Analysis of skin testing and serum-specific immunoglobulin E to predict airway reactivity to cat allergens.

Summary Background When the clinical history is not conclusive, it may be difficult to make an accurate interpretation of the value of skin tests and serum-specific IgE to cat allergens in asthma cases. Objective To analyse the diagnostic efficiency of skin testing (ST) and serum-specific IgE to cat allergens, based on the results of bronchial-specific challenge with cat epithelium. Methods Sixty-four asthma patients (49 with cat exposure and 15 without) who did not clearly relate their asthma symptoms to cat exposure and had a positive skin prick testing and/or a positive cat dander-specific IgE determination (CAP-system) underwent intradermal skin tests and specific bronchial challenge with cat epithelium. The results were analysed by receiver operating characteristics curves (ROC curves) and logistic regression. Sensitivity, specificity, positive predictive values and negative predictive values were calculated for different cut-off points. Results Twenty-seven patients (42.2%) had a positive bronchial-specific challenge. The area under the ROC curve for serum-specific IgE quantification is 0.85, which makes a good diagnostic tool out of this test. Intradermal ST predicts the outcome of the bronchoprovocation test better than skin prick testing (area under the ROC curve of 0.74 vs. area under the ROC curve of 0.54, respectively). The logistic regression analysis shows that the estimated probability of a positive bronchial challenge is 93% if CAP values are 17 kUA/L, whereas if CAP values are less than 0.35 kUA/L the estimated probability of a positive bronchial challenge is 16%. When the intradermal skin test is negative, the estimated probability of a positive bronchoprovocation test is 9%, being the test that better identifies patients with a negative bronchoprovocation test. Conclusions Levels of serum-specific IgE to cat allergens and intradermal ST can be used to diagnose and treat more accurately asthmatic patients sensitized to cat epithelium when there is uncertainty about cat epithelium causality.