To identify animal epithelial allergen sensitivity / Шинэ санаа Шинэ нээлт

Background@#The numbers of pet ownerships tend to increase worldwide.60 to 65 percent of USA citizens are keeping pets at home and 12-15 percent of them have allergic issues. Another research among the European children who have dog allergy increased up to 15.6 percent in 2006 while it was 8.7 percent in 1992. Also, the allergy symptoms usually come out as bronchial asthma. @*Methods@#This study has conducted by hospital based cross sectional study and retrospective and descriptive study model. For the test (BioIC) to identify allergen-specific IgE in 154 patients, hypersensitive to cat, dog and horse allergy.@*Results@#In our study, a total of 154 participants were involved with 1-63 aged (average age 18.7±14.6). By the result of the BioIC test, cat allergy, dog allergy, horse allergy was 114 (74.02%), 52(33.76%), 47(30.51%) respectively.The mean sensitivity rate for cat allergic children was 12.69AU where it indicates 7.61AU in cat allergic adults (p<0.01). The mean sensitivity rate for horse allergic children was 6.04AU where it indicates 2.27AU in horse allergic adults and 7.65AU in dog allergic children and 4.53AU in adults (p<0.04). @*Conclusions@#By the result of the allergen specific IgE test in serum, cat allergy, dog allergy, horse allergy was 114 (74.04%), 52 (33.76%), 47(30.51%) respectively. By the result of the allergen specific IgE test in serum, sensitivity rate of epithelial allergen to cat was strong positive where it indicates medium positive for horse and dog sensitive rate. Children has higher sensitivity rate of epithelial allergen than adults.

Comparison of MAST-CLA System Results and Allergen Detection Rates between Acute and Chronic Urticaria Patients in Gangwon, Yeongseo Province, Korea / 대한피부과학회지

BACKGROUND: The multiple allergosorbent test chemiluminescent assay (MAST-CLA) is a simple system with high sensitivity and specificity for measuring total and allergen-specific IgE antibodies in patients with allergic skin diseases such as urticaria. OBJECTIVE: The purpose of this study was to evaluate total IgE class, allergen frequencies, and their correlations in MAST-CLA in acute and chronic urticaria. METHODS: We performed a retrospective study using medical documents of 2,028 urticaria patients (average age= 34.85 years) who visited Yonsei Wonju Severance Christian Hospital, Yeongseo Province, Korea, between 2003 and 2012. Positive rates of specific IgE and total serum IgE levels in acute and chronic urticaria patients were analyzed. RESULTS: Among the total 2,028 patients, 1,263 (62.3%) had acute urticaria, and 765 (37.7%) had chronic urticaria. The number of patients with higher than class 2 level of serum total IgE was 1,496 (73.8%): 964 (76.3%) of the acute urticaria group and 532 (69.5%) of the chronic urticaria group. More than half of the patients (1,048; 51.7%) showed a positive reaction to at least one allergen-specific IgE. The positive rate of acute urticaria was 53.0% and chronic urticaria 49.5%. In both acute and chronic urticaria, the most commonly detected allergen was Dermatophagoides farinae, followed by D. pterony and house dust. Most patients showed lower positive reactions to food allergens. Peach was the most common food allergen in both groups. Of the patients who showed positive total IgE, 40.4% did not react to any allergen-specific IgE. Also, 26.3% of the patients who were negative for total IgE showed a positive reaction to more than one allergen-specific IgE. The level of total IgE and the number of positive allergen-specific IgE responses were positively correlated in both acute and chronic urticaria patients. CONCLUSION: Our results showed that the positive rate of total IgE was higher in acute urticaria patients than in chronic urticaria patients. Both acute and chronic urticaria patient groups showed the highest positive rates for D. farinae. Positive rates for response to food allergens, such as soybean, chicken, yeast, tuna, and salmon, were lower in the chronic urticaria group. For inhalant allergens, the positive rates of response to white oak and Aspergillus were higher in the acute urticaria group. The level of total IgE and the number of positive allergen-specific IgE responses showed a positive correlation in both groups. Thus, MAST-CLA appears to be a simple and convenient method for determining causative allergens in the occurrence and exacerbation of urticaria, but other studies are necessary to confirm these preliminary findings.

