga Ivashkina
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences (EIMB RAS), 119991 Vavilova str.,32, Moscow, Russia
| | - Yuriy Reznikov
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences (EIMB RAS), 119991 Vavilova str.,32, Moscow, Russia
| | - Alla Rubina
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences (EIMB RAS), 119991 Vavilova str.,32, Moscow, Russia
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Smoldovskaya O, Feyzkhanova G, Arefieva A, Voloshin S, Ivashkina O, Reznikov Y, Rubina A. Allergen extracts and recombinant proteins: comparison of efficiency of in vitro allergy diagnostics using multiplex assay on a biological microchip. Allergy Asthma Clin Immunol 2016; 12:9. [PMID: 26973700 PMCID: PMC4789275 DOI: 10.1186/s13223-016-0117-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/03/2016] [Indexed: 11/10/2022] Open
Abstract
Background Immunological test systems for diagnostics of type I hypersensitivity involve the following types of antigens: whole allergen extracts, individual highly purified proteins and their recombinant analogues. The goal of this study was to compare the results obtained with whole allergen extracts (birch pollen, cat dander, and timothy grass pollen) and their respective recombinant proteins in biochip-based immunoassay. Methods Multiplex fluorescent immunoassay of 139 patients’ blood serum samples was carried out using biological microchips (biochips). sIgE concentrations for the chosen allergens and their recombinant components were measured. ROC analysis was used for comparison of the results and determination of diagnostic accuracy. Results The results for the birch pollen extract and its recombinant allergens have shown that the diagnostic accuracy of the methods utilizing the whole allergen extract, its major component Bet v 1 and the combination of major and minor components (Bet v 1 and Bet v 2) was the same. Values for diagnostic accuracy for the cat dander extract and its major recombinant component Fel d 1 were equal. In contrast with birch pollen and cat dander allergens, using of recombinant components of timothy grass pollen (Phl p 1, Phl p 5, Phl p 7 and Phl p 12) did not allow reaching the diagnostic accuracy of using natural extract. Conclusions Multiplex analysis of samples obtained from patients with allergy to birch pollen and cat dander using biological microchips has shown that comparable accuracy was observed for the assay with natural extracts and recombinant allergens. In the case of timothy grass allergen, using the recombinant components may be insufficient.
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Affiliation(s)
- Olga Smoldovskaya
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences (EIMB RAS), 119991 Vavilova str.,32, Moscow, Russia
| | - Guzel Feyzkhanova
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences (EIMB RAS), 119991 Vavilova str.,32, Moscow, Russia
| | - Alla Arefieva
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences (EIMB RAS), 119991 Vavilova str.,32, Moscow, Russia
| | - Sergei Voloshin
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences (EIMB RAS), 119991 Vavilova str.,32, Moscow, Russia
| | - Olga Ivashkina
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences (EIMB RAS), 119991 Vavilova str.,32, Moscow, Russia
| | - Yuriy Reznikov
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences (EIMB RAS), 119991 Vavilova str.,32, Moscow, Russia
| | - Alla Rubina
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences (EIMB RAS), 119991 Vavilova str.,32, Moscow, Russia
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Hwang H, Kwon J, Kim JY, Lee HH, Oh CE, Choi GS. The RIDA Allergy Screen Versus the Phadiatop Test in 430 Consecutive Patient Specimens. Lab Med 2016; 47:20-9. [DOI: 10.1093/labmed/lmv002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Abstract:Assays for total and allergen-specific (s) IgE are essential serological tests in the diagnostic work-up of immediate type hypersensitivity reactions and atopic diseases. Technical performance characteristics and clinical utility of IgE tests have been published in international guidelines. In the USA and in Europe, IgE tests are mainly performed by accredited medical laboratories and in Germany they are also performed by allergists carrying an OIII-limited license. Both have to perform continuously internal and external quality control measures including proficiency trials twice a year (in Germany). Due to the heterogeneity of the assay’s core allergen reagents, complex extracts and more recently defined allergenic molecules, and heterologous assay calibration, the results of qualitative and quantitative sIgE tests from different diagnostic manufacturers can vary considerably. Proficiency trial results are subsequently grouped according to each assay type. Passing acceptance criteria depend on national rules and regarding quality management. Future challenges include a more valid quantification of sIgE which would allow true comparisons with the international units for total IgE, and the use of harmonized allergen reagents for the most important allergen sources, which have hampered inter-assay comparability in the past.
