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Introduction: Patients with immediate type allergic reactions to penicillins are at risk of anaphylaxis on reexposure. Diagnostic gold standard is drug provocation test (DPT) if allergy is not diagnosed by other means, such as skin testing or in vitro testing with measurement of specific IgE. Specific IgE testing carries low risk for the patient and blood sampling can be performed in primary care, but it is reported to have low sensitivity. The aim of this study was to evaluate if clinical characteristics of patients with suspected allergic reactions to penicillin and elevated specific IgE to penicillins, differed from patients without specific IgE, to identify predictors for elevated specific IgE to penicillins. Methods: Levels of specific IgE to five penicillins (penicillin G, penicillin V, amoxicillin, ampicillin, and penicillin minor determinants) were available for 9,100 patients. Using multiple logistic regression, clinical data from 430 patients in this group who had elevated specific IgE to one or more penicillins were compared to data from 4,094 patients without specific IgE to penicillins, who had undergone DPT with a penicillin. Results: In total 5.2% of patients had elevated specific IgE to one or more penicillins. Significantly more patients with elevated specific IgE had a history of immediate type reactions (<2 h) (OR = 4.34, p < 0.001); circulatory symptoms (OR = 1.63, p = 0.03) or angioedema (OR = 1.46, p = 0.005). Also, significantly more patients with elevated specific IgE had been treated with adrenaline (OR = 2.21, p = 0.005), steroids (OR = 1.76, p < 0.001), or antihistamines (OR = 1.83, p < 0.001). Conclusion: A history of an immediate type reaction requiring treatment, combined with elevated specific IgE to one or more penicillins is suggestive of an IgE mediated penicillin allergy and further allergy investigations may not be needed. Specific IgE to penicillins may be used early in allergy investigation of patients with severe immediate type reactions to penicillins. [ABSTRACT FROM AUTHOR]

In vitro specific IgE (sIgE) testing has become an important tool for the diagnosis of IgE-mediated allergic diseases. Current methods used to detect allergen sIgE are time consuming and/or expensive. Therefore, a new method was developed for rapid quantitative detection of cat dander-sIgE antibody based on homogeneous chemiluminescence immunoassay. Selection of chemibeads with different chemical groups, and the best Light-initiated chemiluminescence assay (LiCA) analytical mode for cat dander-sIgE detection. To validate and eliminate the interference of IgE on the detection of cat dander-sIgE, concentration of biotinylated anti-human IgE antibody was optimized. For quantification of cat dander-sIgE, a calibration curve was established, and the performance of the assay was evaluated according to clinical guidelines. Indirect LiCA is the best mode of analysis and biotinylated anti-human IgE antibody at a dilution ratio of 1:250 minimizes IgE interference. The coefficient of variation of the developed LiCA was 1.49% to 4.66%, with an intermediate precision of 6.90% to 8.21%. The LoB, LoD, and LoQ of the assay were 0.023 kUA/L, 0.056 kUA/L and 0.185 kUA/L. The coefficient of correlation (r) between LiCA and ImmounoCAP was 0.9478. A cat dander-sIgE quantitation assay based on homogeneous chemiluminescence immunoassay was established, which could be a new reliable analytical tool for the determination of cat dander-sIgE. [ABSTRACT FROM AUTHOR]

Background: Double‐blind placebo‐controlled food challenges (DBPCFC) are the gold‐standard to diagnose food allergy. However, they can cause allergic reactions of unpredictable severity. We assessed accuracy of current and new diagnostic tests compared to DBPCFC to baked egg (BE) and to lightly cooked egg (LCE). Methods: Children aged 6 months to 15 years were assessed for possible egg allergy as part of the BAT2 study (NCT03309488). They underwent clinical assessment, skin prick test (SPT), specific IgE (sIgE) and basophil activation test (BAT). The results of the tests were compared with DBPCFC outcomes to both BE and LCE. Results: A total of 150 children underwent DBPCFC to BE, 60 (40%) reacted to and 85 (57%) tolerated BE and 5 (3%) had inconclusive oral food challenges (OFC). Seventy‐seven children tolerant to BE had DBPCFC to LCE and 16 reacted. The test within each modality with the best diagnostic performance for BE allergy was as follows: SPT to egg white (EW) (AUC = 0.726), sIgE to EW (AUC = 0.776) and BAT to egg (AUC = 0.783). BAT (AUC = 0.867) was the best test in the younger than 2 years age group. Applying 100% sensitivity and 100% specificity cut‐offs, followed by OFC, resulted in 100% diagnostic accuracy. BAT enabled the greatest reduction in OFC (41%). Using sIgE followed by BAT allowed to reduce the number of BATs performed by about 30% without significantly increasing the number of OFC. Conclusions: The best diagnostic test was BAT to egg in terms of diagnostic accuracy and reduction in number of OFC. Using sIgE to EW followed by BAT required fewer BATs with sustained OFC reduction and diagnostic accuracy. [ABSTRACT FROM AUTHOR]

In Denmark, tests for specific IgE to penicillins have been used routinely for many years in penicillin allergy investigation. Keywords: anaphylaxis; drug allergy; drug hypersensitivity; immediate type hypersensitivity; penicillin; penicillin allergy; penicillin minor determinants; specific IgE; specific IgE to penicillins EN anaphylaxis drug allergy drug hypersensitivity immediate type hypersensitivity penicillin penicillin allergy penicillin minor determinants specific IgE specific IgE to penicillins 887 890 4 08/14/23 20230801 NES 230801 Key points Specific IgE to penicillins have been recommended in the context of immediate-type allergic reactions. Our study shows that compared to the four commonly used specific IgE assays for penicillins specific IgE MD was positive in a further 29.4% of patients with suspicion of penicillin hypersensitivity, which might increase the sensitivity of penicillin sIgE testing. [Extracted from the article]

We provide a commentary on aspects of a prospective study of the epidemiology of perioperative anaphylaxis in Japan (Japanese Epidemiologic Study for Perioperative Anaphylaxis [JESPA]). Accurate diagnosis of perioperative anaphylaxis is important for research but essential for clinical safety. We evaluate the diagnostic approach used in the JESPA study and caution against over-reliance on diagnostic tests that lack sensitivity and specificity when clinical data suggest an immediate perioperative hypersensitivity reaction is likely. [ABSTRACT FROM AUTHOR]

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Background: Most studies that seek to analyze the prevalence of allergic rhinitis do not include preschool children and the diagnosis in this age group is difficult. Objective: Identify complementary tests to the diagnosis of allergic rhinitis in preschool children and verify if there is scientific robustness to propose a diagnostic algorithm for this condition in this age group. Methods: Systematic review of the literature in four databases: SCIELO, PubMed/MEDLINE, LILACS and SCOPUS. Each article was initially chosen by title, abstract and by the keywords "allergic rhinitis," "diagnosis" and "preschool." Those articles selected entered the complete reading and data extraction phase. The study was registered in the International Prospective Register of Systematic Reviews under number CRD42020207053. Results: Fourteen articles were suitable for analysis. In the assessment using Quality Assessment of Diagnostic Accuracy Studies – 2, all studies had at least one domain considered "high risk" or "undetermined risk." Seven reports of nasal cytology, seven of specific IgE, four of immediate hypersensitivity skin test, one of nasal nitric oxide, three of total IgE and one of urinary leukotriene E4 were found. Eight articles evaluated more than one diagnostic test. Conclusion: There are no defined criteria for the diagnosis of allergic rhinitis in preschool children. Nasal cytology, serum specific IgE and immediate hypersensitivity skin test were the most used tests. A reliable diagnostic criterion in this age group is necessary so that in the future it is possible to propose a diagnostic algorithm for allergic rhinitis in preschool children. [ABSTRACT FROM AUTHOR]