Prevalence of serum allergen-specific immunoglobulin E for canine atopic dermatitis in Korea / 동물의과학연구지

Canine atopic dermatitis (CAD) is an allergic skin disease with characteristic clinical features associated with immunoglobulin E (IgE) antibodies. Identification of the causative allergens is the diagnostic goal, which is essential to treat and manage CAD patients. CAD is commonly associated with environmental allergens surrounding the patients. For this reason, it is important for diagnostic tests to select allergens that are related to the environment of each country and each province. There are two main allergen-specific tests, serological IgE test (SAT) and intradermal skin test (IDT). SAT did not show direct cutaneous reaction but did show serological reaction against allergens. However, SAT is simpler and more convenient than IDT in small animal practice. In this study, we selected domestically prevalent allergens for SAT, including 60 food allergens and 60 inhalant allergens, and tested eight dogs tentatively diagnosed with CAD based on Favrot's criteria. Furthermore, IDT was performed on four dogs from the SAT group for comparison of SAT and IDT, and the results were very similar. In SAT, four types of mites (Bloomia tropicalis, Glycophagus domesticus, Euroglyphus maynei, and mite mixture 1 Korea; house dust mites), four types of molds (Botrytis cinerea, Alternaria alternata, mold fungi mixture 11, mold fungi mixture), and one type of pollen (tree pollen mix 3 Korea) induced a reaction in more than half of dogs tested. In IDT, all four dogs reacted positively to Dermatophagoides farinae, and three reacted positively to Dermatophagoides pteronyssinus and house dust. The mean agreement rate between SAT and IDT in this study was 76.3%. This is the first trial to apply local allergens for SAT in Korean veterinary medicine, and it might play an important role for diagnoses and management of animal allergic diseases.

Comparison of MAST-CLA System Results between Children and Adults with Atopic Dermatitis (2005~2012, Gangwon, Yeongseo Province) / 대한피부과학회지

BACKGROUND: The multiple allergosorbent test chemiluminescent assay (MAST-CLA) system is a simple method with high sensitivity and specificity for measuring total and allergen-specific IgE antibodies in patients with allergic skin diseases such as atopic dermatitis and urticaria. OBJECTIVE: The purpose of this study was to evaluate total IgE class, allergen frequencies, and their correlations in MAST-CLA in children and adults with atopic dermatitis. METHODS: We performed a retrospective study using medical documents of 2,154 atopic dermatitis patients who visited Yonsei Wonju Severance Christian Hospital between 2005 and 2012. Positive rates of specific IgE and total serum IgE levels in children and adults were analyzed. RESULTS: Among 2,154 total patients, 1,189 (55.2%) were children and 965 (44.8%) were adults. The mean age was 20.2 years. The number of patients with greater than class 2 total serum IgE levels was 1,612 (74.8%), 814 children (68.5%) and 798 adults (82.7%). In total, 1,213 patients (56.3%) showed positive reactions to at least one allergen-specific IgE. The positive rates were 55.5% and 57.3% in children and adults, respectively. The most commonly detected allergen was Dermatophagoides farinae, followed by D. pterony and house dust in both children and adults. Most patients showed lower positive reactions to food allergens. The most common food allergen was white egg in children and shrimp in adults; 35.3% of the patients who showed positive total IgE did not react to any allergen-specific IgE. In addition, 31.4% of patients with negative total IgE showed positive reactions to more than one allergen-specific IgE. The total IgE level and number of positive allergen-specific IgE results showed good correlation in both children and adults. CONCLUSION: According to our results, positive rates of both total IgE and allergen-specific IgE were higher in adults with atopic dermatitis than in children. Both adults and children showed higher positive rates for inhalant allergens. Positive rates for food allergens such as egg whites, milk, and soybean were higher in children. The total IgE level and number of positive allergen-specific IgE results showed good correlation in both groups. MAST-CLA would be a simple and convenient method to determine the causative allergen in atopic dermatitis occurrence and exacerbation, but other studies would be necessary for confirmation.

