The principles of rational selection of diagnostic tests in allergology

Aleksandra Gregorius, Radoslaw Spiewak

Department of Experimental Dermatology and Cosmetology, Jagiellonian University Medical College, Krakow, Poland

Source: Gregorius A, Spiewak R. Podstawy racjonalnego wyboru testow diagnostycznych w alergologii. Alergia Astma Immunologia 2013; 18 (4): 221-230. (In Polish)

 

Laboratory and in vivo test results greatly influence further diagnosis and treatment. Therefore, it is essential to select appropriate tests at early stages of the diagnostic process and keep in mind that each test can produce false positive and false negative results. The selection of an optimal test requires a thorough understanding of the terms describing the efficacy of a diagnostic test, such as sensitivity, specificity, positive and negative predictive value, likelihood ratios for a positive and negative test. The present review reports definitions of the relevant terms, along with examples from the allergy practice.

Keywords: allergy, diagnostic test, efficacy, sensitivity, specificity, predictive value.

Reprint (PDF)

Streszczenie

Links:

Dermatologist and allergist in Krakow (Cracow), Poland

References

  1. Krieg AF. Why are clinical laboratory tests performed. JAMA 1975; 233: 76-8.
  2. Wians FH. Clinical Laboratory Tests: Which, Why, and What do the results Mean? Lab Medicine 2009; 40: 105-13.
  3. Price CP. Evidence-based laboratory medicine: supporting decision-making. Clin Chem 2000; 46: 1041-50.
  4. Spiewak R. [Contact allergy - diagnosis and treatment]. Alergia Astma Immunologia 2007; 12: 109-27.
  5. Akobeng AK. Understanding diagnostic tests 1: Sensitivity, specificity and predictive values. Acta Paediatrica 2006; 96: 338-41.
  6. Diepgen TL, Coenraads PJ. Sensitivity, specificity and positive predictive value of patch testing: the more you test, the more you get? ESCD Working Party on Epidemiology. Contact Dermatitis 2000; 42: 315-7.
  7. Horn PS, Pesce AJ. Reference intervals: an update. Clin Chim Acta 2003; 334: 5-23.
  8. Sunderman FW Jr. Current concepts of "normal values," "reference values," and "discrimination values," in clinical chemistry. Clin Chem 1975; 21: 1873-7.
  9. Wieland E. The IFCC recommendations for determining reference intervals: strengths and limitations. J Lab Med 2009; 33: 45-51.
  10. Galen RS. Letter: Predictive value of laboratory tests. Am J Cardiol 1975; 36: 536-8.
  11. Czarnobilska E, Gregorius A, Porebski G i wsp. [The benefits of using basophil activation test as a diagnostic tool prior to specific immunotherapy with inhalant allergens]. Przeglad Lekarski 2012; 69: 1249-53.
  12. Malolepszy J, Medrala W, Kuna P i wsp. Standardy w alergologii. Czesc II. Oznaczanie ca³kowitego stezenia IgE i alergenowo-swoistych IgE w surowicy. Przeg Alergol 2004; 1: 51-9.
  13. van Kampen V, Rabstein S, Sander I i wsp. Prediction of challenge test results by flour-specific IgE and skin prick test in symptomatic bakers. Allergy 2008; 63: 897-902.
  14. Lau S, Nilsson M, Sulser C i wsp. Use of Phadiatop Infant in diagnosis of specific sensitization in young children with wheeze or eczema. Pediatr Allergy Immunol 2008; 19: 337-41.
  15. Canani RB, Ruotolo S, Auricchio L i wsp. Diagnostic accuracy of the atopy patch test in children with food allergy-related gastrointestinal symptoms. Allergy 2007; 62: 738-43.
  16. Paganelli R, Ansotegui IJ, Sastre J i wsp. Specific IgE antibodies in the diagnosis of atopic disease. Clinical evaluation of a new in vitro test system, UniCAP, in six European allergy clinics. Allergy 1998; 53: 763-8.
  17. Ebo DG, Lechkar B, Schuerwegh AJ i wsp. Validation of a two-color flow cytometric assay detecting in vitro basophil activation for the diagnosis of IgE-mediated natural rubber latex allergy. Allergy 2002; 57: 706-12.
  18. Niggemann B, Wahn U. A new dipstick test (Allergodip®) for in vitro diagnosis of latex allergy - validation in patients with spina bifda. Pediatr Allergy Immunol 2000; 11: 56-9.
  19. Hemery ML, Arnoux B, Dhivert-Donnadieu H i wsp. Confirmation of the diagnosis of natural rubber latex allergy by the Basotest method. Int Arch Allergy Immunol 2005; 136: 53-7.
