title: Utility of the ratio of food-specific IgE/total IgE in predicting symptomatic food allergy in children.
abstract: BACKGROUND
  Double-blind, placebo-controlled food challenges are time-consuming, expensive and not without risk to patients. Therefore, an in vitro test that could accurately diagnose food allergy would be of great value.
  
  
  OBJECTIVE
  To evaluate the utility of the ratio of specific immunoglobulin E (IgE)/total IgE compared with specific IgE (sIgE) alone in predicting symptomatic food allergy.
  
  
  METHODS
  We retrospectively analysed 992 controlled oral food challenges performed in 501 children (median age 13 months). The ratio of sIgE/total IgE was calculated and tested for correlation with the outcome of food challenges. Receiver operator characteristics (ROC)-curves were performed; predicted probabilities and predictive decision points were calculated.
  
  
  RESULTS
  A significant correlation was found between the ratio and the outcome of food challenges for cow's milk (CM), hen's egg (HE), and wheat, but not for soy. The ROC and predicted probability curves as well as sensitivity and specificity of the decision points of the ratio were similar to those of sIgE levels for CM, HE and wheat.
  
  
  CONCLUSIONS
  In view of the greater effort needed to determine the ratio, without benefit compared with the sIgE alone, the calculation of the ratio of sIgE/total IgE for diagnosing symptomatic food allergy offers no advantage for CM, HE, wheat or soy. For the majority of cases controlled oral food challenges still remain the method of choice.
authors.affiliation: Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité of Humboldt University, Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Mehl
authors.forename: A
authors.initials: A
authors.lastname: Verstege
authors.forename: U
authors.initials: U
authors.lastname: Staden
authors.forename: M
authors.initials: M
authors.lastname: Kulig
authors.forename: M
authors.initials: M
authors.lastname: Nocon
authors.forename: K
authors.initials: K
authors.lastname: Beyer
authors.forename: B
authors.initials: B
authors.lastname: Niggemann
mesh_terms: D000293:Adolescent; D000818:Animals; D000918:Antibody Specificity; D002648:Child; D002675:Child, Preschool; D004531:Eggs / Q000009:adverse effects*; D005260:Female; D005512:Food Hypersensitivity / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology / Q000378:metabolism*; D007223:Infant; D008297:Male; D008892:Milk / Q000009:adverse effects* / Q000276:immunology; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013025:Glycine max / Q000009:adverse effects; D014908:Triticum / Q000009:adverse effects* / Q000276:immunology
chemical_list: D007073:Immunoglobulin E