title: How to diagnose mould allergy? Comparison of skin prick tests with specific IgE results.
abstract: Diagnosis of mould allergy is complicated due to the heterogeneity of the test material and the decrease in the number of commercial mould skin test solutions that are currently available.
  
  
  
  The aim of this study was to compare skin prick tests (SPT) from different manufacturers to one another and concurrently with sIgE tests for Aspergillus fumigatus (Asp f), Cladosporium herbarum (Cla h), Penicillium chrysogenum (Pen ch), Alternaria alternata (Alt a) and Aspergillus versicolor (Asp v) to ascertain a feasible diagnostic procedure for mould sensitization.
  
  
  
  In this multi-centre study, 168 patients with mould exposure and/or mould-induced respiratory symptoms were included. Mould SPT solutions were analysed biochemically and tested in duplicate on patients' arms. Specific IgE (sIgE) concentrations to corresponding mould species and mould mix (mx1) were measured by ImmunoCAP. SPTs in accordance with one another and with sIgE were further considered. The test efficiency was calculated using receiver-operating characteristic (ROC) analysis.
  
  
  
  Mould sensitization was more frequently detected by the SPT (90 of 168) than by the sIgE tests (56 of 168). Concordances of double SPT positives were only sufficient (≥ 80%) for environmental allergens, two Asp f and three Alt a SPT solutions, whereas all other mould solutions revealed concordances < 80%. The antigen content of SPT solutions was positively associated with concordant SPT double values as well as with sIgE. Taking sIgE as the 'positive standard', all mould SPT solutions revealed test efficiencies > 80%, but varied up to 20% in sensitivity and positive predictive value with the exception of Alt a.
  
  
  
  SPT solutions are sensitive and essential diagnostic tools for the detection of mould sensitization. Our recommendation for diagnosis would be to test at least Alt a, Asp f and Pen ch using SPT and additional sIgE test to mx1.
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Kespohl
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Maryska
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Bünger
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Hagemeyer
authors.affiliation: Department of Dermatology and Allergology, University Medical Center (UKGM), Justus-Liebig University Giessen, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Jakob
authors.affiliation: Malteser Lung and Allergy Centre Bonn, Bonn, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Joest
authors.affiliation: Medical Practice for Pediatrics, Bretten, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Knecht
authors.affiliation: Department of Pulmonary Diseases, Fachkrankenhaus Coswig, Centre for Pulmonary Diseases and Thoracic Surgery, Coswig, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Koschel
authors.affiliation: Berufsgenossenschaftliche Klinik für Berufskrankheiten Falkenstein, Falkenstein, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Kotschy-Lang
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Merget
authors.affiliation: Asthma Allergy Centre, Leverkusen, Germany.
authors.forename: N K
authors.initials: NK
authors.lastname: Mülleneisen
authors.affiliation: Johanniter-Hospital, Treuenbrietzen, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Rabe
authors.affiliation: Department of Dermatology and Allergology, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Röseler
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Sander
authors.affiliation: Allergology, Medical Practice for Respiratory Medicine, Köln, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Stollewerk
authors.affiliation: Pediatric Pneumology/Allergy, Children's Hospital Princess Margaret, Darmstadt, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Straube
authors.affiliation: Pulmonary and Allergy Practice, Lahr, Germany.
authors.forename: H M
authors.initials: HM
authors.lastname: Ulmer
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany.
authors.forename: V
authors.initials: V
authors.lastname: van Kampen
authors.affiliation: Department of Occupational Diseases, Nofer Institute of Occupational Medicine, Lodz, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Walusiak-Skorupa
authors.affiliation: Department of Occupational Diseases, Nofer Institute of Occupational Medicine, Lodz, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Wiszniewska
authors.affiliation: Department of Dermatology and Allergology, University Hospital RWTH Aachen, Aachen, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Wurpts
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Brüning
authors.affiliation: Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Raulf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000485:Allergens / Q000276:immunology*; D000918:Antibody Specificity / Q000276:immunology; D002648:Child; D005260:Female; D005658:Fungi / Q000276:immunology*; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis* / Q000276:immunology*; D007114:Immunization; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012882:Skin Tests; D055815:Young Adult
chemical_list: D000485:Allergens; D007073:Immunoglobulin E
keywords: in vitro diagnosis; mould allergy; multi-centre study; predictive values; sensitivity; skin prick test; specific IgE; specificity