The relationship between RAST and skin test results in patients with asthma or rhinitis: A quantitative study with purified major allergens

Background: Study of the relationship between skin test results and IgE antibody levels is seriously hampered by the use of conventional allergen extracts because the precise amount of relevant allergen for each patient is unknown. Objective: This study was designed to investigate skin reactivity with purified major allergens and to assess the relation with serum levels of IgE antibodies and to determine which additional factors contribute to the skirt test result. Methods: We used five purified major allergens (Der p 1, Der p 2, Fel d 1, Lol p 1, and Lol p 5) in skin tests, RASTs, and histamine release tests in 43 multisensitized patients with asthma or rhinitis. Results: The differences in biologic activity of the five major allergens at a given level of specific IgE art within one order of magnitude. A significant residual variation remains in the correlation between skin test the results and levels of IgE antibodies, which cannot be explained by imprecision of both tests (Pearson log skirt test vs log specific IgE: r = -0.46-0.92). With similar levels of specific IgE, the amount of allergen that is required for a positive skin test result may differ by as which as a factor of 100 between patients. The amount of total IgE in serum contributes significantly to the skirl test result. High values of total IgE are accompanied by a lower skin reactivity for allergen. Within individuals, allergens that cause skin test results that deviate from the prediction based on IgE antibody level often show a similar deviation in the histamine release test. This indicates that die type of lgE response (i.e., affinity or epitope recognition pattern) contributes significantly to the skin test result. Skin reactivity for histamine does nor significantly influence the skin reactions expressed as allergen threshold However; increased skin reactions with higher allergen dosages depend on histamine reactivity. Conclusion: The major allergens tested show similar biologic activities. In addition to IgE antibody level, total serum IgE and type of IgE antibody response contribute significantly to rite skirt test threshold for allergens. Even in a system with purified allergens, IgE antibody levels and skin test results are not interchangeable as an indicator of the degree of allergic sensitization.