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Bousquet PJ, Burbach G, Heinzerling LM, Edenharter G, Bachert C, Bindslev-Jensen C, Bonini S, Bousquet-Rouanet L, Demoly P, Bresciani M, Bruno A, Gjomarkaj M, Canonica GW, Darsow U, Durham S, Fokkens WJ, Giavi S, Gramiccioni C, Papadopoulos NG, Haahtela T, Kowalski ML, Magyar P, Muraközi G, Orosz M, Röhnelt C, Stingl G, Todo-Bom A, von Mutius E, Wiesner A, Wöhrl S, Bousquet J, Zuberbier T. GA2LEN skin test study III: minimum battery of test inhalent allergens needed in epidemiological studies in patients. Allergy 2009; 64:1656-62. [PMID: 19824887 DOI: 10.1111/j.1398-9995.2009.02169.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The number of allergens to be tested in order to identify sensitized patients is important in order to have the most cost-effective approach in epidemiological studies. OBJECTIVE To define the minimal number and the type of skin prick test (SPT) allergens required to identify a patient as sensitized using results of the new Pan-European GA(2)LEN skin prick test study. METHOD In a large Pan-European multicenter (17 centers in 14 countries) patient based study, a standardized panel of 18 allergens has been prick tested using a standardized procedure. Conditional approach allowed to determine the allergens selection. RESULT Among the 3034 patients involved, 1996 (68.2%) were sensitized to at least one allergen. Overall, eight allergens (grass pollen, Dermatophagoides pteronyssinus, birch pollen, cat dander, Artemisia, olive pollen, Blatella and Alternaria) allowed to identified more than 95% of sensitized subjects. However, differences were observed between countries, two allergens being sufficient for Switzerland (grass pollen and cat dander) as opposed to nine for France (grass pollen, Dermatophagoides pteronyssinus, olive pollen, cat dander, Blatella, cypress, dog dander, alder and [Artemisia or Alternaria]). According to country, up to 13 allergens were needed to identify all sensitized subjects. CONCLUSION Eight to ten allergens allowed the identification of the majority of sensitized subjects. For clinical care of individual patients, the whole battery of 18 allergens is needed to appropriately assess sensitization across Europe.
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Affiliation(s)
- P-J Bousquet
- Département de Biostatistique, Epidémiologie Clinique, Santé Publique et Information Médicale, Groupe Hospitalo-Universtaire Carémeau, Nîmes, France
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Burbach GJ, Heinzerling LM, Edenharter G, Bachert C, Bindslev‐Jensen C, Bonini S, Bousquet J, Bousquet‐Rouanet L, Bousquet PJ, Bresciani M, Bruno A, Canonica GW, Darsow U, Demoly P, Durham S, Fokkens WJ, Giavi S, Gjomarkaj M, Gramiccioni C, Haahtela T, Kowalski ML, Magyar P, Muraközi G, Orosz M, Papadopoulos NG, Röhnelt C, Stingl G, Todo‐Bom A, Von Mutius E, Wiesner A, Wöhrl S, Zuberbier T. GA(2)LEN skin test study II: clinical relevance of inhalant allergen sensitizations in Europe. Allergy 2009; 64:1507-1515. [PMID: 19772516 DOI: 10.1111/j.1398-9995.2009.02089.x] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Skin prick testing is the standard for diagnosing IgE-mediated allergies. A positive skin prick reaction, however, does not always correlate with clinical symptoms. A large database from a Global Asthma and Allergy European Network (GA(2)LEN) study with data on clinical relevance was used to determine the clinical relevance of sensitizations against the 18 most frequent inhalant allergens in Europe. The study population consisted of patients referred to one of the 17 allergy centres in 14 European countries (n = 3034, median age = 33 years). The aim of the study was to assess the clinical relevance of positive skin prick test reactions against inhalant allergens considering the predominating type of symptoms in a pan-European population of patients presenting with suspected allergic disease. METHODS Clinical relevance of skin prick tests was recorded with regard to patient history and optional additional tests. A putative correlation between sensitization and allergic disease was assessed using logistic regression analysis. RESULTS While an overall rate of >or=60% clinically relevant sensitizations was observed in all countries, a differential distribution of clinically relevant sensitizations was demonstrated depending on type of allergen and country where the prick test was performed. Furthermore, a significant correlation between the presence of allergic disease and the number of sensitizations was demonstrated. CONCLUSION This study strongly emphasizes the importance of evaluating the clinical relevance of positive skin prick tests and calls for further studies, which may, ultimately, help increase the positive predictive value of allergy testing.
