Occupational Asthma Reference

Lux H, Lenz K, Budnik LT, Baur X, Performance of specific immunoglobulin E tests for diagnosing occupational asthma: a systematic review and meta-analysis., Occup Environ Med, 2019;76:269-278,DOI: 10.1136/oemed-2018-105434

Keywords: IgE, OA, meta-analysis

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Xaver Baur, Institute of occupational medicine, Hamburg Xaver Baur

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To determine the test performance parameters for the retrievable range of high-molecular-weight (HMW) and low-molecular-weight (LMW) occupational allergens and to evaluate the impact of allergenic components and the implementation of measures for test validation.

A protocol with predefined objectives and inclusion criteria was the basis of an electronic literature search of MEDLINE and EMBASE (time period 1967-2016). The specific inhalation challenge and serial peak flow measurements were the reference standards for the specific IgE (sIgE) test parameters. All of the review procedures were reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Seventy-one studies were selected, and 62 entered meta-analysis. Pooled pairs analysis indicated a sensitivity of 0.74(95% CI 0.66 to 0.80) and specificity of 0.71(95% CI 0.63 to 0.77) for HMW allergens and a sensitivity of 0.28(95% CI 0.18 to 0.40) and specificity of 0.89(95% CI 0.77 to 0.95) for LMW allergens. Component-specific analysis improved the test parameters for some allergens. Test validation was handled heterogeneously among studies.

sIgE test performance is rather satisfactory for a wide range of HMW allergens with the potential for component-specific approaches, whereas sensitivity for LMW allergens is considerably lower, indicating methodological complications and/or divergent pathomechanisms. A common standard for test validation is needed.

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This meta-analysis seems to omit rodent allergens, which do not get a mention despite many studies, perhaps there are few with specific challenges, but this is not mentioned in the text. There is no discussion of genetically modified allergens, particularly enzymes, or the effects of isocyanate pre-polymers, which reduce the sensitivity of tests with native allergens. Despite these problems the sensitivity of all tests is <100% (commonly around 80% for high molecular weight allergens). The problems with specificity are not mentioned, if the specificity is measured against a negative specific challenge, as stated in the methods, there will be very little data for analysis.

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