The Level of Serum Immunoglobulin E Measured at General Hospitals in Six Regions of Korea in Children with Allergic Diseases / 소아알레르기및호흡기학회지

PURPOSE: We investigated the change in serum total immunoglobulin E (IgE) and allergen-specific IgE according to allergic diseases and age. METHODS: Allergic markers of children under 18 years of age with allergic diseases for the last 5 years were collected from 12 hospitals nationwide. The total data was 9,710. Data about levels of serum total IgE and allergen-specific IgE to 15 common allergens were collected. RESULTS: In children with asthma, serum total IgE was higher in older age than in younger age until age 7 to 12 years, at which time the level was highest (paper radioimmunosorbent test, 526.7 IU/mL; UniCAP, 339.9 IU/mL). The level was lower in older age than that during younger age. This change was similar to that in children with allergic rhinitis and atopic dermatitis. The level was highest at ages 7 to 12 years in children with allergic rhinitis, and at age 10 to 12 years in children with atopic dermatitis. In children with both asthma and allergic rhinitis, as well as in children with all three diseases, the change in serum total IgE was similar to that of children with an isolated disease. The highest level in children with all three diseases was higher than that in children with an isolated disease. The analysis of allergen-specific IgE positivity showed that food allergens were dominant before the age of 2 years, and that aeroallergens such as house dust mites were dominant. CONCLUSION: Serum total IgE in Korean children with allergic diseases was higher in older age than in younger age until the ages of 7 to 12 years, and then the change in total IgE by age was the opposite.

Analysis of Polycheck Allergy Results of the Recent Two Years: Comparison with Skin Prick Test and ImmunoCAP

BACKGROUND: Multiple Antigen Simultaneous Test (MAST)-immunoblot assay is a practical and economical test, which has been recently introduced nationwide. Authors investigated test efficiency of a MAST-immunoblot assay, Polycheck Allergy (PA). METHODS: A total of 3,153 patients were tested by PA and the results were compared with the results of ImmunoCAP and skin prick test (SPT) in 532 and 75 patients, respectively. The correlation with the lgE results measured by VIDAS was also analyzed. RESULTS: The agreements of PA with SPT were 87.8% in the Inhalant Panel and 89.3% in the Food Panel and the agreement of ImmunoCAP with SPT was 95.2%. The most common allergens giving positive reactions were Dermatophagoides farinae (46.2%) and Dermatophagoides pteronyssinus (40.0%). SPT taken as a reference, PA compared with ImmunoCAP showed higher agreement (D. farinae, 76.0 vs. 70.7%; D. pteronyssinus, 76.0 vs. 74.4%), sensitivity (D. farinae, 72.7 vs. 68.2%; D. pteronyssinus, 75.0 vs. 71.2%) and specificity (D. farinae, 85.0 vs. 81.3%) except for the specificity for D. pteronyssinus (78.3 vs. 87.5%). The rate of allergen specific IgE positive patients was higher than that of negative patients when total IgE was over 100 kU/L. CONCLUSIONS: Our results showed that the agreement, sensitivity and specificity of PA were similar to or better than those of the previously established test, ImmunoCAP. The allergen specific IgE results of PA were in correlation with total IgE. PA may be used for testing allergen specific IgE to diagnose and treat allergic diseases.

Analysis of Polycheck Allergy Results of the Recent Two Years: Comparison with Skin Prick Test and ImmunoCAP

BACKGROUND: Multiple Antigen Simultaneous Test (MAST)-immunoblot assay is a practical and economical test, which has been recently introduced nationwide. Authors investigated test efficiency of a MAST-immunoblot assay, Polycheck Allergy (PA). METHODS: A total of 3,153 patients were tested by PA and the results were compared with the results of ImmunoCAP and skin prick test (SPT) in 532 and 75 patients, respectively. The correlation with the lgE results measured by VIDAS was also analyzed. RESULTS: The agreements of PA with SPT were 87.8% in the Inhalant Panel and 89.3% in the Food Panel and the agreement of ImmunoCAP with SPT was 95.2%. The most common allergens giving positive reactions were Dermatophagoides farinae (46.2%) and Dermatophagoides pteronyssinus (40.0%). SPT taken as a reference, PA compared with ImmunoCAP showed higher agreement (D. farinae, 76.0 vs. 70.7%; D. pteronyssinus, 76.0 vs. 74.4%), sensitivity (D. farinae, 72.7 vs. 68.2%; D. pteronyssinus, 75.0 vs. 71.2%) and specificity (D. farinae, 85.0 vs. 81.3%) except for the specificity for D. pteronyssinus (78.3 vs. 87.5%). The rate of allergen specific IgE positive patients was higher than that of negative patients when total IgE was over 100 kU/L. CONCLUSIONS: Our results showed that the agreement, sensitivity and specificity of PA were similar to or better than those of the previously established test, ImmunoCAP. The allergen specific IgE results of PA were in correlation with total IgE. PA may be used for testing allergen specific IgE to diagnose and treat allergic diseases.