Background: In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation fromthe full document. Methods: ICAR-Allergic Rhinitis 2023 employed established evidence-based reviewwith recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensuswas performed for each topic. The final document was then collated and includes the results of this work. Results: ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. Conclusion: The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment. [ABSTRACT FROM AUTHOR]

• The total IgE reference interval had low accuracy in identifying allergic diseases but higher accuracy in identifying allergic sensitization. • Considering allergen-specific IgE levels when establishing the total IgE reference interval resulted in a lower interval. • The new reference interval enhanced the accuracy of identifying allergic sensitization in children while maintaining its advantage in identifying allergic diseases in children. • Future studies on total IgE reference intervals need to consider the allergen-specific IgE status of the reference population. To establish a next-generation reference interval (RI) for total IgE (tIgE) and evaluate its usefulness. A new allergen-specific IgE (sIgE)-based tIgE RI, including a continuous RI in children, was established using the NHANES 2005–2006 project. The usefulness of the RI was evaluated by sensitivity (Sen), specificity (Spec), positive predictive value (PPV), negative predictive value (NPV), κ coefficient and consistency. The new tIgE RI showed better performance in identifying allergic sensitization (Sen 0.53, Spec 0.90, PPV 0.83, NPV 0.68, κ 0.44, consistency 0.72) than allergic diseases (Sen 0.37, Spec 0.75, PPV 0.55, NPV 0.60, κ 0.13, consistency 0.59). The 2014 U.S. tIgE RI was more effective in identifying allergic diseases (consistency 0.63 vs. 0.54, P <0.001) but less accurate in identifying allergic sensitization (consistency 0.59 vs. 0.67, P <0.001) in children than in adults. The new RI improved the accuracy of identifying allergic sensitization in children to a level similar to that in adults (consistency 0.72 vs 0.73, P =0.37) and maintained its advantage in identifying allergic diseases in children (consistency 0.64 vs 0.55, P <0.001). The established next-generation tIgE RI is useful for identifying allergic sensitization, especially in children. [ABSTRACT FROM AUTHOR]

Eosinophilic esophagitis (EoE) is an immune-mediated esophageal disorder, linked with sensitization to food and airborne allergens. Dietary manipulations are proposed for the management of EoE inflammation and are often successful, confirming the etiological role of food allergens. Three different dietary approaches are widely used: the elemental, the empirical, and the allergy-test-driven approach. We performed a systematic review to assess the evidence on the association of allergens, detected by allergy tests, with clinically confirmed triggers of EoE. We systematically searched PubMed, Scopus, Embase, and the Cochrane Library, through 1 June 2021. We sought studies examining the correlation of skin-prick tests (SPT), atopy patch tests (APT), specific IgE, and serum-specific IgG4, with confirmed triggers of EoE. Data on the use of prick–prick tests were also extracted. Evidence was independently screened by two authors against predefined eligibility criteria. Risk of bias was assessed with the ROBINS-I tool. Of 52 potentially eligible studies, 16 studies fulfilling quality criteria were included. These studies used one to three different allergy tests detecting food sensitization. The positive predictive value was generally low to moderate but higher when a combination of tests was used than single-test evaluations. None of the selected studies used serum-specific IgG4. Although an extreme methodological variability was noticed in the studies, allergy-based elimination diets were estimated to be efficient in 66.7% of the cases. The efficacy of targeted elimination diets, guided by SPT, sIgE, and/or APT allergy tests, does not appear superior to empirical ones. In the future, tests using esophageal prick testing or ex vivo food antigen stimulation may prove more efficient to guide elimination diets. [ABSTRACT FROM AUTHOR]

Keywords: anaphylaxis; carmine; cochineal lice; cross-reactivity; Dermatophagoides pteronyssinus; food hypersensitivity; specific IgE EN anaphylaxis carmine cochineal lice cross-reactivity Dermatophagoides pteronyssinus food hypersensitivity specific IgE 1225 1229 5 10/13/22 20221001 NES 221001 Key messages Cochineal lice sIgE testing is a weak predictor for carmine allergy due to irrelevant cross-reactivity. ONLY IN PRIMARY CARMINE ALLERGY, CARMINIC ACID CAUSES BASOPHIL DEGRANULATION Six patients with cochineal lice sIgE were available for BAT experiments, including COCH1 (Figure 1D-H) and five had a positive BAT for HDM (Figure 1E). Diagnosis of carmine allergy using carminic acid solves interference of house dust mite and crustacean cross-reactivity These experiments supported a carminic acid allergy in patient COCH1, whereas other patients demonstrated clinically irrelevant cross-reactivity due to HDM and/or crustacean sensitization. [Extracted from the article]

Background: An increasing interest in the field of molecular diagnosis of allergy has been developed in recent years and it goes to be as the routine in vitro protocol in allergy diagnosis. friendly allergen nano-bead array (FABER) is a new multiplex assay for the evaluation of specific IgE against 244 allergens including whole extracts and allergenic molecules. The research intended to assess the pattern of IgE sensitization to allergenic components of allergens in allergic adults using FABER 244. Methods: Sixty patients with allergic diseases entered this cross-sectional study. Specific IgE to 122 whole allergens extracts and 122 allergenic components were assessed using an allergen nano-bead array (FABER) for all patients. This test includes inhalant and food allergens. Results: Thirty-seven patients were male (61.7%). The mean (SD) age of patients was 30.73(±6.87) years. As the allergen nano-bead array results showed, Lolium perenne (63.3%), Phleum pratense (60%) and Platanus acerifolia (51.7%) were considered as the most common IgE sensitizations to the aeroallergen extracts. Moreover, Lol p 1, Phl p 1.0102 and Cup a 1 were found as the most frequent allergenic components in our allergic patients. Among protein families, CCD-bearing proteins, expansin, cysteine protease and profilin families illustrated the highest allergic sensitization. Conclusions: The results of the present study demonstrated that despite the higher prevalence of sensitization to Salsola kali (47.2%) using extract-based assays in the previous phase of this research, allergenic components of grasses (Lol p 1, Phl p 1.0102), Cup a 1 as well as Sal k1 as the major components of Cupressuss arizonica and Salsola kali showed the higher sensitization, respectively, in adults' allergic patients using FABER test. [ABSTRACT FROM AUTHOR]

Asthma afflicts an estimated 339 million people globally and is associated with ill health, disability, and early death. Strong risk factors for developing asthma are genetic predisposition and environmental exposure to inhaled substances that may provoke allergic reactions. Asthma guidelines recommend identifying causal or trigger allergens with specific IgE (sIgE) testing after a diagnosis of asthma has been made. Allergy testing with sIgE targets subpopulations of patients considered at high risk, such as those with frequent exacerbations, emergency visits or hospitalizations, or uncontrolled symptoms. Specific recommendations apply to preschool children, school-age children, patients with persistent or difficult-to-control asthma, patients needing oral corticosteroids or high-dose inhaled steroids, patients seeking understanding and guidance about their disease, and candidates for advanced therapies (biologics, allergen immunotherapy). Allergen skin testing is common in specialized settings but less available in primary care. Blood tests for total and sIgE are accessible and yield quantifiable results for tested allergens, useful for detecting sensitization. Results are interpreted in the context of the patient's clinical presentation, age, and relevant allergen exposures. Incorporating sIgE testing into asthma management adds objective information to identify specific allergies and can guide personalized treatment plans, which reinforce patient-doctor communication. Test results can also be used to predict exacerbations and response to therapies. Additional diagnostic information can be gleaned from (i) eosinophil count ≥ 300 μL, which significantly increases the odds of having exacerbations, and emerging eosinophil biomarkers (eg, eosinophil-derived neurotoxin), which can be measured in plasma or serum samples, and (ii) fractional exhaled nitric oxide (FeNO), with values ≥ 25 ppb regarded as the cutoff for diagnosis, evaluating inhaled corticosteroid response, and of probable response to anti-IgE, anti-IL4 and anti-IL5 receptor biologics. Referral to asthma/allergy specialists is warranted when the initial diagnosis is uncertain, and when asthma symptoms, impairment, or exacerbations are repeated or severe. [ABSTRACT FROM AUTHOR]

