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Diagnosis of reaginic allergy with house dust, animal dander and pollen allergens in adult patients. IV. An evaluation of the clinical value of skin test, radioallergosorbent test, case history and combinations of these methods.

With the assumption that a provocation test gives the correct diagnosis, the possibility of predicting an allergy by means of the case history, a skin test, radioallergosorbent test (RAST) and combinations of these methods was evaluated for house dust, cow-, cat-, dog-, and horse-dander, timothy-, marguerite-, dandelion- and birch-pollen allergens. All procedures were found to give a reliable diagnosis provided that a group with doubtfoul group, requiring further diagnostic investigations, was smallest when all three methods were used in combination. It is suggested that, in addition to the case history, the first procedure in routine diagnosis with inhalant allergens should be a skin test. RAST should be used primarily for selected cases and as a complement to the case history and skin test, making provocation tests superfluous for the majority of patients.

Allergens

Mite allergen content in commercial extracts and in bed dust determined by radioallergosorbent tests.

Radioallergosorbent (RAST) direct binding and inhibition type assays were used to quantitate the mite (Dermatophagoides pteronyssinus) allergen content of four commercial mite extracts and a laboratory prepared extract from freeze-dried mites. The content of mite allergen in extracts prepared from twenty samples of dust vacuumed from bedding was measured by RAST inhibition assay. The four commercial mite extracts designated A, B, C and D, and the laboratory extract, designated L, contained 52, 265, 108, 1.5 and 581 arbitrary units of allergen/ml for the direct binding assay and 128, 111, 217, approximately 1 and 1083 arbitrary, but different, units of allergen/ml for the inhibition assay respectively. Qualitative differences between at least two extracts were suggested by the different slopes obtained when allergen binding of anti IgE was plotted against the volume of extract used in the direct binding assay. Differences in slope between the two extracts were also apparent when they were used in the inhibition assay. The quantities of mite allergen/gm of bed dust expressed in arbitrary units for the inhibition assay were 24 to 457 (mean 129) units. These quantities are similar to and sometimes greater than the quantity in 1 ml of mite extract and so confirm bed dust as a potent source of mite allergen. There was no significant correlation between the weight of dust, the numbers of dead and live mites and the allergen content of dust.

Allergens

Diagnosis of reaginic allergy with house dust, animal dander and pollen allergens in adult patients. III. Case histories and combinations of case histories, skin tests and the radioallergosorbent test, RAST, compared with provocation tests.

Case histories alone and combined with the results of skin tests and/or the radioallergosorbent test (RAST) were compared with the results of provocation tests in 397 patients with asthma or allergic rhinitis. Case histories often turned out to be doubtful. The agreement between negative histories and negative provocation tests was 77% and that between positive histories and positive provocation tests 64%. When case histories were supported by concordant skin test or RAST results, the agreement with provocation tests increased to about 90%. When a scoring system for the combinations of different diagnostic methods was employed, a 100% agreement with provocation tests was obtained for cases with high scores. It is concluded that by using the case history in conjunction with RAST and/or skin test results, a reliable diagnosis can be achieved, eliminating the necessity of provocation tests.

Allergens

Allergy to insect stings. IV. Diagnosis by radioallergosorbent test (R.A.S.T.).

Radioallergosorbent tests (RAST(s)) have been developed and assessed for the diagnosis of insect hypersensitivity by using a purified allergen from honeybee venom, phospholipase A, and crude yellow jacket venom. Sera from 193 patients positive both by history and skin test to one of these insects were compared with various groups of control sera. Eighty percent of sera from skin test-positive patients were RAST positive; positive RAST were found in 16% of sera tested from skin test-negative patients. A highly positive RAST correlates well with a positive skin test and clinical sensitivity, but serum IgE is not measurable in many patients with mast cell or basophil bound antibody. Since biologically important reactions of antigen with IgE require that the antibody be cell bound, skin testing would be preferred to RAST if one were limited to a single test for the diagnosis of insect allergy.

Animals

Diagnosis of food allergy by the radioallergosorbent test.

The radioallergosorbent test (RAST) was positive in 52.5% of 200 sera representing 200 food hypersensitivities from 108 patients with a history of definite immediate-type reactions to foods. Corresponding prick test was performed for 170 of the sera. The latter test was positive in 70%, the RAST was positive in 52%, and iether prick test or RAST was positive in 74%. It is concluded that the RAST is positive less frequently than the prick test in the diagnosis of immediate-type food allergy in clinically sensitive patients, but that the performance of both tests increases slightly the possibility of confirming the diagnosis. However, the RAST is useful for further evaluating positive prick tests with foods that do not correlate with clinical hypersensitivity.

Eggs

The diagnosis of hypersensitivity to ingested foods. Reliability of skin prick testing and the radioallergosorbent test with different materials.

The diagnostic reliability in food allergy of skin prick tests (SPT) and the radio-allergosorbent test (RAST) was investigated in paediatric patients with respiratory and skin allergies. SPT and RAST were found to be reliable for the diagnosis of allergy to codfish, peas, nuts, peanuts and egg white. Positive SPT and RAST to cereals were common, but were most often without clinical significance or were correlated with respiratory allergy to the inhalation of flour dust. SPT and RAST were only partly reliable with regard to allergy to cow's milk, and were mostly reliable when used together and showing corresponding results. Experimental allergosorbents for RAST with soy beans and white beans were not reliable. The study shows the need to improve the diagnostic materials and to establish the diagnostic reliability of the material and tests used for each food item in question.

Adolescent

Clinical comparison of skin testing and the radioallergosorbent test in dog-sensitive patients using mixed and breed-specific antigens.