Change in Quality of Life according to the Change in Atopic Dermatitis Severity / 소아알레르기및호흡기학회지

PURPOSE: The aim of this study was to longitudinally examine the correlation between the change of atopic dermatitis (AD) severity and the change of quality of life (QOL). METHODS: We assessed AD severity and QOL of patients and their families, by a prospective followed up for at least 12 months. AD severity was assessed, using the scoring of atopic dermatitis (SCORAD) index. A questionnaire based on dermatitis family impact (DFI), infants' dermatologic quality of life (IDQoL) and children's dermatology life quality index (CDLQI) were used to determine QOL. RESULTS: Seventy-nine AD patients were assessed for total and objective SCORAD and DFI. Among them, 45 patients that were less than 36 months old completed IDQoL and 13 patients that were equal to or more than 36 months old completed CDLQI. Objective SCORAD (oSCORAD) were correlated with DFI (r=0.235), IDQoL (r=0.602) and CDLQI (r=0.589) (P<0.05). At the 2nd interview, median oSCORAD (from 17.4 to 7.8), DFI (from 23.0 to 18.0) and IDQoL (from 9.0 to 6.0) were significantly decreased (P<0.01). The changes of oSCORAD were linearly related with the change of IDQoL (P<0.01), but neither with DFI (P=0.356) nor with CDLQI (P=0.267). Of the 64 patients with decreased oSCORAD, food allergy was accompanied more frequently in those with an increased DFI than those with a decreased DFI (60.7% vs. 27.8%, P<0.01). CONCLUSION: In this longitudinal study, the improvement of AD severity is correlated with the improvement of the patient's QOL, under the age of 3. To improve the family's QOL, we need to find out accompanying factors, such as food allergy, and to support the family accordingly.

Evaluation of the MAST CLA Allergy System for Measuring Total and Allergen Specific IgE in Child and Adult Atopic Dermatitis / 대한피부과학회지

BACKGROUND: The multiple allergosorbent test chemiluminescent assay (MAST-CLA) system is a simple method for measuring total and allergen-specific IgE antibodies in the serum of patients with atopic dermatitis. Total IgE, however, is much frequently higher, even if no allergen-specific IgE antibodies can be detected in serum. OBJECTIVE: The purpose of this study was to evaluate total IgE class, the allergen frequencies and their correlations in MAST-CLA in child and adult atopic dermatitis patients respectively. METHODS: A total of fifty two adult patients and ninety child patients with atopic dermatitis were evaluated by MAST-CLA between march 2002 and march 2005 at Soonchunhyang hospital. Positive rates of specific IgE and the total serum IgE level of the MAST-CLA allergy system were compared between child and adult patients. RESULTS: Among the subjects, 84.5% (80.0% for child patients and 92.3% for adult patients) of patients showed an elevated serum total IgE (more than class level 2) and 54.9% (45.6% for child patients, 71.2% for adult patients) revealed at least more than one allergen-specific IgE by MAST-CLA. The average 3.76 (3.39 for child patients, 4.16 for adult patients) different allergens was simultaneously detected in a single positive serum. Commonly-positive allergen rates, in descending order, were D. farinae 44.4%, D. pteronyssynos 38.7% and house dust 26.8%. Furthermore, the higher total serum IgE level in adult patients, the more probability of allergen-specific IgE positive results being disclosed (p<0.05). The number of allergen-specific IgE positive results was increased in a higher serum total IgE level (p<0.05). But total IgE positive rates which had allergen-specific antibody negative patients was 37.5% (45.8% for child patients, 25.0% for adult patients). Good correlation was obtained between total IgE levels and number of positive allergen-specific IgE in MAST-CLA, with 0.551 correlation coefficiency (p<0.05). CONCLUSION: Our study suggested that the MAST-CLA allergy system is a useful screening test to detect allergen- specific IgE and to evaluate patients with atopic dermatitis. But other allergen screening tests should be used for detecting allergens, when MAST-CLA total IgE class is increased over class 2 with no detectable specific IgE.