Background: Early exposure to allergens through a defect skin barrier has been proposed as a mechanism for inducing sensitization and development of allergic diseases. We hypothesized that early‐onset, severe atopic dermatitis (AD) is associated with development of aeroallergen sensitization and allergic rhinitis. Methods: We included 368 children from the Copenhagen Prospective Studies on Asthma in Childhood2000 (COPSAC2000) at‐risk mother‐child cohort. AD was diagnosed prospectively based on Hanifin&Rajka's criteria and severity assessed using the Scoring Atopic Dermatitis (SCORAD) index. Early‐onset AD was defined as debut ≤1 year, late‐onset as debut from 1–6 years. Aeroallergen sensitization and allergic rhinitis were diagnosed at ages 6–7 and 12 years. Associations between early‐onset and late‐onset AD and allergy endpoints were calculated using general estimating equations (GEE) models to compute the overall odds ratios (OR) for both time points. Results: Early‐onset AD (yes/no) and severity (SCORAD) were associated with development of aeroallergen sensitization during childhood; GEE OR = 1.68 [1.08; 2.62], p =.02 and 1.08 [1.03; 1.12], p <.001, whereas late‐onset AD showed a borderline significant association and late‐onset severity showed no association; GEE OR = 1.65 [0.92; 2.94], p =.08 and 1.01 [0.97; 1.06], p =.55. The same trend was seen for allergic rhinitis with significant association between early‐onset AD and allergic rhinitis; GEE OR = 1.56 [1.01; 2.41], p =.04 and severity; GEE OR = 1.09 [1.05; 1.13], p <.001, whereas late‐onset AD showed no association. The effects on sensitization and rhinitis of early‐onset versus late‐onset AD severity were significantly different: p‐interactionsensitization =.03 and p‐interactionrhinitis <.01. Conclusion: Increasing severity of early‐onset AD, but not late‐onset AD, associates with aeroallergen sensitization and allergic rhinitis later in childhood. [ABSTRACT FROM AUTHOR]

A 54‐year‐old man developed a severe anaphylactic penicillin allergy after 16 years and 5 standard erysipelas treatments by intravenous benzylpenicillin and/or oral phenoxymethylpenicillin without any symptoms of allergy. It is recommended to analyze specific IgE antibodies for phenoxymethylpenicillin, benzylpenicillin, amoxicillin, and cefaclor to select an appropriate antibiotic. [ABSTRACT FROM AUTHOR]

Objective: To study the distribution of inhaled allergen specific IgE in underage patients with allergic diseases in Yancheng area, and to provide evidence for disease prevention and treatment. Methods: A total of 430 underage (< 18 years old) patients with allergic diseases from January 2020 to March 2021 were selected, and their serums were detected by EUROLINE Atopy China(IgE). Results: 166 (38.60 %) were positive for serum allergen IgE among the 430 underage patients.Dust mites and house dust were the main inhalation allergens. The positive rate of IgE was 39% in male and 36% in female (P>0.05). The positive rate of female in middle school group (61.11 %) was higher than that of male (45.83 %)(P<0.05). There was significant difference between age group and IgE positive rate, and the positive rate increased with age. Cockroaches, dust mites, mould, ragweed, house dust and age groups were statistically different. The positive rate of IgE was the highest in respiratory allergic symptoms (48.2 %), and dust mite was the main allergen among different symptoms. All the patients with positive house dust were positive for dust mites, and 70.93 % of them showed respiratory allergic symptoms. Conclusions: Dust mites and house dust are the most important inhaled allergens for patients with allergic diseases in this area. It is of great significance to study the distribution of serum allergens for the prevention, diagnosis and treatment of allergic diseases in minors. [ABSTRACT FROM AUTHOR]

Background: Measurements of allergen-specific IgE antibodies with different manufacturers' assays show modest or poor agreement. This study compares analytical performance of specific IgE tests for whole allergen extracts and individual allergen components of two assay systems, IMMULITE and ImmunoCAP, using human sera as well as monoclonal antibodies. Methods: Comparisons were performed for specific IgE to house dust mite (HDM, n = 44), egg white (EW, n = 36) and the allergen components rDer p 1, rDer p 2, nGal d 1, nGal d 2 and nGal d 4 in human sera and with monoclonal mouse/human chimeric IgE antibodies specific for the same allergen components. Competitive interference with IgE measurement was investigated using allergen-specific monoclonal IgG and IgG4 antibodies. Results: Measurements of IgE to HDM and EW in serial dilutions of human sera revealed weaker dilution linearity with IMMULITE than with ImmunoCAP. Analysis of five different monoclonal IgE antibodies with total and specific IgE assays, expected to return similar levels, gave an average specific/total IgE ratio of 0.96 (range 0.71–1.14) with ImmunoCAP and 1.89 (range 0.76–2.85) with IMMULITE, indicating overestimation of specific IgE by IMMULITE. With the EW IgE tests of both assay systems, measurements of a chimeric anti-Gal d 2 IgE antibody were unaffected by a competing mouse IgG antibody. While the same was true for measurement of a chimeric anti-Der p 1 IgE antibody using the HDM test in ImmunoCAP, a suppression of measured concentrations by up to 42% was observed in IMMULITE. Similarly, measurement of HDM-specific IgE in human sera by ImmunoCAP was unaffected by a competing monoclonal anti-Der p 2 IgG4 antibody while IMMULITE displayed a reduction of HDM-specific IgE values by up to 30%. Conclusions: In this evaluation of analytical performance of two widely used assay systems, ImmunoCAP showed higher accuracy in quantitation of specific IgE and greater resistance against competing allergen-specific non-IgE antibodies which may arise through natural or dietary exposure, or as a result of allergen immunotherapy treatment. [ABSTRACT FROM AUTHOR]

Introduction: Specific immunoglobullins E (sIgE) are important parameters to estimate severity of allergic diseases. Aim: To determine the relationship between the concentration of sIgE antibodies in serum and clinical outcome of allergic diseases. Material and methods: The concentration of sIgE antibodies against allergens Dermatophagoides pteronyssinus, cat dander, Timothy grass, Alternaria alternata were determined in serum of 4077 respondents randomly selected from 9 regions (ECAP study). Positive results of sIgE (≥ 0.35 IU/ml) were correlated with answers in ECRHSII and ISAAC questionnaires. Result: Ige antibodies are more frequently detected in respondents aged over 4 years when they had their first attack of asthma (cat dander p < 0.05, Timothy grass p < 0.05). IgE antibodies are less frequently detected in respondents aged over 29 years when they had the first allergic rhinitis as compared to respondents aged 0-19 years when they had the first allergic rhinitis symptioms (p < 0.05 to p < 0.001). Among respondents showing allergic rhinitis symptoms, IgE antibodies are more frequently detected in respondents showing those symptoms from May to August (p < 0.05 to p < 0.005). Conclusions: The first attack of asthma appears later mainly in patients whose immune systems are more strongly stimulated by allergens. Development of allergic rhinitis in patients aged over 29 years presumably needs weaker stimulation of their immune systems by allergens than in patients aged 0-19 years. Stimulation of an immune system by different types of allergens modifies its response in such a way that seasonal (late spring and summer) factors increase probability of allergic rhinitis symptoms. [ABSTRACT FROM AUTHOR]

