title: Total serum immunoglobulin E as a marker for missed antigens on in vitro allergy screening.
abstract: BACKGROUND
  The diagnosis of inhalant allergies involves a medical history, physical exam, and allergen sensitivity testing; allergen sensitivity can be assessed by a specific immunoglobulin E (IgE) screen for inhalant allergens. Some patients with clinical suspicion for inhalant allergies have a negative specific IgE screen, but high total IgE. We theorize that elevated total IgE may indicate a false-negative screen caused by "missed allergens" not initially identified.
  
  
  METHODS
  Study patients with a negative allergy screen and elevated IgE (>116 kU/L) were identified (n = 26). Control patients (n = 26) were defined as having a negative screen and an IgE <2.95 kU/L. Both groups were tested with an expanded specific IgE panel and completed a questionnaire about other causes of elevated IgE.
  
  
  RESULTS
  The expanded panel was positive for inhalant allergens in 4 study patients (15%) and 0 control patients (p = 0.037). Within the study patients, 50% had asthma and 76.9% had chronic sinusitis. Only 2 control patients had asthma (11.5%), p = 0.003; 4 (19.2%) reported chronic sinusitis, p < 0.0001. Food allergen sensitivity was identified in 5 study patients and 1 control, p = 0.083.
  
  
  CONCLUSIONS
  This pilot study evaluated patients clinically suspected of allergy with a negative inhalant IgE screen. Those with a high total IgE were more likely to have a missed inhalant allergen on expanded testing, as well as asthma and chronic sinusitis, compared to those with a low total IgE. Further investigation of "missed antigen" and the role of chronic respiratory inflammatory disease in patients with elevated total IgE is warranted.
authors.affiliation: Department of Otolaryngology, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Jeanne L
authors.initials: JL
authors.lastname: Hatcher
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Cohen
authors.forename: J Whit
authors.initials: JW
authors.lastname: Mims
mesh_terms: D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000276:immunology*; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002648:Child; D002908:Chronic Disease; D057210:Delayed Diagnosis; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood*; D010865:Pilot Projects; D011446:Prospective Studies; D011852:Radioallergosorbent Test; D012189:Retrospective Studies; D065631:Rhinitis, Allergic; D012221:Rhinitis, Allergic, Perennial / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000485:Allergens; D015415:Biomarkers; D007073:Immunoglobulin E
keywords: allergic rhinitis; asthma; immunoglobulin E; radioallergosorbent test; respiratory hypersensitivity; sinusitis