Occupational Asthma Reference

Baur X, Akdis CA, Budnik LT, Cruz MJ, Fischer A, Förster-Ruhrmann U, Göen T, Goksel O, Heutelbeck AR, Jones M, Lux H, Maestrelli P, Munoz X, Nemery B, Schlünssen V, Sigsgaard T, Traidl-Hoffmann C, Siegel P., Immunological methods for diagnosis and monitoring of IgE-mediated allergy caused by industrial sensitizing agents, Allergy, 2019;:,DOI: 10.1111/all.13809
(Plain text: Baur X, Akdis CA, Budnik LT, Cruz MJ, Fischer A, Forster-Ruhrmann U, Goen T, Goksel O, Heutelbeck AR, Jones M, Lux H, Maestrelli P, Munoz X, Nemery B, Schlunssen V, Sigsgaard T, Traidl-Hoffmann C, Siegel P., Immunological methods for diagnosis and monitoring of IgE-mediated allergy caused by industrial sensitizing agents, Allergy)

Keywords: IgE, occupational asthma, review,

Known Authors

Ben Nemery, Leuven, Belgium Ben Nemery

Torben Sigsgaard, University of Aarhus Torben Sigsgaard

Xaver Baur, Institute of occupational medicine, Hamburg Xaver Baur

Piero Maestrelli, Padova University, Italy Piero Maestrelli

Maria Jesus Cruz, Barcelona Maria Jesus Cruz

Meinir Jones, Royal Brompton Hospital, London Meinir Jones

Xavier Munoz, Barcelona Xavier Munoz

Vivi Schlunssen, Aarhus Vivi Schlunssen

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Abstract

Industrial sensitizing agents (allergens) in living and working environments play an important role in eliciting type I allergic disorders including asthma and allergic rhinitis. Successful management of allergic diseases necessitates identifying their specific causes (i.e. identify the causative agent(s) and the route of contact to allergen: airborne, or skin contact) to avoid further exposure. Identification of sensitization by a sensitive and validated measurement of specific-IgE is an important step in the diagnosis. However, only a limited number of environmental and occupational allergens are available on the market for use in sIgE testing. Accordingly, specific in-house testing by individual diagnostic and laboratory centers is often required. Currently, different immunological tests are in use at various diagnostic centers that often produce considerably divergent results, mostly due to lack of standardized allergen preparation and standardized procedures as well as inadequate quality control. Our review and meta-analysis exhibited satisfactory performance of s IgE detection test for most high molecular weight (HMW) allergens with a pooled sensitivity of 0.74 and specificity of 0.71. However, for low molecular weight (LMW) allergens, pooled sensitivity is generally lower (0.28) and specificity higher (0.89) than for HMW tests. Major recommendations based on the presented data include diagnostic use of sIgE to HMW allergens. A negative sIgE results for LMW agents does not exclude sensitization. In addition, the requirements for full transparency of the content of allergen preparations with details on standardization and quality control is underlined. Development of standard operating procedures for in-house sIgE assays, and clinical validation, centralized quality control and audits are emphasized. There is also a need for specialized laboratories to provide a custom service for the development of tests for the measurement of putative novel occupational allergens that are not commercially available.

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What are the sensitivity and the specificity of specific IgE testing in the diagnosis of validated cases of occupational asthma?
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