  20. Nilsson C, Lilja G, Nordlund M i wsp. Phadiatop Infant® detects IgE-mediated diseases among pre-school children: a prospective study. Pediatr Allergy Immunol 2012; 23: 159-65.
  21. Peters RL, Gurrin LC, Allen KJ. The predictive value of skin prick testing for challenge-proven food allergy: a systematic review. Pediatr Allergy Immunol 2012; 23: 347-52.
  22. Garcia-Marcos L, Castro-Rodriguez JA, Suarez-Varela MM i wsp. A different pattern of risk factors for atopic and non-atopic wheezing in 9-12-year-old children. Pediatr Allergy Immunol 2005; 16: 471-7.
  23. Garcia-Marcos L, Sanchez-Solis M, Martinez-Torres AE i wsp. Phadiatop™ compared to skin-prick test as a tool for diagnosing atopy in epidemiological studies in schoolchildren. Pediatr Allergy Immunol 2007; 18: 240-4.
  24. Vidal C, Gude F, Boquete O i wsp. Evaluation of the phadiatop test in the diagnosis of allergic sensitization in a general adult population. J Investig Allergol Clin Immunol 2005; 15: 124-30.
  25. Vidal C, Boquete O, Gude F i wsp. High prevalence of sensitization to storage mites in general adult population. Allergy 2004; 59: 401-5.
  26. Choi IS, Koh YI, Koh JS, Lee MG. Sensitivity of the skin prick test and specificity of the serum-specific IgE test for airway responsiveness to house dust mites in asthma. J Asthma 2005; 42: 197-202.
  27. Josefson A, Svensson A, Färm G. Validation of self-testing as a method to estimate the prevalence of nickel allergy. Acta Derm Venereol 2011; 91: 526-30.
  28. Petersson G, Dreborg S, Ingestad R. Clinical history, skin prick test and RAST in the diagnosis of birch and timothy pollinosis. Allergy 1986; 41: 398-407.
  29. Krouse JH, Sadrazodi K, Kerswill K. Sensitivity and specificity of prick and intradermal testing in predicting response to nasal provocation with timothy grass antigen. Otolaryngol Head Neck Surg 2004; 131: 215-9.
  30. Jiang XD, Li GY, Dong Z, Zhu DD. Correlation analysis of two serum-specific immunoglobulin E test systems and skin-prick test in allergic rhinitis patients from northeast China. Am J Rhinol Allergy 2011; 25: 116-9.
  31. Bruze M, Isaksson M, Edman B i wsp. A study on expert reading of patch test reactions: inter-individual accordance. Contact Dermatitis 1995; 32: 331-7.
  32. Bodtger U, Jacobsen CR, Poulsen LK, Malling HJ. Long-term repeatability of the skin prick test is high when supported by history or allergen-sensitivity tests: a prospective clinical study. Allergy 2003; 58: 1180-6.
  33. Brasch J, Henseler T, Aberer W i wsp. Patch testing of nickel sulfate and potassium dichromate with a standardized ready-to-use test system gives highly reproducible results: a double-blind multicentre study. Acta Derm Venereol 2001; 81: 122-4.
  34. Bourke JF, Batta K, Prais L i wsp. The reproducibility of patch tests. Br J Dermatol 1999; 140: 102-5.
  35. Ale SI, Maibach HI. Reproducibility of patch test results: a concurrent right-versus-left study using TRUE Test. Contact Dermatitis 2004; 50: 304-12.
  36. Schiessl C, Wolber C, Strohal R. Reproducibility of patch tests: comparison of identical test allergens from different commercial sources. Contact Dermatitis 2004; 50: 27-30.
  37. Ronchetti R, Jesenak M, Barberi S i wsp. Reproducibility of atopy patch tests with food and inhalant allergens. J Biol Regul Homeost Agents 2008; 22: 27-33.
  38. Lazarov A, David M, Abraham D, Trattner A. Comparison of reactivity to allergens using the TRUE Test and IQ chamber system. Contact Dermatitis 2007; 56: 140-5.
  39. Wang J, Godbold JH, Sampson HA. Correlation of serum allergy (IgE) tests performed by different assay systems. J Allergy Clin Immunol 2008; 121: 1219-24.
  40. Greiner M, Pfeiffer D, Smith RD. Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests. Prev Vet Med 2000; 45: 23-41.
  41. Akobeng AK. Understanding diagnostic tests 3: Receiver operating characteristic curves. Acta Paediatrica 2007; 96: 644-7.
  42. Zweig MH, Campbell G. Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 1993; 39: 561-77.