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Tan Y, Halsey JF, Tang T, Wetering SV, Taine E, Cleve MV, Cunningham BT. Application of photonic crystal enhanced fluorescence to detection of low serum concentrations of human IgE antibodies specific for a purified cat allergen (Fel D1). Biosens Bioelectron 2015; 77:194-201. [PMID: 26406461 DOI: 10.1016/j.bios.2015.08.071] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/23/2015] [Accepted: 08/31/2015] [Indexed: 01/21/2023]
Abstract
We demonstrate the detection of low concentrations of allergen-specific Immunoglobulin E (IgE) in human sera using a Photonic Crystal Enhanced Fluorescence (PCEF) microarray platform. The Photonic Crystal (PC) surface, designed to provide optical resonances for the excitation wavelength and emission wavelength of Cy5, was used to amplify the fluorescence signal intensity measured from a multiplexed allergen microarray. Surface-based sandwich immunoassays were used to detect and quantify specific IgE antibodies against a highly purified cat allergen (Fel d1). A comparison of the lowest detectable concentration of IgE measured by the PC microarray system and a commercially available clinical analyzer demonstrated that the PCEF microarray system provides higher sensitivity. The PCEF system was able to detect low concentrations of specific IgE (~0.02 kU/L), which is 5-17-fold more sensitive than the commercially available FDA-approved analyzers. In preliminary experiments using multi-allergen arrays, we demonstrate selective simultaneous detection of IgE antibodies to multiple allergens.
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Affiliation(s)
- Yafang Tan
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, United states
| | - John F Halsey
- Exalt Diagnostics, Urbana-Champaign, IL, United States
| | - Tiantian Tang
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, United states
| | | | - Elaine Taine
- Hycor Biomedical, Indianapolis, IN, United States
| | | | - Brian T Cunningham
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, United states; Department of Bioengineering, University of Illinois at Urbana-Champaign, United States.
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Oppenheimer J. Skin testing versus in vitro testing in the evaluation of aeroallergy: The great debate. Am J Rhinol Allergy 2015; 29:362-4. [PMID: 26358347 DOI: 10.2500/ajra.2015.29.4211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
When one examines reviews regarding diagnostic allergy testing, it generally is noted that the advantage of skin testing is that it uses testing to an end organ, is less expensive, is more sensitive, and provides immediate results, which are easily visualized by the patient. In the case of in vitro testing, it is thought to be more helpful for patients with dermographia or widespread dermatitis, is not affected by H1 or H2 antagonists, and is thought to be safer than skin testing. This may not be entirely correct because studies actually demonstrated phlebotomy to be associated with more morbidity than skin-prick testing. Other concerns regarding both tests include allergen quality, the need from proficiency testing, and the fact that these tests should be used for corroborating a diagnosis as opposed to a screening test for allergy.
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Affiliation(s)
- John Oppenheimer
- Pulmonary and Allergy Associates, Summit, New Jersey and Rutgers, The State University of New Jersey, Newark, New Jersey, USA
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Page ID, Richardson M, Denning DW. Antibody testing in aspergillosis--quo vadis? Med Mycol 2015; 53:417-39. [PMID: 25980000 DOI: 10.1093/mmy/myv020] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 02/09/2015] [Indexed: 12/19/2022] Open
Abstract
Humans are constantly exposed to airborne Aspergillus spores. Most develop Aspergillus-specific antibodies by adulthood. Persons with chronic lung disease or Aspergillus airway colonization often have raised levels of Aspergillus-specific immunoglobululin G (IgG). It is not known whether this signifies an increased risk of future aspergillosis.Chronic and allergic forms of pulmonary aspergillosis are estimated to affect over three million people worldwide. Antibody testing is central to diagnosis of these conditions, with raised Aspergillus-specific IgG in chronic pulmonary aspergillosis and raised Aspergillus-specific IgE in allergic aspergillosis. Antibody levels are also used to monitor treatment response in these syndromes. Acute invasive disease is less common. There is a more limited role for antibody testing in this setting as immunosuppression often results in delayed or absent antibody response.Many methods exist to detect Aspergillus-specific antibodies, but there are limited published data regarding comparative efficacy and reproducibility. We discuss the comparative merits of the available tests in the various clinical settings and their suitability for use in the resource-poor settings where the majority of cases of aspergillosis are thought to occur. We summarize the gaps in existing knowledge and opportunities for further study that could allow optimal use of antibody testing in this field.