Objective: Environmental factors, eating habits, and different ages might affect the profiles of allergy sensitization. The purpose of this study was to survey the different profiles of allergen sensitization in different ages in eastern Taiwan. Materials and Methods: We analyzed the allergic patients who had allergen sensitization examinations by the Phadiatop (atopy screen; IBT Laboratories, Lenexa, KS, USA) and the Pharmacia CAP System method at Haulien Tzu Chi Hospital from January 2010 to December 2015. Results were compared in different ages. Results: A total of 15,455 patients were analyzed. The food and aeroallergen screen sensitization rate of children was significantly higher than that of adults (44.0% vs. 9.9% and 61.9% vs. 52.2% P < 0.05). Children had statistically significantly higher cow milk allergen-specific sensitization rate than that of adults (32.9% vs. 5.8% P < 0.05). The higher sensitization of shrimp occurred in adults than children. (33.6% vs. 24.8% P < 0.05). Conclusion: Our data demonstrate that children have higher cow milk allergy sensitization and adults have higher sensitization of shrimp. [ABSTRACT FROM AUTHOR]

Food allergy is increasing in prevalence, affecting up to 10% of children in developed countries. Food allergy can significantly affect the quality of life and well‐being of patients and their families; therefore, an accurate diagnosis is of extreme importance. Some food allergies can spontaneously resolve in 50%‐60% of cow's milk and egg‐allergic, 20% of peanut‐allergic and 9% of tree nut‐allergic children by school age. For that reason, food‐allergic status should be monitored over time to determine when to reintroduce the food back into the child's diet. The gold‐standard to confirm the diagnosis and the resolution of food allergy is an oral food challenge; however, this involves the risk of causing an acute‐allergic reaction and requires clinical experience and resources to treat allergic reactions of any degree of severity. In the clinical setting, biomarkers have been used and validated to enable an accurate diagnosis when combined with the clinical history, deferring the oral food challenge, whenever possible. In this review, we cover the tools available to support the diagnosis of food allergies and to predict food allergy resolution over time. We review the latest evidence on different testing modalities and how effective they are in guiding clinical decision making in practice. We also evaluate predictive test cut‐offs for the more common food allergens to try and provide guidance on when challenges might be most successful in determining oral tolerance in children. [ABSTRACT FROM AUTHOR]

Background: Analysis of cross-reactivity is necessary for prescribing safe cephalosporins for penicillin allergic patients. Amoxicillin (AX) is the betalactam most often involved in immediate hypersensitivity reactions (IHRs), and cefadroxil (CX) the most likely cephalosporin to cross-react with AX, since they share the same R1 side chain, unlike cefuroxime (CO), with a structurally different R1. We aimed to analyse cross-reactivity with CX and CO in patients with confirmed IHRs to AX, including sIgE recognition to AX, CX, CO, and novel synthetic determinants of CX. Methods: Fifty-four patients with confirmed IHRs to AX based on skin test (ST) and/or drug provocation test (DPT) were included. Serum sIgE to AX and benzylpenicillin was determined by Radioallergosorbent test (RAST). Two potential determinants of CX, involving intact or modified R1 structure, with open betalactam ring, were synthesised and sIgE evaluated by RAST inhibition assay. Results: Tolerance to CX (Group A) was observed in 64.8% cases and cross-reactivity in 35.2% cases (Group B). Cross-reactivity with CO was only found in 1.8% cases from Group B. ST to CX showed a negative predictive value of 94.6%. RAST inhibition assays showed higher recognition to CX as well as to both synthetic determinants (66% of positive cases) in Group B. Conclusions: Cross-reactivity with CX in AX allergic patients is 35%, being ST not enough for prediction. R1, although critical for recognition, is not the unique factor. The synthetic determinants of CX, 1-(HOPhG-Ser-Bu) and 2-(pyrazinone) are promising tools for determining in vitro cross-reactivity to CX in AX allergic patients. [ABSTRACT FROM AUTHOR]

Background: Beta‐lactam (BL)–antibiotics are the most frequent reason for drug‐induced hypersensitivity reactions. Because they are more efficient, less toxic, and less costly than other antibiotics, confirmation or exclusion of BL allergy is worthwhile. However, allergy tests for drug allergies are often false‐negative. Objectives: To evaluate the components of a stepwise diagnostic algorithm for immediate BL hypersensitivity with regard to sensitivity (SENS). Methods: Consecutive patients with suspected allergy to BL antibiotics were retrospectively analyzed with regard to increasing sensitivity (plausible history of immediate BL hypersensitivity serving as external criterion) of (i) skin prick test (SPT) by adding a second reading (n = 746), (ii) BL‐specific IgE‐determination in vitro at two cut‐offs (n = 539), and (iii) adding in vivo testing of minor and major BL determinants (n = 288). Results: In the history‐based population indicative of immediate BL hypersensitivity (n = 457), SPT with a sole 20‐minute reading identified 99 (SENS: 0.21) and SPT with 20‐ and 40‐minute‐reading identified 133 cases (SENS: 0.29). in vitro specific IgE‐examination identified 31 positives at a cut‐off ≥0.35 kUA/L (5.8% of tested) and 99 at cut‐off ≥0.11 kUA/L (18.4% of tested). In 203 SPT‐negative individuals, immediate BL hypersensitivity was identified by additional tests: in 79 by specific IgE (cut‐off ≥0.11 kUA/L) (thereof 53 identified solely by this test) and in 150 by in vivo testing of BL determinants in combination with Penicillin and Ampicillin intradermally (thereof 124 solely by this test); in 26 individuals both additional tests were positive. The combination of the three outpatient‐based test modalities—(i) optimized SPT, (ii) specific IgE at optimized cut‐off, and (iii) in vivo testing of BL determinants/Penicillin/Ampicillin—identified altogether 336/457 individuals with immediate BL‐hypersensitivity (SENS: 0.73), whereas the combination of the two (i) + (ii) identified 212/457 (SENS: 0.46); (i) + (iii) 283/457 (SENS: 0.61). Conclusions: To overcome the low sensitivity of allergological tests, optimized reading times of the SPT of BL, a lower cut‐off for in vitro detection of BL‐specific IgE, and intradermal testing of Penicillin, Ampicillin, and BL‐determinants contribute to overall sensitivity under real life conditions to diagnose immediate BL‐hypersensitivity. [ABSTRACT FROM AUTHOR]

Background: Allergic rhinitis (AR) is one of the most prevalent allergic diseases in children. This study aimed to investigate the association between serum concentrations of vitamin E and AR to determine if the vitamin E level is correlated with the occurrence and severity of AR.Methods: A total of 113 children were enrolled in this cross-sectional study. Sixty-five children in the outpatient group were diagnosed with AR, and 48 healthy children were recruited as controls. All subjects underwent serum vitamin E (adjusted for total cholesterol and triglycerides) measurements. Serum to total IgE (tIgE), the five most common allergen-specific IgE (sIgE) levels and skin prick test (SPT) were measured in children with AR. The severity of AR was assessed with the nasal symptoms score, and the situation of exposure to passive smoking were inquired.Results: Serum vitamin E levels were significantly lower in the AR group than in the normal children (P < 0.001). A significant negative correlation was observed between serum vitamin E levels and sIgE as well as the SPT grade. Serum vitamin E levels were also inversely related to the nasal symptoms score; however, statistical significance was not found.Conclusions: A significantly lower vitamin E level was found in children with AR. Lower serum vitamin E levels may have correlation with the occurrence of AR in children. However, serum vitamin E levels were not statistically correlated with the severity of AR. [ABSTRACT FROM AUTHOR]

