Overview of in vitro allergy tests
- Hendrik Nolte, MD, PhD
Hendrik Nolte, MD, PhD
- Allergy and Asthma Unit
- Bispebjerg University Hospital, Copenhagen, Denmark
- Krzysztof Kowal, MD
Krzysztof Kowal, MD
- Department of Allergy and Internal Diseases
- University Medical School, Bialystok, Poland
- Lawrence DuBuske, MD
Lawrence DuBuske, MD
- Clinical Professor of Medicine
- George Washington University School of Medicine, Washington, DC
Most tests for "allergy" are actually tests for allergic sensitization or the presence of allergen-specific immunoglobulin E (IgE). Most patients who experience symptoms upon exposure to an allergen have demonstrable allergen-specific IgE that specifically recognizes that allergen, making these tests essential tools in the diagnosis of allergic disorders.
The demonstration of sensitization is not sufficient to diagnose an allergy, however, because a sensitized individual may be entirely asymptomatic upon exposure to the allergen in question. Venom- and food-specific IgE has been reported in up to 25 and 60 percent of the general population, respectively [1-4]. Less commonly, patients who react to an allergen may not have any allergen-specific IgE that is detectable with routine testing [5,6]. Furthermore, IgE molecules recognizing specific epitopes of an allergen may differ in their ability to trigger allergic reactions, and the majority of available tests do not distinguish among them.
The clinical response of a sensitized individual to the suspect allergen is best understood as a dynamic physiologic event with multiple variables, of which the presence of allergen-specific IgE is just one. Thus, allergy tests must be interpreted in the context of the patient's specific clinical history, and the diagnosis of an allergic disorder cannot be based solely on a laboratory result. This is true for in vitro assays, as well as for skin testing. (See "The biology of IgE".)
This topic provides an overview of in vitro tests for IgE-mediated allergic disease. Skin testing for allergic disease is reviewed separately. (See "Overview of skin testing for allergic disease".)
Laboratory testing in cases of suspected anaphylaxis is reviewed in greater detail elsewhere. (See "Laboratory tests to support the clinical diagnosis of anaphylaxis".)
- Simons FE, Frew AJ, Ansotegui IJ, et al. Risk assessment in anaphylaxis: current and future approaches. J Allergy Clin Immunol 2007; 120:S2.
- Golden DB, Marsh DG, Freidhoff LR, et al. Natural history of Hymenoptera venom sensitivity in adults. J Allergy Clin Immunol 1997; 100:760.
- Pereira B, Venter C, Grundy J, et al. Prevalence of sensitization to food allergens, reported adverse reaction to foods, food avoidance, and food hypersensitivity among teenagers. J Allergy Clin Immunol 2005; 116:884.
- Stevenson MD, Sellins S, Grube E, et al. Aeroallergen sensitization in healthy children: racial and socioeconomic correlates. J Pediatr 2007; 151:187.
- Golden DB, Tracy JM, Freeman TM, et al. Negative venom skin test results in patients with histories of systemic reaction to a sting. J Allergy Clin Immunol 2003; 112:495.
- Hoffman DR. Fatal reactions to hymenoptera stings. Allergy Asthma Proc 2003; 24:123.
- Hamilton RG, Franklin Adkinson N Jr. In vitro assays for the diagnosis of IgE-mediated disorders. J Allergy Clin Immunol 2004; 114:213.
- YALOW RS, BERSON SA. Immunoassay of endogenous plasma insulin in man. J Clin Invest 1960; 39:1157.
- Wide L, Bennich H, Johansson SG. Diagnosis of allergy by an in-vitro test for allergen antibodies. Lancet 1967; 2:1105.
- Bernstein IL, Li JT, Bernstein DI, et al. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol 2008; 100:S1.
- Nolte H, DuBuske LM. Performance characteristics of a new automated enzyme immunoassay for the measurement of allergen-specific IgE. Summary of the probability outcomes comparing results of allergen skin testing to results obtained with the HYTEC system and CAP system. Ann Allergy Asthma Immunol 1997; 79:27.
- Williams PB, Dolen WK, Koepke JW, Selner JC. Comparison of skin testing and three in vitro assays for specific IgE in the clinical evaluation of immediate hypersensitivity. Ann Allergy 1992; 68:35.