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Affiliation(s)
- Iain D Page
- Institute of Inflammation and Repair, The University of Manchester, UK Manchester Academic Health Science Centre, UK National Aspergillosis Center and Mycology Reference Centre, University Hospital South Manchester, UK
| | - Malcolm Richardson
- Institute of Inflammation and Repair, The University of Manchester, UK Manchester Academic Health Science Centre, UK National Aspergillosis Center and Mycology Reference Centre, University Hospital South Manchester, UK
| | - David W Denning
- Institute of Inflammation and Repair, The University of Manchester, UK Manchester Academic Health Science Centre, UK National Aspergillosis Center and Mycology Reference Centre, University Hospital South Manchester, UK
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Lu CS, Hung AF, Lin CJ, Chen JB, Chen C, Shiung YY, Tsai CY, Chang TW. Generating allergen-specific human IgEs for immunoassays by employing human ε gene knockin mice. Allergy 2015; 70:384-90. [PMID: 25616164 DOI: 10.1111/all.12572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Antigen-specific human IgEs are important reagents in immunoassays to quantify antigen-specific IgEs in allergic patients, but they are not easy to prepare. METHODS We constructed a knockin homozygous mouse strain, referred to as HεκKI strain, whose gene segment encoding γ1 constant region has been replaced by that encoding human ε constant region and gene segment encoding κ constant region replaced by that encoding human κ constant region. The mice were tested for their ability to produce antigen-specific chimeric human IgE (with mouse variable regions) upon the immunization with ovalbumin and papain. Subsequently, the spleen cells from the immunized mice were used as the source of B cells for the preparation of hybridomas, which secreted monoclonal human IgE antibodies specific for the antigens. RESULTS The HεκKI mice expressed human IgE (ε, κ) in serum at levels 10- to 30-fold higher than those of mouse IgE. Upon immunization with an antigen, the mice yielded splenic B cells for preparing hybridomas that secrete chimeric human IgE specific for the antigen. Purified IgEs from those hybridomas could activate a basophilic cell line to undergo degranulation upon the stimulation with their respective antigens. CONCLUSIONS We have developed a human ε gene and κ gene knockin mouse strain, which is useful for producing various antigen-specific chimeric human IgEs for potential use as standards in immunoassays.
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Affiliation(s)
- C.-S. Lu
- Genomics Research Center; Academia Sinica; Taipei Taiwan
| | - A. F. Hung
- Genomics Research Center; Academia Sinica; Taipei Taiwan
| | - C.-J. Lin
- Genomics Research Center; Academia Sinica; Taipei Taiwan
| | - J.-B. Chen
- Genomics Research Center; Academia Sinica; Taipei Taiwan
| | - C. Chen
- Genomics Research Center; Academia Sinica; Taipei Taiwan
| | - Y.-Y. Shiung
- Genomics Research Center; Academia Sinica; Taipei Taiwan
| | - C.-Y. Tsai
- Institute of Molecular Biology; Academia Sinica; Taipei Taiwan
| | - T. W. Chang
- Genomics Research Center; Academia Sinica; Taipei Taiwan
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Huss-Marp J, Gutermuth J, Schäffner I, Darsow U, Pfab F, Brockow K, Ring J, Behrendt H, Jakob T, Ahlgrim C. Comparison of molecular and extract-based allergy diagnostics with multiplex and singleplex analysis. ACTA ACUST UNITED AC 2015; 24:46-53. [PMID: 26709369 PMCID: PMC4686215 DOI: 10.1007/s40629-015-0046-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 02/26/2015] [Indexed: 11/14/2022]
Abstract
Background ImmunoCAP ISAC 112, is a commercially available molecular allergy IgE multiplex test. Data on the comparison of this rather novel test with extract-based as well as molecular ImmunoCAP singleplex IgE tests is missing. Objective To perform a comparison between the ISAC multiplex IgE assay and the ImmunoCAP singleplex test results. Methods Serum samples of 101 adults with grass pollen allergy were analysed for sIgE to 112 allergenic molecules represented on the ISAC test as well as to common atopy-related extract-based allergy tests with the ImmunoCAP System (house dust mite [d1], cat [e1], dog [e5], cow’s milk [f2], hen’s egg [f1], hazelnut [f17], celery [f85], Alternaria alternate [m6], as well as pollen from birch [t3], hazel [t4], mugwort [w6], and ragweed [w1]). Subsequently statistical analysis was performed with the Spearman rank correlation test and the Clopper-Pearson method in order to compare the ISAC multiplex results with the sIgE singleplex results. Results The positive percent agreements (PPA) and negative percent agreement (NPA) of corresponding allergens between the ISAC sIgE test and the extract-based singleplex ImmunoCAP results at cutoff 0.1 kUA/l varied between 60–100 % for PPA and 78–97 % for NPA. Conclusion When taking into account corresponding allergens molecular testing with the ISAC multiplex test correlates well with ImmunoCAP singleplex results.