Peanut allergy (PNA) is an IgE‐mediated immune disorder, which merits particular attention due to its impact on the health and quality of life of millions of patients worldwide. PNA tends to develop in early life and resolves in only 20% of peanut‐allergic children. It accounts for the majority of severe food‐related allergic reactions. An accurate diagnosis of PNA is vital. In this review, we present the approach to the diagnosis of peanut allergy, starting from the history and proceeding to measures of overall sensitization and then to component‐resolved diagnostics and oral food challenges as indicated. Additional testing in development includes basophil activation testing and determination of epitopes for peanut‐allergic responses. Based on the literature, stepwise approaches and predictive models for diagnosing PNA are also presented. [ABSTRACT FROM AUTHOR]

Introduction: Frequently observed multiple sensitizations to several animals highlights the importance of a molecular diagnosis, distinguishing between sensitizations specific to single species and sensitizations due to cross-reactivity. Objective: The aim of our study was to assess the usefulness of a molecular diagnosis in the description of sensitization profiles in allergy patients living in Central Europe, with a particular focus on animal-derived molecules. Methods: The molecular diagnosis was performed using the ImmunoCAP ISAC microarray. Results of 1,255 allergy patients were subjected to statistical analysis. Results: The highest sensitization rates were observed for uteroglobin Fel d 1 (31.8%) and kallikrein Can f 5 (16.4%), followed by animal lipocalins Can f 1 (13.9%), Equ c 1 (6.2%), Fel d 4 (5.3%), Can f 2 (4.2%), and Mus m 1 (4.1%). Sensitization rates to serum albumins Fel d 2, Can f 3, Equ c 3, and Bos d 6 were very low, with the highest being 3.2% to Fel d 2. Detailed subanalysis confirmed the dominant role of Fel d 1 or Can f 5 and/or Can f 1 in cat- or dog-sensitized patients, respectively. Further analysis focused on lipocalins and albumins confirmed a high rate of cosensitizations within both groups. Conclusion: The sensitization to animal allergen molecules is very frequent in Central Europe. The most common is sensitization to species-specific cat uteroglobin Fel d 1 and dog kallikrein Can f 5, followed by sensitizations to animal lipocalins. Our data suggest that commonly observed multiple sensitizations detected by extract approach can be explained not only by true cosensitization, but also by cross-reactivity, mainly in the frame of lipocalins. Cross-reactive serum albumins are minor sensitizers and are probably not important from this point of view. [ABSTRACT FROM AUTHOR]

Introduction: Data on local intraoperative anaphylaxis in Hong Kong is scarce, with few reviews available. We aimed to study the characteristics, presentations and workup results of cases referred to a local allergy clinic.Methods: A retrospective review was performed of patient referrals and workup results for suspected intraoperative anaphylaxis at Queen Mary Hospital drug allergy clinic in 2012-2016.Results: Tryptase was checked in only 81.7% (49/60) of the cases, most of which showed elevation (71.4%, 35/49). Among the 59 patients who received a workup, 47 (79.7%) showed positive findings, with a particularly high yield in the tryptase-positive subgroup (88.6%, 31/35). Among the 54 patients who consented to skin tests (the most sensitive investigation), 43 (79.6%) cases were positive. Overall, neuromuscular blockers were the commonest cause (25.0%, 15/60) of intraoperative anaphylaxis, while antibiotics ranked second (23.3%, 14/60). The timing of reactions was an important indication of potential allergens. For example, the majority of the neuromuscular blocker allergies occurred during the induction phase, while all gelofusine allergic events were in the maintenance phase of anaesthesia. 13 (21.7%) out of 60 cases received subsequent general anaesthesia procedures, with no recurrence of allergic reactions.Conclusion: Proper workup after an intraoperative anaphylactic event has a fairly good chance of identifying the causative allergen. These results are useful for patient management and the planning of subsequent anaesthetic procedures. [ABSTRACT FROM AUTHOR]

Background: Only a limited number of studies have included objective measures of allergic sensitisation (such as skin‐prick test [SPT] and serum specific IgE [sIgE]) when studying time trends in allergic respiratory disease in adults within the current millennium. Methods: Five health examination studies of random samples of individuals aged 18‐69 years resident in the Copenhagen region were conducted in 1990‐1991, 2006‐2008, 2010‐2011, 2012‐2015, and 2016‐2017. Allergic sensitisation was defined by sIgE (in 1990‐1991, 2006‐2008, and, 2012‐2015) or SPT (in 2006‐2008, 2010‐2011, and 2016‐2017) to at least one of the allergens: birch, grass, house dust mite, or cat. Allergic rhinitis was defined as sensitisation and self‐reported nasal symptoms. Results: The age‐ and sex‐standardised prevalence of sIgE‐defined sensitisation increased from 16% in 1990‐1991, to 26% in 2006‐2008, and to 29% in 2012‐2015. The age‐ and sex‐standardised prevalence of SPT‐defined sensitisation increased from 27% in 2006‐2008, to 28% in 2010‐2011, and to 32% in 2016‐2017. Changes in sIgE‐defined and SPT‐defined allergic rhinitis showed similar increasing trends. Conclusion: The prevalence of allergic sensitisation and allergic rhinitis increased in a general adult Danish population over the last three decades and has thus continued to increase in the current millennium. [ABSTRACT FROM AUTHOR]

Asthma guidelines provide clinicians with evidence-based management strategies for this chronic condition. The preferred therapy for patient with persistent asthma is inhaled corticosteroids. However, ∼40% of the patients with persistent asthma continue to present with symptoms while treated according to the guidelines. Multiple factors are being explored to explain the variability in response to inhaled corticosteroids including asthma phenotype and genetic predisposition among others. The nonatopic asthma phenotype has been described in the literature. These patients tend to have milder symptoms of asthma and typically outgrow their asthma by adolescence. They present with chronic asthma symptoms in the absence of a positive allergy test, either skin prick test or specific immunoglobulin E blood test. Although patients with nonatopic asthma share many characteristics with patients with atopic asthma, there are several studies that suggest a different inflammatory pathway may be involved in their pathophysiology. Therefore, it is possible that children with nonatopic asthma could respond differently to inhaled corticosteroids compared with those with atopic asthma. Currently there is a variable definition of this phenotype. Furthermore, there is a paucity of therapeutic trial directed toward the patients with nonatopic asthma specifically. Future research should be guided toward identifying the inflammatory pathways in nonatopic asthma and potential phenotype-guided therapies. [ABSTRACT FROM AUTHOR]

Background: Analysis of cross‐reactivity is necessary for prescribing safe cephalosporins for penicillin allergic patients. Amoxicillin (AX) is the betalactam most often involved in immediate hypersensitivity reactions (IHRs), and cefadroxil (CX) the most likely cephalosporin to cross‐react with AX, since they share the same R1 side chain, unlike cefuroxime (CO), with a structurally different R1. We aimed to analyse cross‐reactivity with CX and CO in patients with confirmed IHRs to AX, including sIgE recognition to AX, CX, CO, and novel synthetic determinants of CX. Methods: Fifty‐four patients with confirmed IHRs to AX based on skin test (ST) and/or drug provocation test (DPT) were included. Serum sIgE to AX and benzylpenicillin was determined by Radioallergosorbent test (RAST). Two potential determinants of CX, involving intact or modified R1 structure, with open betalactam ring, were synthesised and sIgE evaluated by RAST inhibition assay. Results: Tolerance to CX (Group A) was observed in 64.8% cases and cross‐reactivity in 35.2% cases (Group B). Cross‐reactivity with CO was only found in 1.8% cases from Group B. ST to CX showed a negative predictive value of 94.6%. RAST inhibition assays showed higher recognition to CX as well as to both synthetic determinants (66% of positive cases) in Group B. Conclusions: Cross‐reactivity with CX in AX allergic patients is 35%, being ST not enough for prediction. R1, although critical for recognition, is not the unique factor. The synthetic determinants of CX, 1 ‐(HOPhG‐Ser‐Bu) and 2 ‐(pyrazinone) are promising tools for determining in vitro cross‐reactivity to CX in AX allergic patients. [ABSTRACT FROM AUTHOR]