- Williams PB, Barnes JH, Szeinbach SL, Sullivan TJ. Analytic precision and accuracy of commercial immunoassays for specific IgE: establishing a standard. J Allergy Clin Immunol 2000; 105:1221.
- Hamilton RG, Biagini RE, Krieg EF. Diagnostic performance of Food and Drug Administration-cleared serologic assays for natural rubber latex-specific IgE antibody. The Multi-Center Latex Skin Testing Study Task Force. J Allergy Clin Immunol 1999; 103:925.
- Sampson HA, Ho DG. Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol 1997; 100:444.
- Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol 2001; 107:891.
- Sampson HA. Update on food allergy. J Allergy Clin Immunol 2004; 113:805.
- Kelso JM, Sodhi N, Gosselin VA, Yunginger JW. Diagnostic performance characteristics of the standard Phadebas RAST, modified RAST, and pharmacia CAP system versus skin testing. Ann Allergy 1991; 67:511.
- Wood RA, Segall N, Ahlstedt S, Williams PB. Accuracy of IgE antibody laboratory results. Ann Allergy Asthma Immunol 2007; 99:34.
- Division of Clinical Laboratory Devices, Office of Device Evaluation. Review criteria for the assessment of allergen-specific immunoglobulin E (IgE) in vitro diagnostic devices using immunological methods. Public Health Service; Washington, 2000.
- Nelson HS, Nolte H, Creticos P, et al. Efficacy and safety of timothy grass allergy immunotherapy tablet treatment in North American adults. J Allergy Clin Immunol 2011; 127:72.
- Cox LS, Casale TB, Nayak AS, et al. Clinical efficacy of 300IR 5-grass pollen sublingual tablet in a US study: the importance of allergen-specific serum IgE. J Allergy Clin Immunol 2012; 130:1327.
- Wittig HJ, Belloit J, De Fillippi I, Royal G. Age-related serum immunoglobulin E levels in healthy subjects and in patients with allergic disease. J Allergy Clin Immunol 1980; 66:305.
- Kairemo KJ, Lindberg M, Prytz M. IgE myeloma: a case presentation and a review of the literature. Scand J Clin Lab Invest 1999; 59:451.
- Bobinskas AM, Chandu A, Nastri AL. Kimura's disease: an uncommon cause of head and neck masses with potentially serious sequelae. J Surg Case Rep 2015; 2015.
- Nolte H, Storm K, Schiøtz PO. Diagnostic value of a glass fibre-based histamine analysis for allergy testing in children. Allergy 1990; 45:213.
- Boumiza R, Monneret G, Forissier MF, et al. Marked improvement of the basophil activation test by detecting CD203c instead of CD63. Clin Exp Allergy 2003; 33:259.
- Rak S, Löwhagen O, Venge P. The effect of immunotherapy on bronchial hyperresponsiveness and eosinophil cationic protein in pollen-allergic patients. J Allergy Clin Immunol 1988; 82:470.
- Kips JC, Pauwels RA. Serum eosinophil cationic protein in asthma: what does it mean? Clin Exp Allergy 1998; 28:1.
- van Velzen E, van den Bos JW, Benckhuijsen JA, et al. Effect of allergen avoidance at high altitude on direct and indirect bronchial hyperresponsiveness and markers of inflammation in children with allergic asthma. Thorax 1996; 51:582.
- Nolte M, Barber D, Maloney J, et al. Timothy specific IgE levels are associated with efficacy and safety of timothy grass sublingual immunotherapy tablet. Ann Allergy Asthma Immunol 2015; 115:509.
- Ebo DG, Van Vaerenbergh M, de Graaf DC, et al. In vitro diagnosis of Hymenoptera venom allergy and further development of component resolved diagnostics. Expert Rev Clin Immunol 2014; 10:375.
- Beyer K, Teuber SS. Food allergy diagnostics: scientific and unproven procedures. Curr Opin Allergy Clin Immunol 2005; 5:261.
- WIDELY AVAILABLE TESTS
- - Types
- - Technique
- - Competitive binding technique
- - Accuracy
- - Interpretation and role in diagnosis
- Results reported by class
- Total IgE levels
- - Technique
- TESTS FOR ANAPHYLAXIS
- TESTS USED IN RESEARCH
- Component-resolved diagnostics
- Basophil tests
- - Basophil histamine release
- - Others
- Eosinophil cationic protein levels
- UNVALIDATED TESTS