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Affiliation(s)
- Johannes Huss-Marp
- Allergy Research Group, Department of Dermatology, Medical Center, University of Freiburg, Freiburg, Germany ; Thermo Fisher Scientific, Phadia GmbH, Freiburg, Germany ; AbbVie Deutschland GmbH & Co. KG, Mainzer Straße 81, 65189 Wiesbaden, Germany
| | - Jan Gutermuth
- Department of Dermatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ina Schäffner
- Thermo Fisher Scientific, Phadia GmbH, Freiburg, Germany
| | - Ulf Darsow
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany ; ZAUM-Center for Allergy and Environment, Helmholtz Center Munich, Technische Universität München, Munich, Germany
| | - Florian Pfab
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany ; ZAUM-Center for Allergy and Environment, Helmholtz Center Munich, Technische Universität München, Munich, Germany
| | - Knut Brockow
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany ; ZAUM-Center for Allergy and Environment, Helmholtz Center Munich, Technische Universität München, Munich, Germany
| | - Johannes Ring
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany
| | - Heidrun Behrendt
- ZAUM-Center for Allergy and Environment, Helmholtz Center Munich, Technische Universität München, Munich, Germany
| | - Thilo Jakob
- Allergy Research Group, Department of Dermatology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Christoph Ahlgrim
- University Freiburg Medical Center, Department of Exercise Medicine and Sport, University of Freiburg, Freiburg, Germany ; Department of Pneumology, University of Freiburg, Freiburg, Germany ; Department of Pneumology, Freiburg University Medical Center, Albert-Ludwigs-University, Freiburg, Germany
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Huss-Marp J, Gutermuth J, Schäffner I, Darsow U, Pfab F, Brockow K, Ring J, Behrendt H, Jakob T, Ahlgrim C. Vergleich molekularer und extraktbasierter IgE-Diagnostik mittels Multiplex- und Singleplex-Test. ALLERGO JOURNAL 2015. [DOI: 10.1007/s15007-015-0784-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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50
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Jutel M, Papadopoulos NG, Gronlund H, Hoffman HJ, Bohle B, Hellings P, Braunsthal GJ, Muraro A, Schmid-Grendelmeier P, Zuberbier T, Agache I, Agache I. Recommendations for the allergy management in the primary care. Allergy 2014; 69:708-18. [PMID: 24628378 DOI: 10.1111/all.12382] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2014] [Indexed: 01/13/2023]
Abstract
The majority of patients seeking medical advice for allergic diseases are first seen in a primary care setting. Correct diagnosis with identification of all offending allergens is an absolute prerequisite for appropriate management of allergic disease by the general practitioner. Allergy diagnostic tests recommended for use in primary care are critically reviewed in accordance with the significant workload in a primary care setting. Simplified pathways for recognition and diagnosis of allergic diseases are proposed, that should be further adapted to local (national) conditions.
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Affiliation(s)
- M. Jutel
- Department of Clinical Immunology; Wroclaw Medical University; Wroclaw Poland
| | - N. G. Papadopoulos
- 2nd Pediatric Clinic, Allergy Department; University of Athens; Athens Greece
| | - H. Gronlund
- Center for Allergy Research; Karolinska Institutet; Stockholmm Sweden
| | - H.-J. Hoffman
- Department of Respiratory Diseases; Aarhus University Hospital; Aarhus Denmark
| | - B. Bohle
- Department of Pathophysiology; Medical University of Vienna; Vienna Austria
| | - P. Hellings
- Department of Orothinolaryngology; University Hospitals Leuven; Leuven Belgium
| | - G.-J. Braunsthal
- Department of Pulmonology; St. Franciscus Gasthuis; Rotterdam The Netherlands
| | - A. Muraro
- Department of Pediatrics; Referral Centre for Food Allergy; Padua General University Hospital; Padua Italy
| | | | - T. Zuberbier
- Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - I. Agache
- Department of Allergy and Clinical Immunology; SC Theramed SRL; Brasov Romania
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