Background: Well‐known allergy tests are used to evaluate and diagnose allergic diseases. The aim of this study was to assess the role of serum level diamine oxidase (DAO) enzyme as a diagnostic marker in respiratory allergy. Methods: This case‐control study included 40 patients with respiratory allergies (atopic asthma and allergic rhinitis) as well as 40 age‐ and sex‐matched controls. A detailed past medical history of allergy was collected from each participant including family history of allergy. Physical examination, pulmonary function test (PFT) and measurement of serum levels of total immunoglobulin E (IgE) and DAO were performed. Skin‐prick test and specific IgE to common aeroallergens were also carried out. Results: DAO levels were higher in patients than controls. There was a positive correlation between severity of disease and DAO. No significant association was found between DAO level and age, type of respiratory allergy, duration of disease, PFT, eosinophilia, and total IgE. DAO had a high negative predictive value (94.7%) and high sensitivity (97.5%). Conclusion: DAO may be helpful in the assessment of severity and in ruling out respiratory allergy. [ABSTRACT FROM AUTHOR]

Background: Large local reaction to Hymenoptera stings is usually defined as a swelling >10 cm which lasts longer than 24 hours, sometimes associated with erythema, pruritus and blisters. Currently, the risk of subsequent systemic reactions after re‐stings is considered low (2%‐15%). Therefore, a diagnostic workup in case of large local reaction is often judged unnecessary, as well as adrenaline auto‐injector and venom immunotherapy prescription. The aim of this study was to prospectively evaluate the outcome of re‐stings in a real‐world setting, in patients with a history of one previous large local reaction. Methods: We consecutively enrolled patients who experienced their first large local reaction (as per EAACI definition), treated with antihistamine and steroids. They were followed for field re‐stings and assessed for risk of subsequent systemic reactions. Results: We enrolled 662 patients. Out of the 225 re‐stung subjects, 24% did not experience reactions, 52% reported a second large local reaction and 24% had systemic reactions. The risk of subsequent systemic reactions was higher in case of skin test reactivity to Apis mellifera or Vespula species (OR 2.1 and 3.8, respectively), in particular if positive at 0.001 µg/mL concentration (OR 13.4 and 16.5, respectively). Conclusions: Systemic reactions, after a previous large local reaction, occur more frequently than that reported by literature. After analysing the predictive role of large local reactions for systemic reactions, we demonstrated that an accurate diagnostic workup may be considered, particularly skin tests. Further studies in different countries are needed to confirm these results and large local reaction management. [ABSTRACT FROM AUTHOR]

Correct diagnostic management of perioperative hypersensitivity aims to identify the underlying mechanism(s), responsible culprit(s), and safe alternative drugs or techniques. Although drug provocation tests are considered the gold standard, diagnosis of perioperative hypersensitivity mainly relies on skin testing. Use of in vitro tests, such as quantification of specific immunoglobulin E antibodies, serum tryptase, and plasma histamine, as well as basophil activation tests is becoming widespread. These latter tests have the advantage of having no risk of recurrence of immediate hypersensitivity reactions. In this narrative review, we summarise the principles of these in vitro tests, and the possibilities and limitations when these tests are used for testing sensitivity to substances with a high risk of causing perioperative hypersensitivity. Hence, we focus on neuromuscular blocking agents, antibiotics, natural rubber latex, and opiates/opioids. The combination of multiple tests would allow diagnosis of perioperative hypersensitivity with the right balance of safety and accuracy. [ABSTRACT FROM AUTHOR]

Introduction: Although the use of cannabis dates back millennia, the first description of cannabis allergy is relatively recent (1971). Recent large-scale data show that cannabis allergy can manifest severe and generalized symptoms with extensive cross-reactions. Thus, it is essential to become familiarized with its clinical presentation, diagnostic aids, and adequate therapeutic guidance. Areas covered: Here we provide a hands-on overview on cannabis allergy focusing on symptomatology and the reliability of diagnostic options. Recent advances in proteomics are discussed in detail, elucidating the link with nsLTP-related allergies. The proteomics advancements have paved the way for more reliable diagnostics, especially component-based tools. Finally, the current experience in treatment options is highlighted. Expert opinion: Cannabis allergy is an allergy entity which can significantly impact the quality of life. For optimal diagnosis, we advise to start with a validated and standardized crude-extract based test such as sIgE hemp complemented by component-based diagnostics such as sIgE Can s 3 quantifications where available. Future research should lift the veil on the true prevalence of cannabis allergy and the importance of other cannabis allergens to further guide our practice. [ABSTRACT FROM AUTHOR]

IgE plays an essential role in type I hypersensitivity, which manifests various allergic diseases, such as allergic asthma, serum IgE levels are very low (<0.05 mg/ml) in non -allergic humans, values range from < 10 to 10000 IU/ml. To assess the levels of total IgE, the type and concentrations of specific IgE in asthmatic patients in area of study. The venous blood samples were taken from 50 patients and centrifuged at 3,000 rpm for 15 minutes Total Serum IgE levels were estimated in each patient, by ELISA using MEIA. Presence and concentration of Specific IgE were proved by (RIDA® Allergy Screen) which based on (immunoblot). The results showed that 56% of patients have low levels or negative IgE< 250 Iu/ml, 40% of them were females. The high concentration (250-1000) and (>1000) Iu/ml were found in males more than females. specific IgE frequency were variable in different patients, the lowest frequency were in each of Bermuda grass and Crab while the highest frequency were in Aspergillus fumigates. The females were more than males in the study group, the mean of total IgE is higher in males than in females, Aspergillus fumigates followed by Cladosporium, Derm. Farinae(hous dust mite)and Plantain (banana); were the most frequent sensitizer in the area of study. Crab has the higher concentration among 20 allergens. [ABSTRACT FROM AUTHOR]

Oral food challenges remain the gold standard for the diagnosis of food allergy. Nevertheless, the allergy workup is based on the presence of a clinical history, which is evocative of an immune‐allergic reaction, and the first assessment is usually the performance of skin prick tests. Based on these results, allergists are used to evaluate the presence of serum‐specific IgE, which are today the most commonly prescribed in vitro test for the evaluation of a possible food allergy. Other in vitro tests include the basophil activation test, that is becoming more and more employed by clinicians and not only by researchers, and the evaluation of serum IgG4, which is still an issue of debate in the allergy community. The present paper reviews the use of these in vitro tests for the diagnosis of food allergy. [ABSTRACT FROM AUTHOR]

Alcohol is known to cause elevation of serum total IgE (tIgE). Whether it can predispose to allergic disorders, however, is not clear. To assess whether alcohol can cause sensitization to allergens, we analyzed 100 individuals with alcohol use disorder (AUD) and 50 matched healthy controls. Serum tIgE and specific IgE against environmental allergens were measured. We found 93% of individuals with AUD had raised tIgE compared to only 48% of healthy controls (p < 0.0001). Sensitization to aeroallergens was noted in 68% drinkers compared to 24% of controls (p < 0.0001). The degree of sensitization was directly proportional to the amount and duration of alcohol intake. There is a possibility of a link between alcohol abuse and allergic sensitization. [ABSTRACT FROM AUTHOR]

