Comparison of skin prick test and serum specific IgE measured by ImmunoCAP system for various inhalant allergens

Young-Hee Nam; Dong-Sub Jeon; Soo-Keol Lee

doi:10.4168/aard.2015.3.1.47

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Nam, Jeon, and Lee: Comparison of skin prick test and serum specific IgE measured by ImmunoCAP system for various inhalant allergens

Original Article

Allergy, Asthma & Respiratory Disease 2015; 3(1): 47-53.

Published online: 31 January 2015

DOI: https://doi.org/10.4168/aard.2015.3.1.47

Comparison of skin prick test and serum specific IgE measured by ImmunoCAP system for various inhalant allergens

Young-Hee Nam, Dong-Sub Jeon, Soo-Keol Lee

Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.

Correspondence to: Soo-Keol Lee. Department of Internal Medicine, Dong-A University College of Medicine, 32 Daesingongwon-ro, Seo-gu, Busan 602-714, Korea. Tel: +82-51-240-2810, Fax: +82-51-242-5852, skleeai@dau.ac.kr

Received 26 June 2014 Revised 28 August 2014 Accepted 1 September 2014

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Purpose

It appears that much of the discordance between skin prick test (SPT) and ImmunoCAP in clinical practice. We investigated the comparison and correlation between SPT and ImmunoCAP for inhalant allergens.

Methods

A total of 1,400 patients who were tested SPT and ImmunoCAP were recruited from June 2011 to May 2014 in Dong-A University Hospital, and the results of two assays were compared for 17 inhalant allergens. For SPT, mean wheal size≥3 mm or allergen/histamine≥1 at 15 minutes, and the result of ImmunoCAP of ≥0.35 kU/L was considered positive, respectively.

Results

Of the study subjects, bronchial asthma was 29.3%, rhinitis 36.8%, atopic dermatitis 0.6%, and chronic urticaria 4.3%. The agreement rate of between two assays was 77.4%. When ImmunoCAP was compared with SPT as the reference, the sensitivity, specificity was 75.5% and 80.0%, respectively. Significant correlation was observed (r=0.59), and birch, mugwort, Japanese hop, house dust mites, and cockroach showed very strong correlation (r>0.7).

Conclusion

The agreement, sensitivity, and specificity between SPT and ImmunoCAP was various according to allergens. We should determine the clinical relevance of the allergen sensitization using both SPT and ImmunoCAP not alone with combination of clinical symptoms.

Keywords: Allergens, Skin tests, Immunoglobulin E

Figures and Tables

Fig. 1

Distribution of subjects according to the number of allergens with positive results for skin prick test (SPT). A/H, allergen/histamine.

Table 1

Clinical characteristics of study subjects (n=1,400)

Characteristic	Value
Female sex	743 (53.1)
Age (yr)	45.36±17.27
Total IgE (kU/L)	308.68±644.15
Disease
BA	410 (29.3)
AR	515 (36.8)
BA with AR	154 (11.0)
Atopic dermatitis	9 (0.6)
Chronic urticaria	60 (4.3)
Food allergy	28 (2.0)
Others	555 (39.6)

Values are presented as number (%) or mean±standard deviation.

AR, allergic rhinitis; BA, bronchial asthma.

Table 2

Positive rate of skin prick test and ImmunoCAP (n=1,400)

Allergen	Mean wheal≥3 mm	A/H ≥1	Agreement (%)	ImmunoCAP
Tree mix	195 (13.9)	171 (12.2)	91.5
Birch	153 (10.9)	139 (9.9)	93.4	102/214 (47.2)
Alder	151 (10.8)	136 (9.7)	93.6
Beech	133 (9.5)	106 (7.6)	93.7	97/208 (46.6)
Oak	131 (9.4)	97 (6.9)	93.6	27/52 (51.9)
Japanese cedar	48 (3.4)	33 (2.4)	97.5	21/54 (38.9)
Grass mix	57 (4.1)	46 (3.3)	97.1
Rye grass	44 (3.1)	34 (2.4)	97.4	22/68 (32.4)
Timothy grass	59 (4.2)	38 (2.7)	96.7
Orchard grass	51 (3.6)	40 (2.9)	97.3
Bermuda grass	39 (2.8)	28 (2)	97.7	16/41 (39.0)
Ragweed	59 (4.2)	45 (3.2)	97	41/121 (33.9)
Mugwort	116 (8.3)	94 (6.7)	94. 5	57/143 (39.9)
Japanese hop	78 (5.6)	55 (3.9)	96.1	19/47 (40.4)
Alternaria	30 (2.1)	17 (1.2)	98.1	9/21 (42.9)
A. fuminatus	68 (4.9)	31 (2.2)	95.4	17/67 (25.4)
Cladosporium	51 (3.6)	27 (1.9)	96.7
Candida albicans	101 (7.2)	64 (4.6)	93.6
D. pteronyssinus	466 (33.3)	408 (29.1)	79.5	399/1,034 (38.6)
D. farinae	497 (35.5)	427 (30.5)	77.7	460/997 (46.1)
Cat dander	194 (13.9)	148 (10.6)	90.3	39/78 (50.0)
Dog hair	142 (10.1)	77 (5.5)	91.3	33/68 (48.5)
Cockroach	155 (11.1)	79 (5.6)	90.2	5/15 (33.3)
T. putrescentiae	270 (19.3)	170 (12.1)	83	3/9 (33.3)

Values are presented as number (%) unless otherwise indicate.

