Is quantitative sIgE serology suitable to distinguish between silent sensitization and allergic rhinitis to D. pteronyssinus?

BACKGROUND AND OBJECTIVE: Recently, an increasing number of studies focus on the debate whether provocation tests might be replaceable by specific IgE serology in patients sensitized to airborne allergens. Objective: Our study aimed to analyse the concordance between a nasal provocation test with Dermatophagoides pteronyssinus and specific IgE measurements in real-life data.

MATERIAL AND METHODS: In 223 patients with proven sensitization to Dermatophagoides pteronyssinus, the concordance between the result of the provocation test and the IgE titer against several house dust mite components and extracts was retrospectively analysed.

RESULTS: In contrast to other studies, the anti-Der p 1-level alone was not suitable at all to distinguish between silent sensitization and allergy to Dermatophagoides pteronyssinus. ROC curve analysis revealed that the sum of sIgE against Der p 1 and Der p 2 is - after adjustment to the total serum IgE - the best parameter to discriminate between clinically silent and relevant sensitization, however far from reaching a sufficient diagnostic validity.

CONCLUSIONS: Despite the high correlation between sIgE levels and symptoms, no serologic parameter had a sufficiently high accuracy to distinguish between silent sensitization and clinically relevant allergy. Therefore, nasal provocation tests remain the gold-standard to investigate the clinical relevance in Dermatophagoides pteronyssinus sensitization.