Article Figures & Data
Figures
- FIGURE 1
Sum of sensitivity and specificity of serum antigen-specific IgE tests of different ImmunoCAP allergens. A sum of 170 or greater (dashed line) is considered clinically relevant; tests with IgE cutoffs greater than 0.35 kU/L are noted with an asterisk.
Tables
Allergen Recommendations Methodsa Food National Institute of Allergy and Infectious Diseases states food allergy testing is not indicated for evaluation of mild atopic dermatitis or isolated respiratory symptoms, eg, rhinitis or asthma Skin-prick testing and serum antigen-specific IgE testing, with caveats Serum immunoglobulin E (IgE) testing is not indicated for food intolerances, which are not mediated by IgE (see Table 2 for differing characteristics) Serum IgE testing and skin-prick testing are recommended to confirm suspected allergens; not suitable for indiscriminate screening Serum IgE testing and skin-prick testing do not predict reaction severity Positive serum IgE testing indicates sensitization but not necessarily clinical allergy Serum IgE test results may be negative despite clinical reactivity Inhalants Includes pollen, fungus, epidermis, dust mites Skin-prick testing Serum IgE tests with defined quantifiable threshold levels can predict positive respiratory responses after allergen exposure Skin-prick testing is more sensitive for identifying inhalant allergens and is the preferred method of confirming inhalant allergies Latex The only method for assessing latex allergy approved by the US Food and Drug Administration is serum IgE testing Serum antigen-specific IgE testing Serum IgE tests can be used to confirm latex allergy, but a negative result does not exclude sensitization Drugs There are no validated diagnostic tests of sufficient sensitivity for evaluation of IgE-mediated allergy to antibiotics other than penicillin Skin-prick testing for penicillin reaction, serum antigen-specific IgE testing for others For most drugs apart from penicillin, a serum IgE cutoff of 0.35 kU/L is used for allergy evaluation Venom Predictive inconsistencies exist for both skin-prick testing and IgE testing Skin-prick testing and serum antigen-specific IgE testing Patients with a history of venom reaction should be evaluated by both skin-prick testing and serum IgE testing It is important to perform both skin-prick testing and serum IgE testing in patients with a clear history of severe reaction to insect stings when one test has a negative result Any nonzero value of venom IgE is considered positive, despite the 0.35 kU/L cutoff Performing venom skin-prick testing within the refractory period of the insect sting will result in a high chance of false-negative results Serum IgE testing performed within a short period after the insect sting has a high chance of false-negative results, as serum IgE rises slowly after the sting ↵a Diagnostically invalid tests: cytotoxic tests; provocation-neutralization; electrodermal testing; applied kinesiology; iridology; hair analysis; food-specific IgG, IgG4, IgG/IgG4 antibody tests.
Factors consistent with IgE-mediated allergy Onset within 2 hours of ingestion Resolution within 12 hours Vomiting, diarrhea, gastrointestinal pain Symptoms of anaphylaxis (urticaria, angioedema, pruritus, cardiovascular collapse) Acute wheezing, coughing, stridor Factors consistent with non–IgE-mediated allergy or food intolerance Onset hours or days after ingestion Resolution after more than 12 hours; days Nonspecific symptoms (diarrhea, bloody stool, food refusal, colicky pain) Symptoms mainly associated with digestive system Compiled from information in references 10 and 11.
