Molecules and Cells in Allergy - Original Paper
Comparison of the Performance of Skin Prick, ImmunoCAP, and ISAC Tests in the Diagnosis of Patients with AllergyGriffiths R.L.M. · El-Shanawany T. · Jolles S.R.A. · Selwood C. · Heaps A.G. · Carne E.M. · Williams P.E.
Department of Immunology, University Hospital of Wales, Cardiff, UK
Correspondence to: Dr. Paul E. Williams
Department of Immunology, University Hospital of Wales
Cardiff CF14 4XW (UK)
Do you have an account?
Background: Allergy is diagnosed from typical symptoms, and tests are performed to incriminate the suspected precipitant. Skin prick tests (SPTs) are commonly performed, inexpensive, and give immediate results. Laboratory tests (ImmunoCAP) for serum allergen-specific IgE antibodies are usually performed more selectively. The immuno-solid phase allergen chip (ISAC) enables testing for specific IgE against multiple allergen components in a multiplex assay. Methods: We retrospectively analysed clinic letters, case notes, and laboratory results of 118 patients attending the National Adult Allergy Service at the University Hospital of Wales who presented diagnostic difficulty, to evaluate which testing strategy (SPT, ImmunoCAP, or ISAC) was the most appropriate to use to confirm the diagnosis in these complex patients, evaluated in a “real-life” clinical service setting. Results: In patients with nut allergy, the detection rates of SPTs (56%) and ISAC (65%) were lower than those of ImmunoCAP (71%). ISAC had a higher detection rate (88%) than ImmunoCAP (69%) or SPT (33%) in the diagnosis of oral allergy syndrome. ImmunoCAP test results identified all 9 patients with anaphylaxis due to wheat allergy (100%), whereas ISAC was positive in only 6 of these 9 (67%). Conclusions: In this difficult diagnostic group, the ImmunoCAP test should be the preferred single test for possible allergy to nuts, wheat, other specific foods, and anaphylaxis of any cause. In these conditions, SPT and ISAC tests give comparable results. The most useful single test for oral allergy syndrome is ISAC, and SPT should be the preferred test for latex allergy.
© 2017 S. Karger AG, Basel
Royal College of Physicians: Allergy: the unmet need - a blueprint for better patient care. Report of a working party. London, RCP, 2003.
House of Commons Health Committee: The provision of allergy services. Sixth report of session 2003-04. London, TSO, 2004.
House of Lords Science and Technology Committee: Allergy: sixth report of session 2006-07. London, TSO, 2007.
Royal College of Physicians; Royal College of Pathologists: Allergy: still not meeting the unmet need. Report of a joint colleges working party. London, RCP, 2010.
- Sicherer SH, Muñoz-Furlong A, Godbold JH, Sampson HA: US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol 2010;125:1322-1326.
- Nicolaou N, Poorafshar M, Murray C, Simpson A, Winell H, Kerry G, Härlin A, Woodcock A, Ahlstedt S, Custovic A: Allergy or tolerance in children sensitized to peanut: prevalence and differentiation using component-resolved diagnostics. J Allergy Clin Immunol 2010;125:191-197.
- Skypala IJ, Bull S, Deegan K, Gruffydd-Jones K, Holmes S, Small I, Emery PW, Durham SR: The prevalence of PFS and prevalence and characteristics of reported food allergy; a survey of UK adults aged 18-75 incorporating a validated PFS diagnostic questionnaire. Clin Exp Allergy 2013;43:928-940.
- Deinhofer K, Sevcik H, Balic N, Harwanegg C, Hiller R, Rumpold H, Mueller MW, Spitzauer S: Microarrayed allergens for IgE profiling. Methods 2004;32:249-254.
Antonicelli L, Massaccesi C, Braschi MC, Cinti B, Bilo MB, Bonifazi F: Component resolved diagnosis in real life: the risk assessment of food allergy using microarray-based immunoassay. Eur Ann Allergy Clin Immunol 2014;46:30-34.
- Heaps A, Carter S, Selwood C, Moody M, Unsworth J, Deacock S, Sumar N, Bansal A, Hayman G, El-Shanawany T, Williams P, Kaminski E, Jolles S: The utility of the ISAC allergen array in the investigation of idiopathic anaphylaxis. Clin Exp Immunol 2014;177:483-490.
- Cabrera-Freitag P, Goikoetxea MJ, Beorlegui C, Gamboa P, Gastaminza G, Fernández-Benítez M, Ferrer M, Blanca M, Sanz ML: Can component-based microarray replace fluorescent enzimoimmunoassay in the diagnosis of grass and cypress pollen allergy? Clin Exp Allergy 2011;41:1440-1446.
- Sampson HA, Ho GH: Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol 1997;100:444-451.
- Wöhrl S, Vigl K, Zehetmayer S, Hiller R, Jarisch R, Prinz M, Stingl G, Kopp T: The performance of a component-based allergen-microarray in clinical practice. Allergy 2006;61:633-639.
- Heinzerling L, Mari A, Bergmann KC, Bresciani M, Burbach G, Darsow U, Durham S, Fokkens W, Gjomarkaj M, Haahtela T, Bom AT, Wöhrl S, Maibach H, Lockey R: The skin prick test - European standards. Clin Transl Allergy 2013;3:3.
- Focke M, Marth K, Valenta R: Molecular composition and biological activity of commercial birch pollen allergen extracts. Eur J Clin Invest 2009;39:429-436.
- Martínez-Aranguren R, Lizaso MT, Goikoetxea MJ, García BE, Cabrera-Freitag P, Trellez O, Sanz ML: Is the determination of specific IgE against components using ISAC 112 a reproducible technique? PLoS One 2014;9: e88394.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.