Journal List > Allergy Asthma Respir Dis > v.3(1) > 1059150

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

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.

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.

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Table 1

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

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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)

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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

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Allergen Mean wheal≥3 mm A/H≥1
Agreement (%) Kappa P-value Agreement (%) Kappa P-value
Positive Negative Total Positive Negative Total
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

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

Table 4

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

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Allergen Mean wheal≥3 mm A/H≥1
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

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

Table 5

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

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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

A/H, allergen/histamine; A. fuminatus, Aspergillus fuminatus; D. pteronyssinus, Dermatophagoides pteronyssinus; D. farinae, Dermatophagoides farinae; T. putrescentiae, Tyrophagus putrescentiae; NA, not available.

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

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