A new framework for the interpretation of IgE sensitization tests
Open accessAbstract
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.
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Both skin prick testing and specific IgE can be positive without symptoms, and neither can confirm the expression of rhinitis symptoms upon allergen exposure.
“However, both of these tests can be positive in the absence of any symptoms, and neither positive SPT nor IgE can confirm the expression of rhinitis symptoms upon allergen exposure.1009,1010”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [1010]
Allergen sensitization does not necessarily imply clinical responsiveness.
“Nevertheless, all in vitro test results should be evaluated alongside the clinical history, since allergen sensitization does not necessarily imply clinical responsiveness.”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [1010]
Interpretation of allergy tests has moved from dichotomization based on arbitrary criteria to quantification using specific IgE titer and skin prick test wheal size.
“This has changed the way we interpret the results of allergy tests, with a move from dichotomization (labeling patients as being sensitized based on a “positive” test using arbitrary criteria), to quantification of blood or skin tests using sIgE titer and SPT wheal size.893,1010-1012”
From International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (2018) · cites this paper as [1010]
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- Authors
- Roberts, G., Ollert, M., Aalberse, R., Austin, M., Custovic, A., DunnGalvin, A., Eigenmann, P. A., Fassio, F., Grattan, C., Hellings, P., Hourihane, J., Knol, E., Muraro, A., Papadopoulos, N., Santos, A. F., Schnadt, S., & Tzeli, K.
- Affiliations
- University Hospital Southampton NHS Foundation Trust (GB)
- University of Southern Denmark (DK)
- Amsterdam UMC Location University of Amsterdam (NL)
- Anaphylaxis UK (GB)
- Department of Paediatrics; Imperial College London; London UK
- University College Cork (IE)
- University Hospital of Geneva (CH)
- Azienda Ospedaliero-Universitaria Careggi (IT)
- Norfolk and Norwich University Hospital (GB)
- Universitair Ziekenhuis Leuven (BE)
- University Medical Center Utrecht (NL)
- University of Padua (IT)
- National and Kapodistrian University of Athens (GR)
- King's College London (GB)
- German Allergy and Asthma Association (Deutscher Allergie- und Asthmabund (DAAB)); Mönchengladbach Germany
- Corresponding author
- Roberts, G.
- ORCID
- Venue
- Allergy
- Publisher
- Wiley
- Published
- 2016-08-15
- Volume
- 71
- Issue
- 11
- Pages
- 1540-1551
- ISSN
- 0105-4538 (ISSN-L)
- OpenAlex
- W2401029547
- Cited by
- 98
- References
- 65
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 9 · 2023: 13 · 2022: 8 · 2021: 13 · 2020: 8 · 2019: 7 · 2018: 17 · 2017: 8 · 2016: 4
- FWCI
- 11.34
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Allergy (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Archive ouverte UNIGE (University of Geneva) (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Lirias (submittedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion)
- Spiral (Imperial College London) (submittedVersion)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Funders
- ThermoFisher Scientific
- Medical Research Council
- NIAID and the Immune Tolerance Network
- National Peanut Board
- Bühlmann Laboratories AG
- Topics
- Health Sciences › Medicine › Immunology and Allergy › Allergic Rhinitis and Sensitization
- Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Keywords
- skin prick test, serum specific IgE, pretest probability, post-test probability, Bayesian interpretation, atopic dermatitis, provocation tests
- MeSH terms
- Allergens, Diagnostic Tests, Routine, Humans, Hypersensitivity, Immunoglobulin E, Immunoglobulin G, Immunization, Prognosis, Risk Factors, Reproducibility of Results
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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