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Abstract
Background:
The in vivo skin prick test (SPT) or in vitro detection of allergen specific IgE in serum is commonly used for the diagnosis of allergic disease. In this study, we evaluated the usefulness of a new multiple allergen simultaneous test (MAST) immunoblot assay, Polycheck Allergy (Biocheck GmbH, Germany).
Methods:
A total of 100 patients with clinical findings of allergic diseases were tested by SPT and three different MAST assays: Polycheck Allergy (Biocheck GmbH, Germany), MAST CLA allergy system (Hitachi Chemical Diagnostics, USA) and Allergy Screen (R-biopharm, Germany). The results of MAST assays were compared with those of SPT.
Results:
Concordance rates of MAST assays with SPT were 79-100% for Polycheck Allergy, 88.9-100% for MAST CLA and 72.7-98.3% for Allergy Screen. In ROC curve analysis, significant differences were observed in four of 25 allergens analysed: Alternaria, Birch, Hazelnut and D. farinae. For Alternaria and Birch, Polycheck Allergy (P<0.001) and Allergy Screen (P=0.0075) showed significantly larger AUC (area under the curve) than MAST CLA. For Hazelnut, Polycheck Allergy (P=0.0021), and for D. farinae, MAST CLA (P=0.015) showed significantly larger AUCs than the other two tests. The ROC analysis for overall 16 food allergens showed better results in Polycheck Allergy (P<0.001), and that for overall 21 inhalants did not show significant differences among three MAST assays (P>0.05).
REFERENCES
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Table 1.
The results of skin prick test according to the diagnosis in patients of this study (n=100)
Table 2.
Allergens included in three multiple allergen simultaneous tests
| Allergen | Polycheck Allergy | MAST CLA | Allergy Screen |
|---|---|---|---|
| Inhalants contained in common | D. pteronyssinus∗, D. farinae∗, Cockroach∗, Dog∗, Cat∗, Alternaria∗, Birch pollen∗, Ragweed pollen∗, Mugwort pollen∗, Cultivated rye pollen∗, Timothy∗, R. Thistle∗, Ash pollen∗, Acacia∗, Hazel pollen∗, Oak, White∗, Bermuda∗, Cocksfoot∗, Aspergillus∗, Cladosporium∗, Penicillium∗, Yeast, bakers, Sycamore Mix, Dandelion, Cedar, Japanese Goldenrod | ||
| Inhalants contained in each reagent | Redtop pollen | Willow, black | Sallow, Willow |
| Latex | Pigweed | pigweed Mix | |
| Fescue meadow pollen | Housedust | Housedust | |
| Ox-eye-daisy | Cottonwood East | Pine | |
| Alder pollen | Ox-eye-daisy | ||
| Sheep epithelia | Sweet vernal grass | ||
| Lilac pollen | Reed | ||
| Tyrophagus putrescentiae | Poplar Mix | ||
| Candida albicans | |||
| Acarus siro | |||
| Food allergens contained in common | Milk (Cow)∗, Egg-whole∗, Crab∗, Shrimp∗, Peach∗, Mixed nut∗, Cheese∗, Cod∗, Pork∗, Wheat grain∗, Soybean∗, Tuna∗, Salmon∗, Chicken∗, Rice∗, Barley grain∗, Beef, Buckwheat meal, Garlic | ||
| Food allergens contained in each reagent | Onion | Orange | Onion |
| Citrus Mix | Citrus Mix | ||
| Tomato | Tomato | ||
| Potato | |||
| Cacao (Chocolate) | |||
| Mackerel | |||
Table 3.
Positive rate of each allergen specific IgE detected by multiple allergen simultaneous tests and skin prick test
Table 4.
Agreement of each multiple allergen simultaneous test with skin prick test
Table 5.
