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Allergy. 2019 Apr 6. doi: 10.1111/all.13809. [Epub ahead of print]

Immunological methods for diagnosis and monitoring of IgE-mediated allergy caused by industrial sensitizing agents (IMExAllergy).

Author information

European Society for Environmental and Occupational Medicine, Berlin, Berlin, Germany.
Swiss Institute of Allergy and Asthma Research, UZH, Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland.
University Medical Center Hamburg-Eppendorf, Institute for Occupational and Maritime Medicine, Translational Toxicology and Immunology Unit, Hamburg, Germany.
Vall d'Hebron Hospital, Pneumology Department, Barcelona, Spain.
Charité-Universitätsmedizin Berlin, Clinical Research Unit of AllergyBerlin, Germany.
Charité-Universitätsmedizin Berlin, ENT Clinic, Campus VirchowBerlin, Germany.
Friedrich-Alexander-University Erlangen-Nurnberg, Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Erlangen, Germany.
EGE University, Faculty of Medicine, Department of Pulmonary Medicine, Division of Asthma and Allergy, Izmir, Turkey.
Friedrich Schiller University Jena, Institute for Occupational, Environmental and Social Medicine, Jena, Germany.
Imperial College London, National Heart and Lung Institute, London, UK.
Charité-Universitätsmedizin Berlin, Charité Comprehensive Allergy Center, Institute of Occupational MedicineBerlin, Germany.
University of Padova, Department of Cardiologic, Thoracic and Vascular Sciences, Padova, Italy.
KU Leuven, Centre for Environment and Health, Department of Public Health and Primary Care, Leuven, Belgium.
National Research Center for the Working Environment, Copenhagen, Denmark.
Aarhus University, Dept. of Public Health, Environment, Occupation& Health, & Danish Ramazzini Centre, Aarhus, Denmark.
The Christine Kühne Center for Allergy Research and Education (CK-CARE), Augsburg, Germany.
Technical University Munich, UNIKA, Munich, Germany.
National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Health Effects Laboratory, Division Morgantown, WV, USA.


Industrial sensitizing agents (allergens) in living and working environments play an important role in eliciting type I allergic disorders including asthma and allergic rhinitis. Successful management of allergic diseases necessitates identifying their specific causes (i.e. identify the causative agent(s) and the route of contact to allergen: airborne, or skin contact) to avoid further exposure. Identification of sensitization by a sensitive and validated measurement of specific-IgE is an important step in the diagnosis. However, only a limited number of environmental and occupational allergens are available on the market for use in sIgE testing. Accordingly, specific in-house testing by individual diagnostic and laboratory centers is often required. Currently, different immunological tests are in use at various diagnostic centers that often produce considerably divergent results, mostly due to lack of standardized allergen preparation and standardized procedures as well as inadequate quality control. Our review and meta-analysis exhibited satisfactory performance of s IgE detection test for most high molecular weight (HMW) allergens with a pooled sensitivity of 0.74 and specificity of 0.71. However, for low molecular weight (LMW) allergens, pooled sensitivity is generally lower (0.28) and specificity higher (0.89) than for HMW tests. Major recommendations based on the presented data include diagnostic use of sIgE to HMW allergens. A negative sIgE results for LMW agents does not exclude sensitization. In addition, the requirements for full transparency of the content of allergen preparations with details on standardization and quality control is underlined. Development of standard operating procedures for in-house sIgE assays, and clinical validation, centralized quality control and audits are emphasized. There is also a need for specialized laboratories to provide a custom service for the development of tests for the measurement of putative novel occupational allergens that are not commercially available. This article is protected by copyright. All rights reserved.


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