26402 Respiratory Profile, Region 7, Northern Midwest (MI, MN, WI), Serum (RPR7)

​​Immunoglobulin E (IgE), S; House Dust Mites/D.P., IgE; House Dust Mites/D.F., IgE; Cat Epithelium, IgE; Dog Dander, IgE; Bermuda Grass, IgE; Timothy Grass, IgE; Cockroach, IgE; Penicillium, IgE; Cladosporium, IgE; Aspergillus Fumigatus, IgE; Alternaria Tenuis, IgE; Box Eld/Maple, S, IgE; Silver Birch, IgE; Mountain Cedar, IgE; Oak, IgE; Elm, IgE; Cottonwood, IgE; White Ash, IgE; Mulberry, IgE; Short Ragweed, IgE; Russian Thistle, IgE; Rough Marsh Elder, IgE; Nettle, IgE.

​Immunoglobulin E (IgE), S; House Dust Mites/D.P., IgE; House Dust Mites/D.F., IgE; Cat Epithelium, IgE; Dog Dander, IgE; Bermuda Grass, IgE; Timothy Grass, IgE; Cockroach, IgE; Penicillium, IgE; Cladosporium, IgE; Aspergillus Fumigatus, IgE; Alternaria Tenuis, IgE; Box Eld/Maple, S, IgE; Silver Birch, IgE; Mountain Cedar, IgE; Oak, IgE; Elm, IgE; Cottonwood, IgE; White Ash, IgE; Mulberry, IgE; Short Ragweed, IgE; Russian Thistle, IgE; Rough Marsh Elder, IgE; Nettle, IgE.

Assessing sensitization to various inhalant allergens commonly found in the Northern Midwest region including Michigan, Minnesota, and Wisconsin

Defining the allergen responsible for eliciting signs and symptoms

Identifying allergens:

• Responsible for allergic disease and/or anaphylactic episode
• To confirm sensitization prior to beginning immunotherapy
• To investigate the specificity of allergic reactions to insect venom allergens, drugs, or chemical allergens

Gross hemolysis

Gross Lipemia

An elevated concentration of total IgE is not diagnostic for allergic disease, and must be interpreted in the clinical context of the patient, including age, gender, travel history, potential allergen exposure, and family history.

A normal concentration of total IgE does not eliminate the possibility of allergic disease. In patients with a high index of suspicion for allergic disease, testing for allergen-specific IgEs may be warranted.

Testing for allergen-specific IgE antibodies is not useful in patients previously treated with immunotherapy to determine if residual clinical sensitivity exists, or in patients in whom the medical management does not depend upon identification of allergen specificity.

Some individuals with clinically insignificant sensitivity to allergens may have measurable levels of IgE antibodies in serum, and results must be interpreted in the clinical context.

False-positive results for IgE antibodies may occur in patients with markedly elevated serum IgE (>2500 kU/L) due to nonspecific binding to allergen solid phases.

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Immunoglobulin E (IgE) is one of the 5 classes of immunoglobulins, and is defined by the presence of the epsilon heavy chain. It is the most recently described immunoglobulin, having first been identified in 1966. IgE exists as a monomer, and is present in circulation at very low concentrations, approximately 300-fold lower than that of IgG. The physiologic role of IgE is not well characterized, although it is thought to be involved in defense against parasites, specifically helminthes.

The function of IgE is also distinct from other immunoglobulins in that it induces activation of mast cells and basophils through the cell-surface receptor Fc epsilon RI. Fc epsilon RI is a high-affinity receptor specific for IgE present at a high density on tissue-resident mast cells and basophils. Because of this high-affinity interaction, almost all IgE produced by B cells is bound to mast cells or basophils, which explains the low concentration present in circulation. Cross-linking of the Fc epsilon RI -bound IgE leads to cellular activation, resulting in immediate release of preformed granular components (histamine and tryptase) and subsequent production of lipid mediators (prostaglandins and leukotrienes) and cytokines (interleukin-4 and interleukin-5).

Elevated concentrations of IgE may occur in the context of allergic disease. However, increases in the amount of circulating IgE can also be found in various other diseases, including primary immunodeficiencies, infections, inflammatory diseases, and malignancies. Total IgE measurements have limited utility for diagnostic evaluation of patients with suspected allergic disease. In this scenario, testing for the presence of allergen-specific IgEs may provide more information.

Clinical manifestations of allergic disease result from activation of mast cells and basophils, which occurs when Fc epsilon RI -bound IgE antibodies interact with allergen.

In vitro serum testing for specific IgE antibodies may provide an indication of the immune response to an allergen that may be associated with allergic disease.

The allergens chosen for testing often depend upon the age of the patient, history of allergen exposure, season of the year, and clinical manifestations. Sensitization to inhalant allergens (dust mite, mold, and pollen inhalants) primarily occurs in older children, adolescents, and adults, and usually manifests as respiratory disease (rhinitis and asthma).

Elevated concentrations of total IgE may be found in a variety of clinical diseases, including allergic disease, certain primary immunodeficiencies, infections, inflammatory diseases, and malignancies.  Detection of allergen-specific IgE antibodies in serum (Class 1 or greater) indicates an increased likelihood of allergic disease as opposed to other etiologies and defines the allergens that may be responsible for eliciting signs and symptoms.