Sensitivity and specificity of each multiple allergen simultaneous test compared with skin prick test
| Allergen | Polycheck Allergy | MAST CLA | Allergy Screen | |||
|---|---|---|---|---|---|---|
| Sensitivity | Specificity | Sensitivity | Specificity | Sensitivity | Specificity | |
| Milk (n=99) | 0.0 (0/1)∗ | 93.9 (92/98) | 0.0 (0/1) | 92.9 (91/98) | 0.0 (0/1) | 73.5 (72/98) |
| Egg White (n=99) | - (0/0) | 96.0 (95/99) | - (0/0) | 88.9 (88/99) | - (0/0) | 96.0 (95/99) |
| Crab (n=59) | 100.0 (2/2) | 100.0 (57/57) | 100.0 (2/2) | 93.0 (53/57) | 100.0 (2/2) | 96.5 (55/57) |
| Shrimp (n=59) | 33.3 (1/3) | 98.2 (55/56) | 33.3 (1/3) | 92.9 (52/56) | 33.3 (1/3) | 98.2 (55/56) |
| Peach (n=59) | - (0/0) | 94.9 (56/59) | - (0/0) | 94.9 (56/59) | - (0/0) | 98.3 (58/59) |
| D. pterony (n=100) | 95.3 (81/85) | 93.3 (14/15) | 91.8 (78/85) | 100.0 (15/15) | 96.5 (82/85) | 100.0 (15/15) |
| D. farinae (n=100) | 97.6 (82/84) | 75.0 (13/16) | 100.0 (84/84) | 81.3 (13/16) | 94.0 (79/84) | 93.8 (15/16) |
| Cockroach mix (n=100) | 0.0 (0/2) | 88.8 (87/98) | 0.0 (0/2) | 92.9 (91/98) | 50.0 (1/2) | 92.9 (91/98) |
| Dog (n=100) | 62.5 (5/8) | 80.4 (74/92) | 87.5 (7/8) | 93.5 (86/92) | 87.5 (7/8) | 77.2 (71/92) |
| Cat (n=100) | 100.0 (12/12) | 81.8 (72/88) | 83.3 (10/12) | 100.0 (88/88) | 75.0 (9/12) | 94.3 (83/88) |
| Alternaria (n=99) | 83.3 (5/6) | 93.5 (87/93) | 0.0 (0/6) | 98.9 (92/93) | 100.0 (6/6) | 79.6 (74/93) |
| Birch (n=99) | 90.0 (9/10) | 89.9 (80/89) | 40.0 (4/10) | 100.0 (89/89) | 90.0 (9/10) | 84.3 (75/89) |
| Ragweed (n=95) | 0.0 (0/1) | 96.8 (91/94) | 0.0 (0/1) | 97.9 (92/94) | 0.0 (0/1) | 87.2 (82/94) |
| Mugwort (n=99) | 50.0 (3/6) | 100.0 (93/93) | 66.7 (4/6) | 92.5 (86/93) | 50.0 (3/6) | 98.9 (92/93) |
| Cultivated Rye (n=95) | - (0/0) | 96.8 (92/95) | - (0/0) | 97.9 (93/95) | - (0/0) | 94.7 (90/95) |
| Timothy grass (n=88) | - (0/0) | 96.6 (85/88) | - (0/0) | 97.7 (86/88) | - (0/0) | 84.1 (74/88) |
| R. Thistle (n=40) | - (0/0) | 82.5 (33/40) | - (0/0) | 95.0 (38/40) | - (0/0) | 80.0 (32/40) |
| Ash mix (n=92) | 0.0 (0/1) | 100.0 (91/91) | 0.0 (0/1) | 97.8 (89/91) | 0.0 (0/1) | 95.6 (87/91) |
| Acacia (n=40) | - (0/0) | 100.0 (40/40) | 42.9 (3/7) | 97.5 (39/40) | - (0/0) | 90.0 (36/40) |
| Hazelnut (n=92) | 100.0 (7/7) | 89.4 (76/85) | 22.2 (2/9) | 100.0 (85/85) | 42.9 (3/7) | 95.2 (80/84) |
| Oak, White (n=93) | 22.2 (2/9) | 100.0 (84/84) | - (0/0) | 98.8 (83/84) | 66.7 (6/9) | 91.6 (76/83) |
| Cocksfoot (n=88) | - (0/0) | 98.9 (87/88) | - (0/0) | 97.7 (86/88) | - (0/0) | 93.2 (82/88) |
| Aspergillus (n=95) | - (0/0) | 94.7 (90/95) | - (0/0) | 98.9 (94/95) | - (0/0) | 95.8 (91/95) |
| Cladosporium (n=95) | - (0/0) | 97.9 (93/95) | - (0/0) | 100.0 (95/95) | - (0/0) | 80.0 (76/95) |
| Penicillium (n=66) | - (0/0) | 97.0 (64/66) | - (0/0) | 100.0 (66/66) | - (0/0) | 78.8 (52/66) |
| Mean | 55.6 | 93.5 | 44.5 | 96.0 | 59.1 | 90.0 |
Table 6.