A/H, allergen/histamine; A. fuminatus, Aspergillus fuminatus; D. pteronyssinus, Dermatophagoides pteronyssinus; D. farinae, Dermatophagoides farinae; T. putrescentiae, Tyrophagus putrescentiae.

Table 3

The agreement between skin prick test and ImmunoCAP

Allergen	Mean wheal≥3 mm					A/H≥1
	Agreement (%)			Kappa	P-value	Agreement (%)			Kappa	P-value
	Positive	Negative	Total	Kappa	P-value	Positive	Negative	Total	Kappa	P-value
Birch	36.9	49.1	86.0	0.717	<0.001	35	51.9	86.9	0.734	<0.001
Beech	31.7	48.1	79.8	0.589	<0.001	27.4	50.5	77.9	0.546	<0.001
Oak	38.5	40.4	78.9	0.578	<0.001	34.6	44.2	78.8	0.581	<0.001
Japanese cedar	20.4	51.9	72.3	0.389	0.003	16.7	53.7	70.4	0.33	0.01
Rye grass	25.0	60.3	85.3	0.664	<0.001	20.6	64.7	85.3	0.638	<0.001
Bermuda grass	22.0	56.1	78.1	0.511	0.001	9.8	53.7	63.5	0.145	0.281
Ragweed	22.3	62.0	84.3	0.63	<0.001	19.0	64.5	83.5	0.592	<0.001
Mugwort	34.3	51.7	86.0	0.712	<0.001	30.1	54.5	84.6	0.673	<0.001
Japanese hop	38.3	44.7	83.0	0.664	<0.001	36.2	53.2	89.4	0.781	<0.001
Alternaria	23.8	42.9	66.7	0.31	0.154	14.3	57.1	71.4	0.364	0.031
A. fumiatus	9.0	61.2	70.2	0.18	0.139	9.0	64.2	73.2	0.231	0.055
D. pteronyssinus	31.1	58.3	89.4	0.773	<0.001	27.9	58.9	86.8	0.711	<0.001
D. farinae	33.5	49.1	82.6	0.647	<0.001	29.4	50.5	79.9	0.586	<0.001
Cat dander	42.3	26.9	69.2	0.385	<0.001	41.0	32.1	73.1	0.462	<0.001
Dog hair	38.2	19.1	57.3	0.157	0.15	36.8	33.8	70.6	0.413	0.001
Cockroach	33.3	33.3	66.6	0.4	0.053	26.7	60.0	86.7	0.7	0.007
T. putrescentiae	33.3	44.4	77.7	0.571	0.058	11.1	44.4	55.5	0	>0.9
Mean	30.2	47.0	77.3			25.0	52.5	77.5

Table 4

The sensitivity and specificity of ImmunoCAP compared with skin prick test as the reference

Allergen	Mean wheal≥3 mm		A/H≥1
Allergen	Sensitivity (%)	Specificity (%)	Sensitivity (%)	Specificity (%)
Birch	90.8	82.7	97.4	81.0
Beech	85.7	76.3	90.5	72.4
Oak	83.3	75.0	-44.2	71.9
Japanese cedar	68.8	73.7	69.2	70.7
Rye grass	77.3	89.1	87.5	84.6
Bermuda grass	81.8	76.7	57.1	64.7
Ragweed	84.4	84.3	92.0	81.2
Mugwort	80.3	90.2	84.3	84.8
Japanese hop	72.0	95.5	85.0	92.6
Alternaria	62.5	69.2	100	66.7
A.fumiatus	40.0	78.8	46.2	79.6
D. pteronyssinus	91.0	88.7	91.7	84.7
D. farinae	87.7	79.5	89.6	75.1
Cat dander	64.7	77.8	69.6	78.1
Dog hair	54.2	65.0	67.6	74.2
Cockroach	50.0	100	80.0	90.0
T. putrescentiae	60.0	100	33.3	66.7
Mean	72.6	82.5	78.3	77.6

Table 5

Correlation between mean wheal size of skin prick test and serum specific IgE levels measured by ImmunoCAP system

Allergen	Correlation (r)	P-value	Correlation (^*r)	P-value
Birch	0.725	<0.001	0.385	<0.01
Beech	0.675	<0.001	0.534	<0.01
Oak	0.634	<0.001	0.552	<0.01
Japanese cedar	0.43	0.001	0.529	<0.01
Rye grass	0.67	<0.001	0.517	<0.01
Bermuda grass	0.571	<0.001	-0.125	0.469
Ragweed	0.598	<0.001	0.417	NA
Mugwort	0.715	<0.001	0.255	0.003
Japanese hop	0.735	<0.001	0.464	0.002
Alternaria	0.414	0.062	0.61	0.009
A. fumiatus	0.231	0.06	0.428	0.001
D. pteronyssinus	0.787	<0.001	0.464	<0.01
D. farinae	0.779	<0.001	0.506	<0.01
Cat dander	0.521	<0.001	0.062	0.6
Dog hair	0.395	0.001	0.387	0.002
Cockroach	0.786	0.001	0.627	0.029
T. putrescentiae	0.44	0.236	0.175	0.744

^*r means partial correlation coefficient adjusted by sex, age, and total IgE levels.

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