The Relationship among the Clinical Evaluation, Total IgE, and Allergen-Specific IgE of MAST-CLA in Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Even though the cause of atopic dermatitis is still unknown, it is considered an allergic reaction whose onset is frequently and strongly associated with both hereditary and environmental factors. The multiple allergosorbent test-chemiluminescent assay(MAST-CLA) is a new assay for serum allergen-specific IgE, and allows up to 35 allergens to be tested simultaneously. Furthermore, the MAST-CLA has shown good sensitivity, specificity, and a correlation with the RAST and skin prick test. OBJECTIVE: The purpose of this study was to find total IgE and allergen-specific IgE and to evaluate the correlations between clinical status and abnormal immunologic findings in MAST-CLA on atopic dermatitis patients. METHODS: Our study was designed by analyzing outpatients with atopic dermatitis via physical examination, questionnaires and the MAST-CLA with a total IgE and 35 allergen-specific IgE in 100 patients. RESULTS: The results were as follows; 1. Among the subjects(mean age=11.6 years, mean age of onset=28.7 months olds), 87% of patients showed elevated serum total IgE levels(more than class level 2) and 72% revealed at least more than one allergen-specific IgE by MAST-CLA. 2. The positive allergens rate, in descending order, were D. farinae 58%, D. pteronyssynus 54%, house dust 43%(aeroallergens), egg white 31%, milk 30%, and crab 22%(food allergens). 3. Good correlation was obtained between total IgE levels and number of positive allergen-specific IgE in MAST-CLA, with 0.497 correlation coefficient(p0.05). CONCLUSION: Our data suggested that MAST-CLA is a sensible and useful method to investigate the causative allergen-specific IgE and to evaluate in patients with atopic dermatitis with additional benefit of a non-isotopic technique and therefore not very expensive

Allergen Patterns using MAST cla Test in Korean pediatric patients / 대한임상병리학회지

BACKGROUND: The MAST CLA test is known to have almost the same sensitivity and specificity as the skin prick test for diagnosing allergic diseases. We report the types of allergens causing allergic diseases in Korean pediatric patients and re-evaluate the positive cut-off level used in Korea. METHODS: The MAST CLA tests were done on patients, ages less than 14-years, who visited the allergy clinic in the pediatric department from May 1999 to September 2000. We separated the patients into 2 age groups, one group of less than 3 years and dependent on milk feeding and another group of older than 3 years. RESULTS: Among 599 patients, 353 patients were male, 246 patients were female. 261 patients had at least one positive allergen-specific IgE antibody in the allergy disease group. The overall positive rate was 63.0% and 61.3% in the male and female groups, respectively among the allergy diseases group. The order of allergic origin frequencies was; milk, egg whites, D. farinae, D. pteronyssinus, and house dust. But patients who were less than 3 years of age and dependent on milk feeding, the order of allergen frequencies changed to milk, egg whites, and soybeans. By changing the positive cut-off from class 2 to class 1, the positive rates for allergen-specific IgE increased from 34.4% to 62.3%. Class 1 positive results showed good clinical correlations. CONCLUSIONS: Allergen origins for patients under 3 years of age and those of older groups were different. By changing the positive cut-off from class 2 to class 1, the detection rate for allergens increased which also showed good clinical correlation with symptoms. Allergen origin should be defined by the MAST CLA test for prompt therapy.

The effect of hydrocortisone and interleukin 4 on allergen-specific IgE production by peripheral blood mononuclear cells from atopic patients / 천식및알레르기

BACKGROUND: Although the basic cellular and molecular requirements for the induction and synthesis of whole human IgE antibody have extensively been investigated, the mechanisms involved in the regulation of allergen-specific IgE synthesis are not yet fully understood. OBJECTIVES: The aims of this study were to elucidate the differences in the total and specific IgE regulation by hydrocortisone(HC) with interleukin 4 (IL-4) between atopics and non-atopics and to determine the relationship between in vitro IgE synthesis and serum IgE levels. METHODS: Peripheral blood mononuclear cells(PBMCs) from sixteen atopic asthma patients sensitive to Dermatophagoides farinae(D.f) and seven non-atopics were cultured with IL-4 and/or HC. Total and D.f-specific IgE in culture supernatant were measured using ELISA and FAST methods respectively. RESULTS: PBMCs from 8 of 16 atopics produced D.f-specific IgE in vitro either spontaneously or by IL-4 and/or HC. HC had more profound effects than IL-4 in these patients. They also showed higher total IgE synthesis by HC, and higher specific serum IgE levels than the others. IL-4 and/or HC did not induce any D.f-specific IgE synthesis by PBMCs from non-atopics. CONCLUSION: These data suggest that atopic patients have allergen-specific B cells that have already been switched to IgE production, probably due to in vivo priming effect of IL-4.