  43. Pastorello EA, Incorvaia C, Ortolani C i wsp. Studies on the relationship between the level of specific IgE antibodies and the clinical expression of allergy: I. Definition of levels distinguishing patients with symptomatic from patients with asymptomatic allergy to common aeroallergens. J Allergy Clin Immunol. 1995; 96: 580-7.
  44. Simoni M, Biavati P, Baldacci S i wsp. The Po River Delta epidemiological survey: reference values of total serum IgE levels in a normal population sample of North Italy (8-78 yrs). Eur J Epidemiol 2001; 17: 231-9.
  45. Fernandez C, Bevilacqua E, Fernandez N i wsp. Asthma related to Alternaria sensitization: an analysis of skin-test and serum-specific IgE efficiency based on the bronchial provocation test. Clin Exp Allergy 2011; 41: 649-56.
  46. Diaz-Vazquez C, Torregrosa-Bertet MJ, Carvajal-Uruena I i wsp. Accuracy of ImmunoCAP Rapid in the diagnosis of allergic sensitization in children between 1 and 14 years with recurrent wheezing: the IReNE study. Pediatr Allergy Immunol 2009; 20: 601-9.
  47. Bernardini R, Pucci N, Azzari C i wsp. Sensitivity and specificity of different skin prick tests with latex extracts in pediatric patients with suspected natural rubber latex allergy - a cohort study. Pediatr Allergy Immunol 2008; 19: 315-8.
  48. Dodig S, Richter D, Benko B i wsp. Cut-off values for total serum immunoglobulin E between non-atopic and atopic children in north-west Croatia. Clin Chem Lab Med 2006; 44: 639-47.
  49. Carosso A, Bugiani M, Migliore E i wsp. Reference values of total serum IgE and their significance in the diagnosis of allergy in young European adults. Int Arch Allergy Immunol 2007; 142: 230-8.
  50. Plebani M, Borghesan F, Basso D, Faggian D. Receiver-operating characteristic (ROC) curves: a fundamental tool for improving the clinical usefulness of in vitro IgE tests. Allergy 1996; 51: 407-11.
  51. Rondon C, Canto G, Blanca M. Local allergic rhinitis: a new entity, characterization and further studies. Curr Opin Allergy Clin Immunol 2010; 10: 1-7.
  52. Rondon C, Campo P, Herrera R i wsp. Nasal allergen provocation test with multiple aeroallergens detects polysensitization in local allergic rhinitis. J Allergy Clin Immunol 2011; 128: 1192-7.
  53. Rondon C, Campo P, Togias A i wsp. Local allergic rhinitis: concept, pathophysiology, and management. J Allergy Clin Immunol 2012; 129: 1460-7.
  54. Poon AW, Goodman CS, Rubin RJ. In vitro and skin testing for allergy: comparable clinical utility and costs. Am J Manag Care 1998; 4: 969-85.
  55. Hamilton RG, Biagini RE, Krieg EF. Diagnostic performance of Food and Drug Administration-cleared serologic assays for natural rubber latex-specific IgE antibody. The Multi-Center Latex Skin Testing Study Task Force. J Allergy Clin Immunol 1999; 103: 925-30.
  56. Akkerdaas JH, Wensing M, Knulst AC i wsp. How accurate and safe is the diagnosis of hazelnut allergy by means of commercial skin prick test reagents? Int Arch Allergy Immunol 2003; 132: 132-40.
  57. Niggemann B, Nilsson M, Freidrichs F. Pediatric allergy diagnosis in primary care is improved by in vitro allergen-specific IgE testing. Pediatr Allergy Immunol 2008; 19: 325-31.
  58. Rajagopalan R, Anderson RT, Sarma S i wsp. The use of decision-analytical modelling in economic evaluation of patch testing in allergic contact dermatitis. Pharmacoeconomics 1998; 14: 79-95.
  59. Rajagopalan R, Anderson RT, Sarma S i wsp. An economic evaluation of patch testing in the diagnosis and management of allergic contact dermatitis. Am J Contact Dermat 1998; 9: 149-54.
  60. Spiewak R. Patch testing for contact allergy and allergic contact dermatitis. Open Allergy J 2008; 1: 42-51.
  61. Czarnobilska E, Obtulowicz K, Dyga W, Spiewak R. The most important contact sensitizers in Polish children and adolescents with atopy and chronic recurrent eczema as detected with the expanded European Baseline Series. Pediatr Allergy Immunol 2011; 22: 252-6.
  62. Gregorius A, Spiewak R. [A comparison of patch test results with the European Baseline Series, Polish Baseline Series and an original extended series in the diagnosis of patients with suspected contact allergy]. Alergoprofil 2011; 7: 25-31.

© Radoslaw Spiewak (contact).
This page is part of the www.RadoslawSpiewak.net website.
Document created: 18 February 2014, last updated: 19 February 2014.