Objective: To assess the frequency of atopy (specific IgE levels), to evaluate the allergic symptoms using the Allergy Questionnaire for Athletes (AQUA), and to determine whether atopy is associated with allergic symptoms in elite endurance athletes. Design: Cross-sectional study. Setting: Assessments were performed at Hospital das Clinicas--São Paulo University Medical School. Participants: Fifty-nine elite endurance athletes (triathletes and runners). Main Outcome Measures: Allergic symptoms were assessed by a validated self-report AQUA questionnaire and atopy by specific IgE level. Results: The frequency of atopy (specific IgE to at least one inhalant allergen) and allergic symptoms was 57.6% and 54.2%, respectively. In addition, no association was observed between atopy and allergic symptoms. Conclusions: A possible implication from our results is that atopy screening in elite athletes should be performed using AQUA questionnaire and measuring specific IgE simultaneously. [ABSTRACT FROM AUTHOR]

Background and aim: Standardized techniques help us to better diagnosis and follow up of allergic diseases. In this study, we determined the sensitivity, accuracy, and specificity of an Immunoblotting test compared to ImmunoCAP as the reference in vitro test for detection of specific IgE in allergic patients. Methods: In this cross-sectional study, specific IgE level was determined in patients with allergic symptoms who referred to the Immunology, Asthma and Allergy Research Institute, Tehran, Iran from 2010-2016, by two techniques. Eleven different allergens (six aeroallergens and five food allergens) were determined, and 303 specific IgE tests were performed for the patients by each method. The Immunoblotting test is a multiplex assay on a nitrocellulose membrane coated with 20 selected allergens. ImmunoCAP is considered as the reference method for determination of in vitro specific IgE. Its principle is an automated sandwich immunoassay, and allergens were bound to the solid phase, covalently. Finally, the fluorescence of elute was determined. Specific IgE more than 0.35 KU/L was considered as a positive test. Sensitivity, specificity, accuracy, kappa coefficient, positive and negative likelihood ratio (+/- LR), and correlation coefficient (calculated with Spearman test) between two tests were determined using statistical analysis (SPSS software, version 18). Results: One hundred and thirty five patients entered this study. The median age of the patients was 3.75 years with the males constituting 54.8% of the population. The most common cheif complaints were respiratory (51.6%), skin (41.8%) and gastrointestinal (27.9%) symptoms, respectively. The sensitivity, specificity, accuracy, +LR and -LR were 83%, 97%, 92%, 27.66 and 0.17, respectively. The kappa coefficient of the immunoblotting test was 0.81 compared to the reference technique. The correlation coefficient for positive tests between the two methods was 0.71 (p<0.001). Conclusion: Regarding the presence of 20 allergens in a RIDA allergy panel and according to our findings, this immunoblotting test with high sensitivity could be used as a fast and cost-efficient screening test. However, ImmunoCAP is recommended when the accurate level of specific IgE is required. ImmunoCAP findings are particularly helpful for immunotherapy and the elimination diet. [ABSTRACT FROM AUTHOR]

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Background Previous studies of serum total IgE (t-IgE) were not able to discriminate well-enough atopic from non-atopic subjects, that is, with or without serum-specific IgE antibodies to allergens. Objectives To model growth curves of the total IgE levels in children without atopic sensitization (hereafter defined as 'normal' t-IgE levels) and to test their usefulness in predicting atopic sensitization. Methods The German Multicentre Allergy Study ( MAS), a birth cohort with 1314 recruited newborns, began in 1990 and examined the participants until age 20 years. Total and specific IgE (t-IgE, s-IgE) were analyzed with a fluorescent enzyme immunoassay Immuno CAP ( TFS, Sweden) at ages 1, 2, 3, 5, 6, 7, 10, 13, and 20 years. Participants were classified as 'never atopic' if all their available serum samples had negative response (cutoff: <0.35 kUA/L) for s-IgE to the nine common foodborne and airborne allergenic extracts (milk, egg, soy, wheat, house dust mite, cat, dog, birch, and grass) tested in the MAS birth cohort. By contrast, participants were defined as atopic if they had, for at least at one available serum sample, s-IgE≥0.35 kUA/L to at least one allergenic extract tested. The evolution of t-IgE levels in the 'never atopic' children was described by growth curves, estimated by exploiting a quantile regression model. A 'reference' percentile, based on the t-IgE value measured at age 5 years, was assigned to each child with no IgE sensitization at that age. Upward deviations from the own 'reference' quantile of t-IgE in atopic and 'never atopic' children were calculated and a ROC analysis was used to identify the best cutoff point for predicting atopic sensitization. Results Overall, 1113 of 1314 children were included in this analysis. Of these, 469 were 'never atopic' and 644 atopic. Quantile trajectories of t-IgE levels in 'never atopic' subjects were stable from 5 years of age, increased to a plateau at age 10-13 years, and decreased slightly afterward. The onset of atopic s-IgE responses was characterized by an upward deviation of serum t-IgE levels from their 'reference' trajectory. T-IgE quantiles predicted the onset of atopy with high efficiency ( AUC>80%). ROC analysis showed that deviations from the t-IgE level 'reference' quantile above 0.32, 0.41, 0.42, 0.30, and 0.58 kU/L (log-units) at 6, 7, 10, 13, and 20 years of age, respectively, predicted an atopic sensitization. Conclusion The growth curves of 'normal' serum t-IgE concentrations were estimated in 'never atopic' children; for each individual who was non-atopic at 5 years of age a 'reference' quantile was identified that represented the individual's 'normal' level of t-IgE production. Upward deviations of observed t-IgE levels from the own 'reference' quantile, from 6 to 20 years of age, predicted at each year the occurrence of atopic sensitization. Clinical Implications The trajectory of t-IgE levels can be elaborated since age 5 years in non-atopic children. A child whose t-IgE levels are consistently higher than those predicted by his/her growth curve may have developed atopic sensitization. [ABSTRACT FROM AUTHOR]

Background Accurate assessment of atopic sensitization is pivotal to clinical practice and research. Skin prick test ( SPT) and specific IgE (sIgE) are often used interchangeably. Some studies have suggested a disagreement between these two methods, and little is known about their association with allergic diseases. The aims of our study were to evaluate agreement between SPT and sIgE, and to compare their association with allergic diseases in 10-year-old children. Methods Skin prick test, sIgE measurements, and assessment of allergic diseases were performed in children aged 10 years in the Protection against Allergy: STUdy in Rural Environments ( PASTURE) cohort. The agreement between SPT and sIgE was assessed by Cohen's kappa coefficient with different cutoff values. Results Skin prick tests and sIgE were performed in 529 children. The highest agreement (κ=.44) was found with a cutoff value of 3 and 5 mm for SPT, and 3.5 IU/mL for sIgE. The area under the curve ( AUC) obtained with SPT was not significantly different from that obtained with sIgE. For asthma and hay fever, SPT (cutoff value at 3 mm) had a significantly higher specificity ( P<.0001) than sIgE (cutoff value at 0.35 IU/mL) and the specificity was not different between both tests ( P=.1088). Conclusion Skin prick test and sIgE display moderate agreement, but have a similar AUC for allergic diseases. At the cutoff value of 3 mm for SPT and 0.35 IU/mL for sIgE, SPT has a higher specificity for asthma and hay fever than sIgE without difference for sensitivity. [ABSTRACT FROM AUTHOR]