Evaluation of the MAST CLA Assay System for Measuring Total IgE: Comparison with the Pharmacia CAP System / 대한임상병리학회지

BACKGROUND: Multiple allergosorbent test chemiluminescent assay (MAST CLA) is a simple method for measuring total and allergen-specific IgE in human serum. Total IgE level, however, was much frequently high, even if no allergen-specific IgE could be detected in serum. The aim of this study was to evaluate the total IgE class of the MAST CLA system. METHODS: We studied 649 patients in whom MAST CLA (MAST Immunosystems, Inc., Mountain View, CA, USA) was tested and compared the results with those of total IgE, Phadiatop FEIA & RAST FEIA using Pharmacia CAP system (Pharmacia AB, Uppsala, Sweden). RESULTS: MAST CLA specific IgE was positive in 139 (21.4%) among 649 patients. Total IgE was increased over class 2 in 379 (74.3%) among 510 MAST CLA allergen-specific IgE -negative patients. Total IgE assayed by Pharmacia CAP system was increased over 100 kU/L in 33 (54.1%) among 61 MAST CLA allergen-specific IgE -negative patients. Especially, total IgE assayed by Pharmacia CAP system was increased over 100 kU/L in 25 (69.4%) of 36 patients when MAST CLA total IgE class is over 2. Phadiatop FEIA which is a screening test for inhalant allergy was positive in 11 (50.0%) of 22 MAST CLA allergen-specific IgE -negative patients, and especially, positive in 8 (66.7%) of 12 MAST CLA allergen-specific IgE -negative patients who had MAST CLA total IgE class over 2. Nine of 11 patients with positive Phadiatop FEIA were also found to be positive in d1 and/or d2 by RAST FEIA. CONCLUSIONS: It is concluded that another allergen screening tests should be used for detecting allergen-specific IgE, when MAST CLA total IgE is increased over class 2 with no detectable MAST CLA specific IgE because the sensitivity of MAST CLA allergen-specific IgE could be low.

The Relationship between Total Serum IgE, Allergen-Specific IgE, and Skin Prick Test in Children with Atopic Asthma

PURPOSE: Skin prick test and determination of allergen-specific IgE antibodies in serum are methods commonly used to diagnose allergies. Several studies indicate that skin test and specific IgE have roughly the same diagnostic precision, although discrepancies exist. The objective of this study was to evaluate the influence of total serum IgE on the relation between skin prick test and allergen-specific IgE antibody. METHODS: We performed skin prick tests using 14 major inhalant allergens and measured total IgE and specific IgE for two major allergens [Dermatophagoides farinae(D.f.) and Dermatophagoides pteronyssinus (D.p.)] in serum of 230 children with atopic asthma. RESULTS: Positivity of skin prick test was 92.2% for D.f., 89.6% for D.p., and 22.6% for cockroach. Allergen/Histamine(A/H) ratio and allergen-specific IgE score showed a positive correlation for D.f.(r=0.39, P<0.01), and for D.p.(r=0.38, P<0.01). Total serum IgE and allergen-specific antibody score showed a positive correlation for D.f.(r=0.50, P<0.01), and for D.p.(r=0.53, P<0.01). There was no correlation between total serum IgE and A/H ratio on skin prick test for the two allergens. However, total serum IgE had the tendency to increase according to the number of positive allergens on skin prick test. At each level of A/H ratio for D.f. and D.p. on skin prick test, patients with high total IgE had higher antigen-specific IgE scores than patients with low total IgE. CONCLUSION: Our results show that the relationship between skin prick test and antigen-specific IgE was influenced by the level of serum total IgE. This indicates that the level of serum total IgE should be taken into account when skin prick test and allergen-specific IgE are compared.

