Analysis index

2 ml serum

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Clarification of allergic symptoms, test for sensitization

IgE, total allergen-specific IgE (EAST = RAST) (Type I reaction), Allergen-specific IgG (Precipitin) (Type III reaction). Nowadays the term “allergy” means an illness, where the body reacts to repeated contact with a foreign, usually harmless substance with an excessive immune reaction. There are four allergic reaction types, which may also occur as a combination:

1. Type I (Immediate type): Release of histamine by mediation of IgE. Reaction onset is within seconds to a few minutes. Clinical presentation: Quincke’s edema, urticaria, caused by food allergens for example, asthma, allergic rhinitis, caused by inhalation antigens (mainly seasonal), anaphylactic shock, caused by insect poison or medication.
2. Type II (Cytotoxic type): Cytolysis by immune complex formation between cell membrane antigens and specific IgG (IgM)-antibodies. Reaction onset is within hours to days. Clinical presentation: Agranulocytosis, hemolytic anemia, thrombopenia, transplant rejection.
3. Type III (Arthus type): Vascular wall damage caused by IgG-class immune complexes. Reaction onset is within 6 to 8 hours. Clinical presentation: Vasculitis allergica, glomerulonephritis, serum sickness, exogenous allergic alveolitis (such as farmer’s lung, pigeon breeder’s disease etc.).
4. Type IV (Cellular allergy of the late type): Vascular wall damage caused by formation of lymphokines from T-lymphocytes and antigens in the skin area. Reaction onset is within 1 to 3 days. Clinical presentation: Contact dermatitis, i.e. medication exanthema, prosthesis stomatitis etc.

In type I allergy, the determination of total IgE and especially evaluation of allergen-specific IgE (EAST = RAST), due to the higher specificity, is important for the securing of the different in vivo tests. A detailed anamnesis is the basis of well-aimed diagnostics. In patients, who receive antihistamine treatment or steroid therapy, evaluation is contraindicated.

CAUTION: A monospecific allergy may still be existent, despite normal total IgE.

In diagnostic use, testing of group allergens should take priority over individual allergens. Evaluation of class IgG4 blocking antibodies can be used for determining the success of hyposensitization therapy in special cases, however, the significance is controversial.

Evidence of precipitating IgG antibodies correlates with allergic type III illnesses. A selection of the special antigen should be made based on a corresponding medical history.

For type II and type IV allergies, there are only excessive and hardly reproducible tests available, such as lymphocyte stimulation test and histamine release test.

Step diagnostics: An inhalation mixture (SX1) and food mix (FX5) captures over 90 % of all sensitized persons suffering from allergies. By determining the total IgE, an atopy is less likely using the mix allergens SX1 and FX5, in case of negative screening. Increased IgE levels indicate sensitization by other allergens, parasite infections or immunological diseases.

Allergy diagnostics in children: Recent studies have shown that sensitization to chicken egg protein is a good indicator for allergy tendency in children. It was established, that over 40 % of children, who show IgE antibodies to chicken egg protein in their first year of life, are sensitive to house dust mites by the age of three. 40 % of those children develop asthma by the age of five.

Useful allergen tests: In children, the following foods should be tested during screening for food allergens: Cow’s milk, chicken egg, soy, wheat, peanut, fish. Screening for inhalation allergens should cover the following tests: One representative  of grass pollen (such as timothy or rye), a representative of tree pollen (such as birch), a representative of herb pollen (such as mugwort), a representative of house dust mites (such as dermatophagoides pteronyssinus), cat, dog, horse, cladosporium herbarum, alternaria alternate. More than 90 % of clinical relevant allergens are captured by these allergen panels. More and more recombinant allergens are developed. By this, marker allergens were discovered, which are helpful to the understanding of cross allergies and to estimate, how and if a specific immunotherapy (SIT), should be carried out. Examples for the main allergen of birch is Bet v 1, which is also found in food such as apples, carrots and hazelnuts. In the diagnostics of peanut allergy, testing for rAra h 2, a storage protein, may be important. rAra h 2 positive patients carry a high risk of systemic and serious reactions. In peach allergies, those, who react to Pru p 3, are in danger of developing severe reactions. On suspicion of peanut allergy, rAra h 2 and F13 can be used, or, on suspicion of fruit allergy (peaches) rPru p 1 and rPru p 3 can be used. Pollen, mite and latex allergies often show associations to food allergies.