The receiver operating characteristics (ROC) curve analysis of three multiple allergen simultaneous tests
| Allergen | AUC (95% CI) | P value | ||
|---|---|---|---|---|
| Polycheck Allergy | MAST CLA | Allergy Screen | ||
| Milk (n=99) | - | - | - | - |
| Egg White (n=99) | - | - | - | - |
| Crab (n=59) | 1.00 (1.00-1.00) | 0.99 (0.97-1.00) | 1.00 (0.98-1.00) | 0.47 |
| Shrimp (n=59) | 0.66 (0.33-0.99) | 0.64 (0.29-0.99) | 0.66 (0.33-0.99) | 0.083 |
| Peach (n=59) | - | - | - | - |
| D. pterony (n=100) | 0.97 (0.95-1.00) | 0.96 (0.93-0.99) | 0.98 (0.96-1.00) | 0.092 |
| D. farinae (n=100) | 0.98 (0.96-1.00) | 1.00 (1.00-1.00) | 0.96 (0.93-0.99) | 0.015 |
| Cockroach mix (n=100) | 0.44 (0.41-0.48) | 0.46 (0.44-0.49) | 0.70 (0.24-1.00) | 0.31 |
| Dog (n=100) | 0.73 (0.54-0.92) | 0.91 (0.78-1.00) | 0.84 (0.69-0.98) | 0.11 |
| Cat (n=100) | 0.96 (0.93-1.00) | 0.92 (0.81-1.00) | 0.86 (0.73-0.99) | 0.20 |
| Alternaria (n=99) | 0.88 (0.71-1.00) | 0.49 (0.48-0.51) | 0.98 (0.96-1.00) | <0.001∗ |
| Birch (n=99) | 0.93 (0.83-1.00) | 0.70 (0.54-0.86) | 0.93 (0.82-1.00) | 0.0075 |
| Ragweed (n=95) | - | - | - | - |
| Mugwort (n=99) | 0.75 (0.53-0.97) | 0.81 (0.59-1.00) | 0.75 (0.53-0.97) | 0.51 |
| Cultivated Rye (n=95) | - | - | - | - |
| Timothy grass (n=88) | - | - | - | - |
| R. Thistle (n=40) | - | - | - | - |
| Ash mix (n=92) | - | - | - | - |
| Acacia (n=40) | - | - | - | - |
| Hazelnut (n=92) | 0.98 (0.95-1.00) | 0.71 (0.52-0.91) | 0.69 (0.49-0.89) | 0.0021∗ |
| Oak, White (n=93) | 0.61 (0.47-0.76) | 0.61 (0.46-0.75) | 0.79 (0.62-0.95) | 0.061 |
| Orch (Cockft) (n=88) | - | - | - | - |
| Aspergillus (n=95) | - | - | - | - |
| Cladosporium (n=95) | 0.99 (0.97-1.00) | - | - | - |
| Penicillium (n=66) | 0.64 (0.29-0.99) | - | - | - |
| Inhalants, total | 0.94 (0.91-0.96) | 0.91 (0.89-0.94) | 0.92 (0.90-0.94) | 0.094 |
| Food allergens, total | 0.74 (0.51-0.97) | 0.72 (0.48-0.96) | 0.71 (0.48-0.94) | <0.001 |
∗ Significant difference among Polycheck Allergy, Allergy Screen and MAST CLA based on Benjamini and Hochberg method.
Alternaria: Polycheck Allergy vs MAST CLA, P<0.001; MAST CLA vs Allergy Screen, P<0.001; Polycheck Allergy vs Allergy Screen, P=0.18.
Hazelnut: Polycheck Allergy vs MAST CLA, P=0.0065; MAST CLA vs Allergy Screen, P=0.81; Polycheck Allergy vs Allergy Screen, P=0.0024.
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