Cell-Based Functional IgE Assays Are Superior to Conventional Allergy Tests for Shrimp Allergy Diagnosis
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AbstractBACKGROUND: The diagnosis of shellfish allergy currently relies on patient history, skin prick test (SPT), and serum specific IgE (sIgE) quantification. These methods lack sufficient diagnostic accuracy, whereas the gold standard of oral food challenges is risky and burdensome. Markers of reactivity and severity of allergic reactions to shellfish will improve clinical care of these patients.
OBJECTIVES: This study compared the diagnostic performance of SPT, sIgE, basophil activation test (BAT), and IgE crosslinking-induced luciferase expression (EXiLE) test for shrimp allergy.
METHODS: Thirty-five subjects with documented history of shrimp allergic reactions were recruited and grouped according to results of double-blind, placebo-controlled food challenge (DBPCFC). In addition to routine diagnostics, BAT (Flow CAST) and EXiLE test with shrimp extract and tropomyosin were performed.
RESULTS: Of 35 subjects, 15 were shrimp allergic with pruritus, urticaria, and itchy mouth on DBPCFC, whereas 20 were tolerant to shrimp. Tropomyosin only accounted for 53.3% of sensitization among subjects with challenge-proven shrimp allergy. BAT using shrimp extract as stimulant showed the highest area under curve value (0.88), Youden Index (0.81), likelihood ratio (14.73), odds ratio (104), and variable importance (4.27) when compared with other assays and tropomyosin diagnosis. Results of BAT significantly correlated with those of EXiLE (r=0.664, P < .0001).
CONCLUSIONS: BAT is a more accurate diagnostic marker for shrimp allergy than SPT and shrimp sIgE, whereas the EXiLE test based on an IgE crosslinking assay is a good alternative to AT. Tropomyosin may not be the most important shrimp allergen in Chinese, which warrants further investigation to search for other major allergens and diagnostic markers.
Acceptance Date04/01/2021
All Author(s) ListChristine Y.Y. Wai, Nicki Y.H. Leung, Agnes S.Y. Leung, Yuki Shum, Patrick S.C. Leung, Ka Hou Chu, Yat Wah Kwan, Qun Ui Lee, Joshua S.C. Wong, Ivan C.S. Lam, Pui Fung Li, Kary J.Y. Xu, Cheuk Yin Lam, Jinlyu Sun, Gary W.K. Wong, Ting Fan Leung
Journal nameJournal of Allergy and Clinical Immunology: In Practice
Year2021
Month1
Volume Number9
Issue Number1
PublisherAmerican Academy of Allergy, Asthma & Immunology
Place of PublicationUnited States of America
Pages236 - 244.e9
ISSN2213-2198
eISSN2213-2201
LanguagesEnglish-United States
KeywordsShrimp allergy, Basophil activation test, IgE crosslinking-induced luciferase expression test, DBPCFC, Tropomyosin, CD63, CCR3

Last updated on 2021-16-06 at 00:10