STUDIES ON THE RELATIONSHIP BETWEEN THE LEVEL OF SPECIFIC IGE ANTIBODIES AND THE CLINICAL EXPRESSION OF ALLERGY .1. DEFINITION OF LEVELS DISTINGUISHING PATIENTS WITH SYMPTOMATIC FROM PATIENTS WITH ASYMPTOMATIC ALLERGY TO COMMON AEROALLERGENS

Background: The detection of specific IgE antibodies to environmental allergens does not always coincide with a diagnosis of clinically evident allergic disease, because some patients with positive skin and/or in vitro test results have no symptoms related to the allergen or allergens that induced the antibodies. Objective: In a multicenter study the optimal cutoff values for specific IgE antibody levels and skin test results that could discriminate between patients with symptomatic and those with asymptomatic allergy were determined. Methods: IgE antibodies specific for a panel of common aeroallergens were assayed with the Pharmacia CAP system (Pharmacia, Uppsala, Sweden) in two groups of patients, a group of 267 patients with symptomatic allergy and a group of 243 healthy, nonallergic control subjects. The cutoff values were established by receiver operating characteristic analysis. Results: A significantly higher mean specific IgE antibody value was found in patients with symptomatic allergy compared with patients with asymptomatic allergy (p < 0.001) and in patients with symptomatic allergy compared with healthy control subjects (p < 0.001). The optimal cap system cutoff value between patients with symptomatic and those with asymptomatic allergy was 11.7 kU/L and when seasonal allergens were compared with perennial allergens, the cutoffs were 10.8 kU/L and 8.4 kU/L, respectively. The optimal cutoff value for the skin prick test was a wheal area 32 mm(2) for seasonal allergens and 31 mm(2) for perennial allergens. The skin test had a lower diagnostic value (sum of sensitivity and specificity) than the CAP system Conclusions: Cutoff values for specific serum IgE antibody levels are likely to be useful in clinical practice to distinguish symptomatic from asympotomatic allergy in patients with positive skin test results.