title: Codfish allergy in adults. Specific tests for IgE and histamine release vs double-blind, placebo-controlled challenges.
abstract: BACKGROUND
  At present, several in vitro tests for immunoglobulin E (IgE)-mediated food allergy are available. An estimation of the diagnostic accuracy of the various tests used in predicting clinical sensitivity to codfish in a well-characterized allergic material is necessary.
  
  
  OBJECTIVE
  To compare the diagnostic value of four specific IgE tests, and histamine release from basophils (HR) in identifying clinical type I allergy to codfish. As a true diagnosis, double-blind, placebo-controlled food challenges (DBPCFC) were employed.
  
  
  METHODS
  Eight clinically codfish-allergic adult patients were investigated together with 30 codfish-tolerant control subjects for evidence of codfish-specific reactivity by Phadebas RAST (PHA), Pharmacia CAP System RAST (CAP), Magic Lite (ML) and HR. To characterize the diagnostic properties of a freshly prepared raw codfish extract, experiments were conducted employing an in-house radioallergosorbent test (RAST), the Maxisorp RAST (MAXI) and HR. Finally, protein profile and IgE-reacting allergens were detected by means of sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting.
  
  
  RESULTS
  The sensitivities of HR with commercial extract and the three commercially available specific IgE analyses were 0.83 and 1.00 respectively. Specificities were 1.00 (HR) and 0.87-1.00 (specific IgE tests). Freshly prepared codfish extracts improved the sensitivity of HR. SDS-PAGE revealed approximately 29 bands (< 14.3-200 kDa) including a band of 12-13 kDa, and in immunoblotting 18 sera identified 17 IgE-binding bands. The protein migrating at 12-13 kDa was identified in the fresh codfish extract tested with sera from all clinical codfish allergics, while no significant reaction was seen in the control subjects.
  
  
  CONCLUSIONS
  Based on the small number of adult patients included in our study, the in vitro assays with commercial and fresh extracts have high sensitivity and are acceptable for screening for codfish allergy. Specificity of Phadebas, CAP, and our in-house RAST was less than unity, whereas ML and strong binding of IgE to a 12-13 kDa protein completely matches DBPCFC results, and thus seems sufficient for establishing the diagnosis.
authors.affiliation: Food Allergy Unit, National University Hospital, Copenhagen, Denmark.
authors.forename: T K
authors.initials: TK
authors.lastname: Hansen
authors.forename: C
authors.initials: C
authors.lastname: Bindslev-Jensen
authors.forename: P S
authors.initials: PS
authors.lastname: Skov
authors.forename: L K
authors.initials: LK
authors.lastname: Poulsen
mesh_terms: D000328:Adult; D000818:Animals; D004311:Double-Blind Method; D004591:Electrophoresis, Polyacrylamide Gel; D000939:Epitopes; D005399:Fishes / Q000276:immunology*; D005512:Food Hypersensitivity / Q000175:diagnosis / Q000209:etiology*; D006636:Histamine Release; D006801:Humans; D015151:Immunoblotting; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D012882:Skin Tests; D012967:Sodium Dodecyl Sulfate; D014020:Tissue Extracts / Q000276:immunology
chemical_list: D000939:Epitopes; D014020:Tissue Extracts; D012967:Sodium Dodecyl Sulfate; D007073:Immunoglobulin E