ALEX versus ISAC multiplex array in analyzing food allergy in atopic children

When comparing these multiplex arrays one should be aware that both platforms employ different methodologies and units of measurement [ 5 ], and in addition ALEX uses a CCD inhibitor while ISAC does not [ 1 , 2 , 3 , 5 ]. A different range is used; 0. Hoang et. Therefore a pilot study was performed testing ALEX in serum samples of ten children with multiple food allergies who were previously last year tested by ISAC. Ten patients with multiple food allergies were included with a mean age of 11,8 years range 7—16 and the majority was male. Verification of this difference was performed using a singleplex sIgE test ImmunoCap on the same serum sample. One clinically irrelevant difference was found in patient 1 who tolerates small amounts of soy.

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Additional positive sensitizations for many allergens were found by ALEX Table 1 without resulting in additional food allergy diagnosis not diagnosed by ISAC in these ten patients so far. In all ten patients multiple additional sensitizations, mainly for allergen extracts, with unknown clinical relevance were found Table 1. In patient 2 moderate sensitization for buckwheat component storage protein, Fag e 2 and high sensitization for whole allergen buckwheat extract was found by ALEX, with no sensitization in ISAC for buckwheat component. Because of unexplained anaphylaxis in this patient a buckwheat food challenge was performed, however this was negative in agreement with ISAC. In addition, in seven patients ALEX revealed sensitizations for buckwheat extract with unknown relevance in five of them. Furthermore, many sensitizations low — very high all with unknown clinical relevance were found by ALEX for a. A food challenge with poppy seed was performed in patient 2, showing unexplained anaphylaxis and high sensitization for poppy seed found by ALEX, but was negative.

Patient 8 with dust mite and seafood allergy sensitized for tropomyosin showed very high sensitizations for cricket, mealworm and grasshopper extracts in ALEX possibly tropomyosin cross-sensitizations. Therefore he was advised to avoid those insects in his diet, however no food challenge tests with these insects were performed so clinical relevance remained unknown. In both patients ALEX showed no sensitization for tuna whole allergen extract while sensitization for the parvalbumin component Thu a 1 was very high.

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Remarkably, in all other fishes the sensitization for parvalbumin was considerably higher than whole fish allergen extracts. Very low or negative sensitization was found for specific nuts in four out of ten patients with a nut allergy Table 1. This could help clinicians to decide together with their patients to perform a food challenge with these specific nut s in case of a desired wish for introduction. In line with this, in two out of four patients with a known allergy for legumes, negative or very low sensitization was found for specific legumes which might be worth challenging Table 1. Negative sensitization for banana extract was found by ALEX in patient 1. He avoids banana because of oral allergy and abdominal symptoms and a positive skin pricktest for banana six years ago. Comparing both tests ALEX provides more sIgE results including whole allergen extracts and components for nuts, cereals, seeds, legumes, fish and seafood, fruits, vegetables, meats and spices.

In general, multiplex arrays could help clinicians to study cross-sensitization patterns in individual patients, however for this purpose allergen components are more informative than allergen extracts. In this study no additional food allergies were identified by ALEX compared to ISAC, however in case of negative sensitization results clinicians could more safely optimize and personalize dietary advice Table 1. This study showed multiple sensitization results found by ALEX with unknown clinical relevance, which could potentially increase clinical complexity and costs by an increase in further evaluation food challenge tests to establish relevancy of sensitizations. Pediatric allergists should be aware of this disadvantage of using ALEX, even more in young children with severe eczema who have not introduced all sorts of food yet. In theory a more extended testing platform could be interesting in patients with unexplained anaphylaxis, however this was not studied in the present pilot study.

This study was limited by patient numbers, however based on the results of this study, future studies should investigate the impact of additional positive sensitizations found by ALEX on clinical decision making and healthcare cost in severe atopic children. The data that support the findings of this study are available on request from the corresponding author [LS]. The data are not publicly available due to participant privacy. Extended IgE profile based on an allergen macroarray: a novel tool for precision medicine in allergy diagnosis. World Allergy Organ J. Comparison of two multiplex arrays in the diagnostics of allergy. Clin Transl Allergy. A qualitative and quantitative comparison of IgE antibody profiles with two multiplex platforms for component-resolved diagnostics in allergic patients. Clin Exp Allergy. CAS Google Scholar. Validation of a commercial allergen microarray platform for specific immunoglobulin E detection of respiratory and plant food allergens.

Ann Allergy Asthma Immunol. Modeling the conversion between specific IgE test platforms for nut allergens in children and adolescents. Download references. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Laura J. Sonneveld, Joyce A. Emons, Nicolette J. You can also search for this author in PubMed Google Scholar. In addition, the ImmunoCAP testing system has revolutionized the level of automation and speed which these tests are processed. Based on the high binding capacity and solid phase technology, ImmunoCAP tests are both highly sensitive and highly specific. Contents move to sidebar hide. Article Talk.

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