A study of clinical history, intradermal test end points and RAST values with six different dog antigens was made in 20 patients and 5 control subjects. Skin testing was found to be more useful clinically than the RAST. Considerable variability among mixed epidermal extracts was noted. There was no apparent advantage to testing with three individual-breed extracts studied, compared to the most potent mixed epidermal antigen. The results of this study suggest that further efforts toward standardization of potency, methods of preparation and, possibly, breed composition of dog allergenic extracts are required to develop improved allergens for clinical use.

Animals

Allergy to pollen from different deciduous trees in Sweden. An investigation with skin tests, provocation tests and the radioallergosorbent test (RAST) in springtime hay fever patients.

92 adult patients with springtime allergy were investigated with skin tests, provocation tests and the RAST. Allergen extracts from 12 different deciduous trees were used. Positive reactions, often of high intensity, were most often found with birch, alder, bog-myrtle, beech and hazel allergens whereas oak, aspen, linden, elm, sallow, maple and poplar allergens more often gave negative or only weak positive test results. Cross sensitizations were found between botanically related as well as between less related species of the trees. Almost all patients with a clinically relevant tree pollen allergy had positive provocation tests with birch pollen. No patient had positive reactions to all the 12 allergens included in the study. 68% had positive provocation tests with the combination birch, alder and hazel. It is concluded that for diagnostic screening purposes it is sufficient to use birch pollen allergen. If the majority of relevant tree pollens are to be included in a diagnostic or therapeutic programme in Western Sweden it should contain birch, alder, hazel, beech and bog-myrtle allergens.

Adolescent

[Allergic rhinitis--does the radioallergosorbent test improve the diagnosis? (author's transl)].

A comparison between the skin test and radioallergosorbent test RAST) in 127 patients with allergic rhinitis reveals no advantage of RAST. This contrasts with the results obtained in other allergic diseases. However, the determination of a single pollen allergen allows the in vitro diagnosis of allergic rhinitis, which, obviously, is due to cross reactivity of pollen allergens. This makes the RAST a useful procedure in routine diagnosis, especially in the case of patients living far away from an allergy centre. In these cases RAST can easily be used as a screening test.

Allergens

Predictability of the radioallergosorbent test (RAST) in ragweed pollenosis.

The radioallergosorbent test was compared with currently accepted allergy diagnostic techniques in ragweed-sensitive and unselected patients. The radioallergosorbent test was positive in 28 of 30 patients with proved histories, positive scratch tests, and positive nasal provation tests to ragweed. The radioallergosorbent test was also positive in 69 per cent of 40 clinically sensitive patients whose diagnoses were corroborated by scratch tests alone. In unselected patients evaluated by intracutaneous testing with short ragweed extract, 10 minus 3 g per ml, the incidence of positive radioallergosorbent test scores was reduced to 43 per cent. No false positive results were encountered in these studies. A good relationship was observed between radioallergosorbent test scores and the maximal tolerable dose of ragweed administered during a course of "rush" immunotherapy in clinically allergic patients. These results suggest that the radioallergosorbent test has several unique advantages in assessing clinical sensitivity to ragweed.

Allergens

The diagnosis of immediate type allergy to Cladosporium herbarum. Differences between extracts and the efficacy of radioallergosorbent test (RAST) assays.

The radioallergosorbent test (RAST) was used to demonstrate IgE antibodies to Cladosporium herbarum in 35 children. Freeze-dried samples of Cladosporium herbarum were obtained from two commercial products, extracted and used for the preparation of two rast disc series which were compared with the commercially available Phadebas Cladosporium herbarum discs. Marked qualitative differences were found.

Child

Comparison of the radioallergosorbent test to intradermal skin testing in the diagnosis of stinging insect venom allergy.

RAST and skin tests were compared for five venoms in a group of 60 patients with histories of stinging insect allergy. Twelve patients were skin test negative to all venoms and also RAST negative. The 48 skin test positive patients gave an 88% correlation of RAST and skin test with 92% of the skin test positive patients RAST positive and 82% of the RAST positive patients skin test positive. If patients strongly positive to honey bee showing positive RAST to vespids with negative skin test were not counted, then 91% of the RAST positive patients were skin positive. The term "false" should not be used in relating RAST to skin test results without supporting challenge evidence.

Bee Venoms

A comparative study of skin tests and determination of the serum level of specific IgE immunoglobulins by means of the radioallergosorbent test in subjects with atopy.

On 73 patients suspected for atopic diseases, 258 skin tests and radioallergosorbent tests (RAST) for specific IgE in serum were carried out. The results of both tests were compared in connection with the clinical picture. A good qualitative positive correlation was found, especially for grass pollen and house dust. False positive results with RAST cannot be excluded. The RAST seems to be a valuable adjunct to extensive allergologic diagnostic investigation, particularly in cases where difficulties can be expected in the performance or the interpretation of skin tests.

Allergens

A modified technique for the radioallergosorbent test.

A modification of the radioallergosorbent test (RAST) is described utilizing a multiple automated sample harvester. The technique increases the efficiency of the procedure by shortening the time required for its performance. A study is reported in which this method is compared to that recommended by the manufacturer.

Absorption

The radioallergosorbent test in the diagnosis of canine atopic disease.

The radioallergosorbent test (RAST) was adapted for use in the dog employing purified anti-canine IgE. The agreement between positive RAST and positive skin test ranged from 82% for ragweed to only 12.5% for dandelion. Agreement between negative tests in the case of all allergens was 100%. Further developmental studies of canine RAST are warranted in view of the value of the dog as an experimental model of atopic disease.

Animals