title: A new framework for the interpretation of IgE sensitization tests.
abstract: IgE sensitization tests, such as skin prick testing and serum-specific IgE, have been used to diagnose IgE-mediated clinical allergy for many years. Their prime drawback is that they detect sensitization which is only loosely related to clinical allergy. Many patients therefore require provocation tests to make a definitive diagnosis; these are often expensive and potentially associated with severe reactions. The likelihood of clinical allergy can be semi-quantified from an IgE sensitization test results. This relationship varies though according to the patients' age, ethnicity, nature of the putative allergic reaction and coexisting clinical diseases such as eczema. The likelihood of clinical allergy can be more precisely estimated from an IgE sensitization test result, by taking into account the patient's presenting features (pretest probability). The presence of each of these patient-specific factors may mean that a patient is more or less likely to have clinical allergy with a given test result (post-test probability). We present two approaches to include pretest probabilities in the interpretation of results. These approaches are currently limited by a lack of data to allow us to derive pretest probabilities for diverse setting, regions and allergens. Also, cofactors, such as exercise, may be necessary for exposure to an allergen to result in an allergic reaction in specific IgE-positive patients. The diagnosis of IgE-mediated allergy is now being aided by the introduction of allergen component testing which may identify clinically relevant sensitization. Other approaches are in development with basophil activation testing being closest to clinical application.
authors.affiliation: David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK. g.c.roberts@soton.ac.uk.|NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK. g.c.roberts@soton.ac.uk.|Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK. g.c.roberts@soton.ac.uk.
authors.forename: G
authors.initials: G
authors.lastname: Roberts
authors.affiliation: Department of Infection and Immunity, Luxembourg Institute of Health (LIH), Esch-sur-Alzette, Luxembourg and Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Ollert
authors.affiliation: Department of Immunopathology, Sanquin Research, Amsterdam and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Aalberse
authors.affiliation: Anaphylaxis Campaign, Farnborough, UK.
authors.forename: M
authors.initials: M
authors.lastname: Austin
authors.affiliation: Department of Paediatrics, Imperial College London, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Custovic
authors.affiliation: Department of Paediatrics and Child Health, School of Applied Psychology, University College Cork, Cork, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: DunnGalvin
authors.affiliation: Department of Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: P A
authors.initials: PA
authors.lastname: Eigenmann
authors.affiliation: Careggi Hospital, Florence, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Fassio
authors.affiliation: Dermatology Centre, Norfolk & Norwich University Hospital, Norwich, UK.
authors.forename: C
authors.initials: C
authors.lastname: Grattan
authors.affiliation: University Hospitals Leuven, Leuven, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Hellings
authors.affiliation: Paediatrics and Child Health, University College Cork, Cork, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Hourihane
authors.affiliation: Departments of Immunology and Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Knol
authors.affiliation: Department of Pediatrics, University of Padua, Padova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Muraro
authors.affiliation: Centre for Pediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK.|Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
authors.forename: N
authors.initials: N
authors.lastname: Papadopoulos
authors.affiliation: Division of Asthma, Allergy & Lung Biology, Department of Paediatric Allergy, King's College London, London, UK.|MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK.|Immunoallergology Department, Coimbra University Hospital, Coimbra, Portugal.
authors.forename: A F
authors.initials: AF
authors.lastname: Santos
authors.affiliation: German Allergy and Asthma Association (Deutscher Allergie- und Asthmabund (DAAB)), Mönchengladbach, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Schnadt
authors.affiliation: Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
authors.forename: K
authors.initials: K
authors.lastname: Tzeli
mesh_terms: D000485:Allergens / Q000276:immunology; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000592:standards*; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis* / Q000276:immunology*; D007114:Immunization; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology*; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors
chemical_list: D000485:Allergens; D007074:Immunoglobulin G; D007073:Immunoglobulin E
keywords: IgE sensitization tests; clinical allergy; serum-specific IgE; skin prick testing