Changes of specific IgE, Bronchial hyperreactivity and sinusitis after immunotherapy in asthmatic children / 천식및알레르기

BACKGROUND: Though immunotherapy(IT) has become an effective rnethod in extrinsic allergic patients who didn't respond to pharmacologic therapy or couldn't avoid allergen, the mechanism, termination index and prognostic index of IT have not been clarified yet. METHOD: We selected 81 asthmatic children on immunotherapy with house dust mite (Dermatophagoides pteronyssinus and Dermatophagoides farinae). We measured the hematologic findings, the levels of serum IgG and IgE, allergen(house dust, Dermatophagoides pteronyssinus and Dermatophagoides farinae)-specific IgE concentrations, lymphocyte subsets and methacholine challenge test yearly during IT, and checked the radiographs of chest and paranasal sinus. RESULTS: Peripheral white blood cell count, the percentage of eosinophil and total eosinophil count decreased significantly after 2 years of IT. Serum IgG level increased significantly after 3 years of IT. Serum total and specific IgE levels decreased significantly after 3 years of IT, but they were still higher than the normal values. CD4+, CD8+, and B lymphocytes did not change with the IT, but CD3+ lymphocytes increased significantly after 2 years of IT. PC20-methacholine increased significantly after 1 year of IT, but no correlation was found between the duration of IT and bronchial hyperreactivity. Twenty-eight patients(34.6%) had abnormal findings on chest radiographs: 15 patients(53.6%) as bronchitis, 10 patients(35.7%) as bronchopneumonia, 2 patients(7.1%) as hyperinflation and 1 patient(3.6%) as atelectasis. Sixty-three patients(77.8%) had abnormal findings on paranasal sinus radiographs. In the follow-up radiographs of 49 patients, 28 patients(57.1%) showed improvement of paranasal sinusitis after 1 year of IT. CONCLUSION: This study showed some changes of the immunologic findings such as eosinophil count, IgG, IgE, allergen-specific IgE and CD3+ lymphocytes, and improvement of bronchial hyperreactivity and paranasal sinusitis' in asthmatic children during IT. These findings were closely related to clinical improvement.

Analysis of MAST Chemiluminescent Assay (MAST CLA) Results Performed in Asan Medical Center: Suggestion for the improvement of MAST CLA performance / 대한임상병리학회지

BACKGROUND: Multiple allergosorbent test chemiluminescent assay (MAST CLA) is a simple method for in vitro measurement of allergen-specific IgE antibodies. In the present study, the diagnostic performance of MAST CLA was evaluated from the data of Asan Medical Center. METHODS: With the test results of Korea IgE Panel, Korean Food Panel and Korean Inhalant Panel, we evaluated the next following. First, the change of the positive rates of allergen-specific IgE antibodies after the Korea IgE panel was divided into each Food Panel and Inhalant Panel; Second, the diagnostic performance of total IgE determined by MAST CLA in comparison with those determined by RIA; Third, the discrepancy of reactive intensity in Food and Inhalant Panels tested with the same specimens; Fourth, the diagnostic performance of MAST CLA compared with RAST, in detecting the IgE antibodies to three most common allergens. RESULTS: Overall positive rate was 33.9% (548/1,617); 39.3% for Korea IgE Panel, 22.9% for Food Panel, 34.6% for Inhalant Panel. Positive rate was increased only 0.5% for Food Panel and only 0.3% for Inhalant Panel by the new allergens added. The sensitivity, specificity, and concordance rate of total IgE levels determined by MAST CLA in comparison with those determined by RIA was 68.4%, 64.9%, 66.8% in Food Panel, and, 87.6%, 44.4%, 68.5% in Inhalant Panel. Five of the eighteen specimens tested by Food and Inhalant Panels simultaneously showed discrepant reactivity with the extent of class 1. The sensitivity, specificity, and concordance rate of MAST CLA compared with RAST were 36.1%, 100.0%, 67.1% for D. farinae, 30.8%, 96.8%, 60.6% for D. pteronyssinus, and 21.4%, 96.2%, 70.0% for housedust. CONCLUSIONS: The allergens newly added to Food and Inhalant Panels were not contributable to the detection of allergen-specific IgE. The specificity of total IgE was so low that positive total IgE result without specific IgE should be interpreted as false positive. The sensitivity to common allergens was also too low. So, MAST CLA needs further improvement to be used as a primary screening test for allergy.