Allergen-Specific Immunoglobulin E

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Allergen-Specific Immunoglobulin E

Synonym/acronym: Allergen profile, radioallergosorbent test (RAST), ImmunoCAP® Specific IgE.

Common use

To assist in identifying environmental allergens responsible for causing allergic reactions.

Specimen

Serum (2 mL per group of six allergens, 0.5 mL for each additional individual allergen) collected in a gold-, red-, or red/gray-top tube.

Normal findings

(Method: Radioimmunoassay or fluorescence enzyme immunoassay)
RAST Scoring Method (Radioimmunoassay) and ImmunoCAP® Scoring Guide (Fluorescence Enzyme Immunoassay)Conventional and SI units Allergen Specific IgE
Specific IgE Allergen Antibody LevelkU/L
Absent or undetectable allergyLess than 0.35
Low allergy0.35–0.7
Moderate allergy0.71–3.5
High allergy3.51–17.5
Very high allergy17.5–50
Very high allergy51–100
Very high allergyGreater than 100

Description

Allergen-specific immunoglobulin E (IgE) is generally requested for groups of allergens commonly known to incite an allergic response in the affected individual. The test is based on the use of a radiolabeled or non-radiolabeled anti-IgE reagent to detect IgE in the patient’s serum, produced in response to specific allergens. The panels include allergens such as animal dander, antibiotics, dust, foods, grasses, insects, trees, mites, molds, venom, and weeds. Allergen testing is useful for evaluating the cause of hay fever, extrinsic asthma, atopic eczema, respiratory allergies, and potentially fatal reactions to insect venom, penicillin, and other drugs or chemicals. RAST and non-radiolabeled methods are alternatives to skin test anergy and provocation procedures, which can be inconvenient, painful, and potentially hazardous to patients. ImmunoCAP® FEIA is a newer, nonradioactive technology with minimal interference from nonspecific binding to total IgE versus allergen-specific IgE.

A nasal smear can be examined for the presence of eosinophils to screen for allergic conditions. Either a single smear or smears of nasal secretions from each side of the nose should be submitted, at room temperature, for Hansel staining and evaluation. Normal findings vary by laboratory but generally, greater than 10–15% is considered eosinophilia or increased presence of eosonophils. Results may be invalid for patients already taking local or systemic corticosteroids.

This procedure is contraindicated for

    N/A

Indications

  • Evaluate patients who refuse to submit to skin testing or who have generalized dermatitis or other dermatopathic conditions
  • Monitor response to desensitization procedures
  • Test for allergens when skin testing is inappropriate, such as in infants
  • Test for allergens when there is a known history of allergic reaction to skin testing
  • Test for specific allergic sensitivity before initiating immunotherapy or desensitization shots
  • Test for specific allergic sensitivity when skin testing is unreliable (patients taking long-acting antihistamines may have false-negative skin test)

Potential diagnosis

Different scoring systems are used in the interpretation of RAST results.

Increased in

  • Related to production of IgE, the antibody that primarily responds to conditions that stimulate an allergic response

  • Allergic rhinitis
  • Anaphylaxis
  • Asthma (exogenous)
  • Atopic dermatitis
  • Echinococcus infection
  • Eczema
  • Hay fever
  • Hookworm infection
  • Latex allergy
  • Schistosomiasis
  • Visceral larva migrans

Decreased in

    Asthma (endogenous) Pregnancy Radiation therapy

Critical findings

    N/A

Interfering factors

  • Recent radioactive scans or radiation within 1 wk of the test can interfere with test results when radioimmunoassay is the test method.

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this test can assist in identification of causal factors related to allergic reaction.
  • Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
  • Obtain a history of the patient’s immune and respiratory systems, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Note any recent procedures that can interfere with test results.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
  • Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
  • Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

  • Potential complications: N/A
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Inform the laboratory of the specific allergen group to be tested. Perform a venipuncture.
  • Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding and hematoma formation and secure gauze with adhesive bandage.
  • Promptly transport the specimen to the laboratory for processing and analysis.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting health-care provider (HCP), who will discuss the results with the patient.
  • Nutritional Considerations: Should be given to diet if food allergies are present. Lifestyle adjustments may be necessary depending on the specific allergens identified.
  • Recognize anxiety related to test results. Administer allergy treatment if ordered. As appropriate, educate the patient in the proper technique for administering his or her own treatments as well as safe handling and maintenance of treatment materials. Treatments may include eye drops, inhalers, nasal sprays, oral medications, or shots. Remind the patient of the importance of avoiding triggers and of being in compliance with the recommended therapy, even if signs and symptoms disappear.
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include arterial/alveolar oxygen ratio, blood gases, CBC, eosinophil count, fecal analysis, hypersensitivity pneumonitis, IgE, and PFT.
  • See the Immune and Respiratory systems tables at the end of the book for related tests by body system.
References in periodicals archive ?
American Esoteric Labs Launches ImmunoCAP Specific IgE Blood
Find out about Phadia's ImmunoCAP Specific IgE, EISA autoimmune assays, and automated laboratory system technology platforms at www.
The NIH Guidelines highlights the advantages of ImmunoCAP specific IgE testing compared to other technologies by stating "the predictive values associated with clinical evidence of allergy for ImmunoCAP cannot be applied to other test methods.
Phadia will utilize data from the Quest Health Trends Report to expand and extend the use of the ImmunoCAP Specific IgE blood test to support a guidelines-based approach to diagnosing and managing allergic diseases.
Another study published in the Annals of Allergy, Asthma & Immunology in July 2007 demonstrated that the ImmunoCAP Specific IgE system was directly traceable to the World Health Organization (WHO) standard preparation for total IgE in the detection of quantitative specific IgE antibodies.
This wealth of information on allergies and asthma in the US was made possible by data collected from Quest Diagnostic's use of the ImmunoCAP Specific IgE blood test from Phadia, the market leading in vitro allergy diagnostic test.
The assays used in this study included the ImmunoCAP Specific IgE blood test, Turbo-RAST (HYA*TEC(R) offered by LabCorp (Laboratory Corporation of America)) and 3gAllergy Universal Module (Siemens' Immulite(R) system).
The immunoCAP Specific IgE blood test quantitatively measures levels of specific IgE.
Finally, the guideline also highlights the advantages of ImmunoCAP specific IgE testing compared to other technologies by stating "the predictive values associated with clinical evidence of allergy for ImmunoCAP cannot be applied to other test methodsO.
All family members were tested for allergies to several allergens including dust mites -- a common allergen -- using the ImmunoCAP Specific IgE blood test.
All family members were tested for allergies to several allergens including dust mites - a common allergen - using the ImmunoCAP Specific IgE blood test.