Diagnostic Accuracy of Specific IgE Against Wheat and Rye in Flour-Induced Occupational Asthma.
(2024) The Journal of Allergy and Clinical Immunology: In Practice — Vol. 12, n° 8, p. 2017-2025 (2024)
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- (en) BACKGROUND: Assessment of IgE-mediated sensitization to flour allergens is widely used to investigate flour-induced occupational asthma. The diagnostic efficiency of detecting specific IgE antibodies (sIgEs) against wheat and rye flour, however, has not been thoroughly compared with other diagnostic procedures. OBJECTIVE: We sought to evaluate the diagnostic accuracy of sIgE against wheat and rye compared with specific inhalation challenge (SIC) with flour as the reference standard. METHODS: This retrospective multicenter study included 264 subjects who completed an SIC with flour in eight tertiary centers, of whom 205 subjects showed a positive SIC result. RESULTS: Compared with SIC, sIgE levels of 0.35 kUA/L or greater against wheat and rye provided similar sensitivities (84% to 85%, respectively), specificities (71% to 78%), positive predictive values (91% to 93%), and negative predictive values (56% to 61%). Increasing the threshold sIgE value to 5.10 kUA/L for wheat and to 6.20 kUA/L for rye provided a specificity of 95% or greater and further enhanced the positive predictive value to 98%. Among subjects with a positive SIC, those who failed to demonstrate sIgE against wheat and rye (n = 26) had significantly lower total serum IgE level and blood and sputum eosinophil counts and a lesser increase in postchallenge FeNO compared with subjects with a detectable sIgE. CONCLUSION: High levels of sIgE against wheat and/or rye flour strongly support a diagnosis of flour-induced occupational asthma without the need to perform an SIC. The absence of detectable sIgE against wheat and rye in subjects with a positive SIC seems to be associated with lower levels of TH2 biomarkers.
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Doyen, V., Migueres, N., Frère, A., Walusiak-Skorupa, J., Wiszniewska, M., Suojalehto, H., Munoz, X., Romero-Mesones, C., van Kampen, V., Sastre, J., Quirce, S., Barranco, P., Rifflart, C., de Blay, F., & Vandenplas, O. (2024). Diagnostic Accuracy of Specific IgE Against Wheat and Rye in Flour-Induced Occupational Asthma. The Journal of Allergy and Clinical Immunology: In Practice, 12(8), 2017-2025. https://doi.org/10.1016/j.jaip.2024.05.014 (Original work published 2024)