Sesame is an important global allergen affecting ~0.1% of the North American population. It is a major cause of anaphylaxis in the Middle East and is the third most common food allergen in Israel. We conducted a systematic review of original articles published in the last 10 years regarding the diagnosis and management of sesame allergy. Skin prick testing appears to be a useful predictor of sesame allergy in infants, although data are less consistent in older children and adults. The diagnostic capacity of serum-specific immunoglobulin E is poor, especially in studies that used oral food challenges to confirm the diagnosis. Doubleblind, placebo-controlled food challenge thus remains the diagnostic gold standard for sesame allergy. The cornerstone of sesame allergy management is allergen avoidance, though accidental exposures are common and patients must be prepared to treat the consequent reactions with epinephrine. Novel diagnostic and treatment options such as component-resolved diagnostics, basophil activation testing, and oral immunotherapy are under development but are not ready for mainstream clinical application. [ABSTRACT FROM AUTHOR]

Background Atopic diseases are among the most common chronic diseases in adolescents, and it is uncertain whether the prevalence of atopic diseases has reached a plateau or is still increasing. The use of the ISAAC (International Study of Asthma and Allergy in Childhood) questionnaire has provided comparable prevalence rates from many countries, whereas studies including clinical examinations and strict diagnostic criteria are scarce. We aimed to investigate the prevalence of atopic diseases, the pattern of sensitization, and comorbidities at 14 years in a prospective birth cohort. Methods The children were examined eight times from birth to 14 years. Visits included questionnaire-based interviews, clinical examination, skin prick test, and specific IgE. Results Follow-up rate at 14 years was 66.2%. The 12-month prevalence of any atopic disease was high (40.3%) mostly due to a high prevalence of rhinoconjunctivitis (32.8%), whereas the prevalence of asthma was 12.9% and of atopic dermatitis 8.1%. In children with at least one atopic disease, 60% were sensitized, while only 16% of those without atopic diseases were sensitized. The frequency of sensitization depended on the phenotype. Among children with rhinoconjunctivitis only, rhinoconjunctivitis with concomitant asthma or atopic dermatitis or both 62.5%, 81.5%, 70%, and 100%, respectively, were sensitized, whereas it was 7.7% and 33.3% of children with only asthma or atopic dermatitis. Conclusion The prevalence of rhinoconjunctivitis was high in adolescence. Children with rhinoconjunctivitis with and without comorbidities were frequently sensitized. Children with asthma without concomitant allergic rhinoconjunctivitis were rarely sensitized. [ABSTRACT FROM AUTHOR]

Background To date, most studies of the 'allergy epidemic' have been based on self-reported data. There is still limited knowledge on time trends in allergic sensitization, especially among adults. Objective To study allergic sensitization, its risk factors and time trends in prevalence. Methods Within West Sweden Asthma Study ( WSAS), a population-based sample of 788 adults (17-60 years) underwent skin prick tests ( SPTs) for 11 aeroallergens 2009-2012. Specific IgE was analysed in 750 of the participants. Those aged 20-46 years ( n = 379) were compared with the European Community Respiratory Health Survey sample aged 20-46 year from the same area ( n = 591) in 1991-1992. Results Among those aged 20-46 years, the prevalence of positive SPT to pollen increased, timothy from 17.1% to 29.0% ( P < 0.001) and birch from 15.6% to 23.7% ( P = 0.002) between 1991-1992 and 2009-2012. Measurements of specific IgE confirmed these increases. Prevalence of sensitization to all other tested allergens was unchanged. In the full WSAS sample aged 17-60 years, any positive SPT was seen in 41.9%, and the dominating sensitizers were pollen (34.3%), animals (22.8%) and mites (12.6%). Pollen sensitization was strongly associated with rhinitis, whereas indoor allergens were more associated with asthma. Growing up with livestock or furred pets decreased the risk of sensitization, adjusted odds ratio 0.53 (0.28-0.995) and 0.68 (0.47-0.98), respectively. Conclusion Pollen sensitization has increased in Swedish adults since the early 1990s, while the prevalence of sensitization to other allergens has remained unchanged. This is one plausible explanation for the increase in rhinitis 1990-2008 in Swedish adults, during which time the prevalence of asthma, which is more associated with perennial allergens, was stable. Contact with animals in childhood seems to reduce the risk of sensitization well into adulthood. One major factor contributing to the rise in pollen allergy is a significant increase in levels of birch and grass pollen over the past three decades. [ABSTRACT FROM AUTHOR]

Background Chlorhexidine is an effective disinfectant, which may cause severe allergic reactions. Plasma level of specific IgE to chlorhexidine (Immuno CAP®) has high estimated sensitivity and specificity when measured within 6 months of allergic reaction, but knowledge of the dynamics over longer time periods is lacking and it is unknown whether levels fall below <0.35 kUA/L in patients with previously elevated levels. It is also unclear whether re-exposure influences levels of specific IgE. Objective To investigate the dynamics of specific IgE in chlorhexidine allergic patients with and without re-exposure. Methods All patients diagnosed with chlorhexidine allergy in the Danish Anaesthesia Allergy Centre January 1999 to March 2015 were invited to participate. The study included blood samples from the time of reaction and time of investigation and blood samples drawn prospectively over several years. Results Overall, 23 patients were included. Specific IgE within hours of reaction was available in eight patients and was >0.35 kUA/L in six of these. During allergy investigations, usually 2-4 months later, specific IgE was >0.35 kUA/L in 22 of 23 patients. In the following months/years specific IgE declined <0.35 kUA/L in 17 of 23 patients (most rapidly within 4 months). Nine re-exposures in the healthcare setting were reported by seven patients (35%). Most re-exposures caused symptoms and were followed by an increase in specific IgE. Two patients with specific IgE <0.35 kUA/L reacted upon re-exposure. Conclusions & Clinical Relevance Time from reaction should be considered when interpreting specific IgE results. Specific IgE is >0.35 kUA/L in most patients at time of reaction but should be repeated after a few weeks/months if negative. The optimal sampling time seems to be >1 month and <4 months. A value <0.35 kUA/L neither excludes allergy nor implies loss of reactivity in previously sensitized patients. Re-exposures are common, often iatrogenic, and can cause a rebound in specific IgE. [ABSTRACT FROM AUTHOR]

Background 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. Objectives 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. Methods 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 Immuno CAP. SPTs in accordance with one another and with sIgE were further considered. The test efficiency was calculated using receiver-operating characteristic ( ROC) analysis. Results 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. Conclusions 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. [ABSTRACT FROM AUTHOR]

Allergic rhinitis (AR) is the most common chronic disease in childhood and yet is often ignored and/or misdiagnosed. It can present as part of the atopic spectrum of disorders and can affect not only the nose but also its connections, manifesting often with a multiplicity of symptoms, sometimes atypical. If uncontrolled or inappropriately treated, AR can severely impair quality of life for children and their families. Growing evidence of its association with bronchial asthma is emerging: both as a risk factor for asthma development and a major factor in exacerbations. This article aims to give advice about diagnosis and management of this important, common condition to generalists who will encounter it frequently in their clinical practice. The use of evidence-based guidelines for AR therapy results in improved disease control. Current management is based on avoidance of triggering allergen(s), non-sedative anti-histamines for mild disease, and use of non-systemically bioavailable nasal steroids for moderate/severe disease. The use of an intranasal combined preparation of fluticasone propionate and azelastine for those unresponsive to these measures is under investigation. Allergen-specific immunotherapy, currently recommended for severe cases, is the only treatment modality potentially able to alter long term not only disease severity, but also progression. Immunotherapy is often unavailable to deserving patients and concern regarding risk/benefit and acceptability can hamper its use in children. Evidence on efficacy and safety of the more child-friendly sublingual route of administration is emerging, however further well-designed paediatric studies are needed. Education of patients, carers and of practitioners in the nature of AR, the possible need for long term concordance with therapy and the optimal use of this is a vital part of disease management. [ABSTRACT FROM AUTHOR]