Specific diagnosis of exogenous bronchial asthma in adults comparison between case history intra cutaneous test radio allergo sorbent test histamine release from basophil leukocytes and bronchial provocation
Osterballe, O.; Malling H L.; Weeke, B.
Allergy 34(3): 175-186
Adults (22) with extrinsic bronchial asthma were examined with 26 different allergens from 5 groups: house dust + mite (30 BP [bronchial provocation]), animal dandruff (30 BP), pollen (12 BP), mold fungi (11 BP), and feather + cotton (10 BP). The same allergen batch was used for each allergen extract in all analyses. Based on the results of the single analyses: case history (CH), intracutaneous test (ST), RAST [radioallergosorbent test], histamine release from basophil leukocytes (HR), and the results of the analysis combinations and the true diagnosis BP, the sensitivity and specificity (SE and SP) were calculated and shown graphically. An evaluation of the diagnostic reliability of the single analyses and analysis combinations was then possible. HR was generally the best individual analysis with very few false positive and false negative values, followed by RAST, ST and CH. None was able to predict allergy for feather + cotton. Otherwise, BP was positive when HR and RAST reached scores 2 and 3 with the exception of RAST for animal dandruff. Score 3 had to be reached to predict positive BP by ST. Ch would only provide the diagnosis with a maximum score in the pollen group. BP was positive in any analysis combination resulting in score 6 or more. ST appeared to be the most sensitive of the individual analyses. All the patients with ST score 0 showed negative BP for all allergen groups, whereas a corresponding sensitivity for HR score 0 was only achieved with animal dandruff, and for RAST score 0 for pollen only. BP is in many cases necessary if a definite diagnosis is required.