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.

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.

Analysis of MAST-CLA Results as a Diagnostic Tool in Allergic Skin Diseases

BACKGROUND: Urticaria and atopic dermatitis are representative allergic skin diseases that can be mediated by IgE. Measuring levels of specific IgE can be used to confirm causative agents of these skin diseases. OBJECTIVE: To analyze results from the multiple allergosorbent test chemiluminescent assay (MAST-CLA), which measures specific IgE in the presence of a causative agent/allergen, in IgE-mediated skin diseases. METHODS: A total of 404 patients with urticaria, atopic dermatitis or pruritus were enrolled in the present study. Positive rates of specific IgE as well as total serum IgE from the MAST-CLA were compared. RESULTS: Positive rates of specific IgE were highest in atopic dermatitis patients, followed by urticaria, and then pruritus, with 57.0%, 37.1%, and 20.8%, respectively (p<0.05). House dust mite species were the most common allergens in both atopic dermatitis and urticaria skin diseases. There were no differences in the overall MAST-CLA results between acute and chronic urticaria. The relative positive rate of inhalant allergen was significantly higher in adult than in child atopic dermatitis patients. CONCLUSION: Results from the MAST-CLA showed diversity among the three disease groups, and within each disease group, with different positive rates of specific IgE, a different mean allergen number per patient, and so on. Therefore, we concluded that MAST-CLA could be a useful diagnostic tool for various allergic skin diseases.

Correlation between Results of the Multiple Allergosorbent Test-Chemiluminescent Assay (MAST-CLA) and Clinical Severity of Chronic Urticaria / 대한피부과학회지

BACKGROUND: Numerous in vivo and in vitro diagnostic techniques are used in diagnosis of allergy. The multiple allergosorbent test-chemiluminescent assay (MAST-CLA) can check serum allergen-specific IgE, and allows up to 35 allergens to be tested simultaneously. The study about the relationship between the result of MAST-CLA and the clinical severity of chronic urticaria is not plentiful in the worldwide literature. OBJECTIVE: The purpose of this study was to determine whether there was a robus correlation between abnormal immunologic findings on the MAST-CLA and clinical severity of disease in chronic urticaria patients. METHODS: The MAST-CLA (MAST Immunosystem, Inc., California, USA) was performed on serum samples from in-patients and out-patients with chronic urticaria between August 2005 and July 2006. Urticaria severity scores of patients and the result of MAST-CLA were analyzed. RESULTS: Almost all patients (98.7%) had a positive total IgE level (more than class level 2) and 56.1% had at least more than one allergen-specific IgE. The main positive allergens were D. farinae (40.1%), D. pteronyssynus (36.7%), Housedust (33.8%), Shrimp (30.7%), Egg white (22.4%), and Cow's milk (20.6%). A positive correlation was found between total IgE levels and the number of positive allergen-specific IgEs in the MAST-CLA. The correlation coefficient was 0.205 (p<0.05). The correlation of the total IgE levels and the number of allergen-specific IgEs with the clinical severity of urticaria (Urticaria severity scores) was not statistically significant. CONCLUSION: Total IgE levels and the number of allergen-specific IgEs could be a good predictor for each other, but both of them chould not be used to predict the clinical severity of chronic urticaria.

Validity of MAST-CLA for diagnosis of arthropod allergy using receiver operating characteristic (ROC) analysis

Many allergists are currently focusing on the development of new diagnostic tools, and are attempting to improve both the sensitivity and specificity. A multiple allergen simultaneous test-chemiluminescent assay (MAST-CLA) is one of the most popular diagnostic tools used in the Republic of Korea. However, there remains controversy among allergists with regard to the cut-off point for a positive result. The present study was conducted in order to determine the validity of MAST-CLA as compared with that of the skin prick test, with particular emphasis on arthropod allergens, on the basis of percentage agreement rates and k-values, and also to suggest the optimal positive cutoff points using receiver operating characteristic (ROC) curves. The study was conducted with 97 subjects (54 men, 43 women). Optimal individual cut-off points were calculated as follows; class II for Dermatophagoides farinae, class I for Dermatophagoides pteronyssinus, and trace for a cockroach mix. These findings suggest that attempting to apply optimal individual cut-off points will be a good way of improving diagnostic tests, particularly MAST-CLA.

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.

