title: Correlation of skin test results and specific immunoglobulin E blood levels with nasal provocation testing for house-dust mite allergies.
abstract: BACKGROUND
  Allergen-specific immunotherapy for house-dust mite (HDM) allergies is associated with lower success rates when compared with similar treatments for other inhalant allergens, such as grass or birch. One reason might be the greater difficulty in diagnosing patients with assumed HDM allergies because symptoms occur perennially and may differ from those of a conventional allergic rhinitis.
  
  
  OBJECTIVE
  The aim of the study was to compare the different methods of diagnosis in patients with assumed HDM allergy.
  
  
  METHODS
  We performed a retrospective analysis of nasal provocation tests (NPT) from patients (n = 161) evaluated for Dermatophagoides pteronyssinus (n = 127) and Dermatophagoides farinae (n = 104) allergies, and compared the results with other allergen testing methods (skin-prick test [SPT], intracutaneous test, and allergen specific immunoglobulin E levels [sIgE] to detect sensitization). Receiver operating characteristic curves were used for the analyses and the areas under the curve were calculated.
  
  
  RESULTS
  For D. pteronyssinus and D. farinae, 86 and 70 complete data files, respectively, were available. For both tested HDMs, the results of the receiver operating characteristic curves showed a significant correlation for SPT and sIgE, with the results of the NPT (area under the curve, 0.742 to 0.763) but not for the intracutaneous test. In patients with a positive SPT (≥3 mm), an allergy was confirmed by the NPT in 69% of cases for D. pteronyssinus and 71% for D. farinae. A positive sIgE result (ImmunoCAP class of ≥2) was verified by the NPT in 69% of cases (D. pteronyssinus) and 70% (D. farinae).
  
  
  CONCLUSIONS
  The predictability value for a positive NPT result is best for SPT and sIgE. Nevertheless, even if the results of both test systems are combined, the positive predictive value that was achieved was only 0.77 for D. pteronyssinus and 0.69 for D. farinae. Therefore, in patients eligible for immunotherapy for HDM, an NPT should be performed before the start of the therapy to verify a clinically relevant allergy.
authors: Department of Otorhinolaryngology, Head and Neck Surgery, AMEOS Klinikum Haldensleben, Germany.
authors: Boris R
authors: BR
authors: Haxel
authors: Tilman
authors: T
authors: Huppertz
authors: Patrick
authors: P
authors: Boessert
authors: Florian
authors: F
authors: Bast
authors: Kai
authors: K
authors: Fruth
mesh_terms: D000328:Adult; D000818:Animals; D039741:Antigens, Dermatophagoides / Q000276:immunology; D040001:Dermatophagoides farinae / Q000276:immunology*; D040002:Dermatophagoides pteronyssinus / Q000276:immunology*; D003888:Desensitization, Immunologic / Q000379:methods*; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis*; D007114:Immunization; D007073:Immunoglobulin E / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012882:Skin Tests / Q000379:methods; D055815:Young Adult
chemical_list: D039741:Antigens, Dermatophagoides; D007073:Immunoglobulin E