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Occup Environ Med. 2019 Apr;76(4):269-278. doi: 10.1136/oemed-2018-105434. Epub 2019 Feb 25.

Performance of specific immunoglobulin E tests for diagnosing occupational asthma: a systematic review and meta-analysis.

Author information

1
Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Occupational Medicine, Berlin, Germany.
2
Occupational, Social and Environmental Medicine, University Hospital Jena - Friedrich Schiller University Jena, Jena, Germany.
3
Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Biometrics and Clinical Epidemiology, Berlin, Germany.
4
University Medical Center Hamburg-Eppendorf, Institute for Occupational and Maritime Medicine, Translational Toxicology and Immunology Unit, Hamburg, Germany.
5
European Society for Environmental and Occupational Medicine (EOM), Berlin, Germany.

Abstract

OBJECTIVES:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

KEYWORDS:

allergy; in-vitro; occupational asthma; occupational health practice; sensitizers

PMID:
30804164
DOI:
10.1136/oemed-2018-105434

Conflict of interest statement

Competing interests: The authors declare that they have no conflict of interest. HL conducted this study as part of the requirements for the German medical doctor degree at Charité—Universitätsmedizin Berlin, Berlin, Germany.

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