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Affiliation(s)
- G. J. Burbach
- Department of Dermatology and Allergy, Charité Universitätsmedizin–Berlin, Berlin, Germany
| | - L. M. Heinzerling
- Department of Dermatology and Allergy, Charité Universitätsmedizin–Berlin, Berlin, Germany
| | - G. Edenharter
- Department of Dermatology and Allergy, Charité Universitätsmedizin–Berlin, Berlin, Germany
| | - C. Bachert
- Department of Otorhinolaryngology, University Hospital, Ghent, Belgium
| | | | - S. Bonini
- Consiglio Nazionale delle Ricerche, Rome, Italy
| | | | | | | | | | - A. Bruno
- Consiglio Nazionale delle Ricerche, Palermo, Italy
| | | | - U. Darsow
- Department of Dermatology and Allergy Biederstein and Division of Environmental Dermatology and Allergy Helmholtz Center, Technical University, Technische Universität, Munich, Germany
| | - P. Demoly
- University Hospital, Montpellier, France
| | - S. Durham
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - W. J. Fokkens
- Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands
| | - S. Giavi
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University, Athens, Greece
| | - M. Gjomarkaj
- Consiglio Nazionale delle Ricerche, Palermo, Italy
| | | | - T. Haahtela
- University Central Hospital, Skin and Allergy Hospital, Helsinki, Finland
| | - M. L. Kowalski
- Department of Clinical Immunology and Allergy, Medical University of Lodz, Lodz, Poland
| | - P. Magyar
- Allergy Centre, Semmelweis Medical University, Budapest, Hungary
| | - G. Muraközi
- Allergy Centre, Semmelweis Medical University, Budapest, Hungary
| | - M. Orosz
- Allergy Centre, Semmelweis Medical University, Budapest, Hungary
| | - N. G. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University, Athens, Greece
| | - C. Röhnelt
- Department of Dermatology and Allergy, Charité Universitätsmedizin–Berlin, Berlin, Germany
| | - G. Stingl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - A. Todo‐Bom
- Allergy Centre, Department of Pulmonology, Coimbra University, Coimbra, Portugal
| | - E. Von Mutius
- Allergy Centre, Ludwig Maximilians University, Munich, Germany
| | - A. Wiesner
- Allergy Centre, Children’s University Hospital, Zurich, Switzerland
| | - S. Wöhrl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - T. Zuberbier
- Department of Dermatology and Allergy, Charité Universitätsmedizin–Berlin, Berlin, Germany
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Heinzerling LM, Burbach GJ, Edenharter G, Bachert C, Bindslev‐Jensen C, Bonini S, Bousquet J, Bousquet‐Rouanet L, Bousquet PJ, Bresciani M, Bruno A, Burney P, Canonica GW, Darsow U, Demoly P, Durham S, Fokkens WJ, Giavi S, Gjomarkaj M, Gramiccioni C, Haahtela T, Kowalski ML, Magyar P, Muraközi G, Orosz M, Papadopoulos NG, Röhnelt C, Stingl G, Todo‐Bom A, Von Mutius E, Wiesner A, Wöhrl S, Zuberbier T. GA(2)LEN skin test study I: GA(2)LEN harmonization of skin prick testing: novel sensitization patterns for inhalant allergens in Europe. Allergy 2009; 64:1498-1506. [PMID: 19772515 DOI: 10.1111/j.1398-9995.2009.02093.x] [Citation(s) in RCA: 220] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Skin prick testing is the standard for diagnosing IgE-mediated allergies. However, different allergen extracts and different testing procedures have been applied by European allergy centres. Thus, it has been difficult to compare results from different centres or studies across Europe. It was, therefore, crucial to standardize and harmonize procedures in allergy diagnosis and treatment within Europe. AIMS The Global Asthma and Allergy European Network (GA(2)LEN), with partners and collaborating centres across Europe, was in a unique position to take on this task. The current study is the first approach to implement a standardized procedure for skin prick testing in allergies against inhalant allergens with a standardized pan-European allergen panel. METHODS The study population consisted of patients who were referred to one of the 17 participating centres in 14 European countries (n = 3034, median age = 33 years). Skin prick testing and evaluation was performed with the same 18 allergens in a standardized procedure across all centres. RESULTS The study clearly shows that many allergens previously regarded as untypical for some regions in Europe have been underestimated. This could partly be related to changes in mobility of patients, vegetation or climate in Europe. CONCLUSION The results of this large pan-European study demonstrate for the first time sensitization patterns for different inhalant allergens in patients across Europe. The standardized skin prick test with the standardized allergen battery should be recommended for clinical use and research. Further EU-wide monitoring of sensitization patterns is urgently needed.
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Affiliation(s)
- L. M. Heinzerling
- Department of Dermatology and Allergy, Charité Universitätsmedizin‐Berlin, Berlin, Germany
| | - G. J. Burbach
- Department of Dermatology and Allergy, Charité Universitätsmedizin‐Berlin, Berlin, Germany
| | - G. Edenharter
- Department of Dermatology and Allergy, Charité Universitätsmedizin‐Berlin, Berlin, Germany
| | - C. Bachert
- Department of Otorhinolaryngology, University Hospital, Ghent, Belgium
| | | | - S. Bonini
- Consiglio Nazionale delle Ricerche, Rome, Italy
| | | | | | | | | | - A. Bruno
- Consiglio Nazionale delle Ricerche, Palermo, Italy
| | - P. Burney
- Imperial College for Science, Technology and Medicine, London, UK
| | | | - U. Darsow
- Department of Dermatology and Allergy Biederstein and Division of Environmental Dermatology and Allergy Helmholtz Center, Technical University, Technische Universität, Munich, Germany
| | - P. Demoly
- University Hospital, Montpellier, France
| | - S. Durham
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - W. J. Fokkens
- Academic Medical Centre, Department of Otorhinolaryngology, Amsterdam, the Netherlands
| | - S. Giavi
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University, Athens, Greece
| | - M. Gjomarkaj
- Consiglio Nazionale delle Ricerche, Palermo, Italy
| | | | - T. Haahtela
- Skin and Allergy Hospital, University Central Hospital, Helsinki, Finland
| | - M. L. Kowalski
- Department of Clinical Immunology and Allergy, Medical University of Lodz, Lodz, Poland
| | - P. Magyar
- Semmelweis Medical University, Budapest, Hungary
| | - G. Muraközi
- Semmelweis Medical University, Budapest, Hungary
| | - M. Orosz
- Semmelweis Medical University, Budapest, Hungary
| | - N. G. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University, Athens, Greece
| | - C. Röhnelt
- Department of Dermatology and Allergy, Charité Universitätsmedizin‐Berlin, Berlin, Germany
| | - G. Stingl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | | | - A. Wiesner
- Children’s University Hospital, Zurich, Switzerland
| | - S. Wöhrl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - T. Zuberbier
- Department of Dermatology and Allergy, Charité Universitätsmedizin‐Berlin, Berlin, Germany
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