title: Quantification of specific IgE antibodies in immediate drug hypersensitivity: More shortcomings than potentials?
abstract: BACKGROUND
  For many physicians, quantification of serum drug-specific IgE (sIgE) antibodies constitutes the first measure in the diagnostic approach of immediate drug hypersensitivity reactions (IDHR).
  
  
  OBJECTIVE
  To review the accuracy and limitations of the main drug-sIgE tests, especially those that are commercially available.
  
  
  METHODS
  A literature search was conducted, using the key-words allergy, diagnosis, drugs, hypersensitivity, specific IgE antibodies; this was complemented by the authors' own experience.
  
  
  RESULTS
  The drugs that have mostly been studied appeared to be β-lactam antibiotics, neuromuscular blocking agents (NMBA) and morphine, the latter as a biomarker for sensitisation to substituted ammonium structures that constitute the major epitope of NMBA. For β-lactams sensitivity and specificity varied between 0-85% and 52-100%, respectively. For NMBA, sensitivity and specificity varied between 38.5-92% and 92-100%, respectively. With respect to sIgE to morphine it appears this drug to be a sensitive biomarker for sensitisation to rocuronium and suxamethonium but not for atracurium. However, sIgE morphine should not be applied in isolation to diagnose IDHR to NMBA nor opiates.
  
  
  CONCLUSIONS
  Although drug-sIgE assay can provide valuable information they should not be performed in isolation to establish correct diagnosis, as their predictive value is not per se absolute. Larger comprehensive studies are urgently required to determine the accuracy of drug-sIgE assays.
authors.affiliation: Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology, University of Antwerp, Antwerp University Hospital, Belgium; Faculty of Medicine and Health Science, Department of Pediatrics, University of Antwerp, Antwerp University Hospital, Belgium.
authors.forename: I I
authors.initials: II
authors.lastname: Decuyper
authors.affiliation: Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology, University of Antwerp, Antwerp University Hospital, Belgium. Electronic address: immuno@uantwerpen.be.
authors.forename: D G
authors.initials: DG
authors.lastname: Ebo
authors.affiliation: Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology, University of Antwerp, Antwerp University Hospital, Belgium.
authors.forename: A P
authors.initials: AP
authors.lastname: Uyttebroek
authors.affiliation: Faculty of Medicine and Health Science, Department of Pediatrics, University of Antwerp, Antwerp University Hospital, Belgium.
authors.forename: M M
authors.initials: MM
authors.lastname: Hagendorens
authors.affiliation: Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology, University of Antwerp, Antwerp University Hospital, Belgium.
authors.forename: M A
authors.initials: MA
authors.lastname: Faber
authors.affiliation: Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology, University of Antwerp, Antwerp University Hospital, Belgium.
authors.forename: C H
authors.initials: CH
authors.lastname: Bridts
authors.affiliation: Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology, University of Antwerp, Antwerp University Hospital, Belgium.
authors.forename: L S
authors.initials: LS
authors.lastname: De Clerck
authors.affiliation: Faculty of Medicine and Health Science, Department of Immunology, Allergology, Rheumatology, University of Antwerp, Antwerp University Hospital, Belgium.
authors.forename: V
authors.initials: V
authors.lastname: Sabato
mesh_terms: D015415:Biomarkers / Q000097:blood; D004342:Drug Hypersensitivity / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D007073:Immunoglobulin E / Q000097:blood*; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D007073:Immunoglobulin E
keywords: Allergy; Beta-lactam; Drugs; Immediate drug hypersensitivity reaction (IDHR) specific IgE (sIgE); Neuromuscular blocking agents (NMBA); Opiates; Penicillin; Tryptase