A Study on the Relationship of Allergy-related Labaratory Findings with the Clinical Severity of Atopic Dermatitis / 대한피부과학회지

BACKGROUND: The serum levels of serum total IgE, peripheral eosinophils and eosinophil cationic protein (ECP) are known to be elevated in patients with atopic dermatitis. However, the relationship between these laboratory findings and the clinical severity of atolpic dermatitis is controversial. OBJECTIVE: The purpose of this study was to evaluate serum total IgE, peripheral eosinophil counts, ECP as severity indices or disease markers of atopic dermatitis in Korea. METHODS: One hundred and thirty patients were evaluated for the symptoms and signs of atopic dermatitis, and classified into a mild, moderate or severe group according to the clinical severity. We measured for total serum IgE, peripheral eosinophil counts, ECP and assessed allergen-specific IgE using multiple allergosorbent test-chemiluminescent assay (MAST-CLA) and CAP-fluoroenzyme immunoassay (CAP-FEIA). RESULTS: Serum total IgE and peripheral eosinophil counts of patients with atopic dermatitis showed a statistically significant correlation with the clinical severity (p<0.05). Patients from the severe atopic dermatitis group revealed significantly higher ECP level than those in the mild or moderate group (p<0.05). The most common inhalant allergen was D. farinae, followed by D. pteronyssinus, housedust, and the most common food allergen was wheat, followed by soyabean and egg white. CONCLUSION: Total serum IgE, peripheral eosinophils and eosinophil cationic protein (ECP) were good indices reflecting the severity of atopic dermatitis.

Analysis of Simultaneous Positivity to Multiple Allergens on MAST CLA Test / 대한진단검사의학회지

BACKGROUND: Allergic patients showing a simultaneously positive reaction to multiple allergens are frequently found. The purpose of this study was to analyze the pattern of simultaneously positive results to the allergens of MAST CLA Korean inhalant and food panels. METHODS: From March 2004 to March 2005, we analyzed the results of the MAST CLA allergy test performed at Bundang Jesaeng General Hospital. During this period, 1, 421 inhalant panels and 331 food panels were tested. RESULTS: Mite-farinae (40.3%) and mite-pterony (34.8%) specific IgE were the most frequently detected in the inhalant panel and also in the food panel. Simultaneously positive rates to two or more allergens were 41.9% (595/1421) in the inhalant panel and 32.3% (107/331) in the food panel. Allergens with a highly positive rate (Mite-f, Mite-p, house dust) were frequently detected simultaneously with other allergens, and allergens known to have cross-reactivity showed simultaneously positive results among themselves (i.e. among various pollen allergens; among allergens associated with the pollen-food syndrome; among grain allergens; among milk and cheese; among fungi allergens; among house dust mites and house dust; among cockroach, crab and shrimp; and among cat and dog). CONCLUSIONS: Simultaneous positivity on the MAST CLA allergy test can be found frequently among various allergens, especially allergens with cross-reactivity. More advanced techniques using recombinant allergens may be needed for further analysis of this finding.

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.

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 Usefulness of Serum Total IgE Test by Multiple Allergosorbent Test-Chemiluminescent Assay(MAST-CLA): Comparison with Paper Radioimmunosorbent Test(PRIST)

PURPOSE: Multiple allergosorbent test-chemiluminescent assay(MAST-CLA) is a semiquantitative method for detecting total IgE and specific IgE in serum. The purposes of this study are to investigate the correlation between MAST-CLA and Paper radioimmunosorbent test(PRIST), and to find out whether MAST-CLA can replace PRIST in measuring of serum total IgE. METHODS: Data of 162 subjects were analyzed by linear regression analysis for MAST-CLA (MAST class) and PRIST(PRIST IgE, PRIST class, PRIST log10 IgE). Diagnostic sensitivity, specificity, efficiency, positive and negative predictive values were calculated by standard methods. RESULTS: The sensitivity of MAST-CLA was 64.0%, specificity was 56.0%, efficiency was 56.0%, positive predictive value was 87.2% and negative predictive value was 21.8%. The overall correlation coefficiency(r) of total IgE between MAST class vs PRIST IgE was 0.176(P<0.05), MAST class vs PRIST class was 0.308(P<0.001), MAST class vs PRIST log10 IgE was 0.301(P<0.001). According to age classification, good correlation was obtained in the 3-6 yr age group(MAST class vs PRIST IgE : r=0.283, P<0.01, MAST class vs PRIST log10 IgE : r=0.377, P<0.001), but there were no significant correlation in the 7-10 yr age group and in the 11-15 yr age group. CONCLUSION: A different correlation was observed between the two tests according to age, so we suggest that simultaneous use of PRIST should be performed considering the age when MAST-CLA is used as an atopy screening.

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.