Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 4:4:1241650.
doi: 10.3389/falgy.2023.1241650. eCollection 2023.

Back to basics: likelihood ratios for olive and grass pollen specific IgE in seasonal allergic rhinitis

Bárbara Manzanares  1   2   3 , Rafael González  1   2   4 , Pilar Serrano  1   2   4 , Ana Navas  1   2 , Corona Alonso  1   2 , Lourdes Fernandez  1   2 , Aurora Jurado  1   2   4 , Carmen Moreno-Aguilar  1   2   4
Affiliations

Back to basics: likelihood ratios for olive and grass pollen specific IgE in seasonal allergic rhinitis

Bárbara Manzanares et al. Front Allergy. .

Abstract

Introduction: Specific IgE (sIgE) is merely a sensitization marker that cannot be used for allergy diagnosis if there are no associated clinical symptoms. As of 2023, there is still no evidence regarding the quantity of sIgE necessary to confirm or exclude clinical disease. Therefore, this study aimed to calculate cut-offs for sIgE, allowing us to effectively diagnose olive or grass pollen allergy and select allergenic immunotherapy (AIT) candidate patients in a region under high olive and grass allergenic pressure.

Methods: An observational retrospective study consisting of the review of electronic medical records from 1,172 patients diagnosed with seasonal rhino-conjunctivitis and suspected allergy to olive or grass pollen. Symptoms correlated with sIgE to Poaceae and Oleaceae whole extracts and sIgE to genuine allergenic components were evaluated. Optimal cut-off values were calculated using receiver operating characteristic curves. Relevant clinical symptoms and AIT indications were taken into consideration when determining the clinical allergy diagnosis.

Results: sIgE to Lolium showed the best area under the curve (AUC) for both diagnosis (0.957) and an indication of AIT (0.872). The optimal cut-off values for grass diagnosis and AIT indication were 1.79 kUA/L and 8.83 kUA/L, respectively. A value of 5.62 kUA/L was associated with a positive likelihood ratio (LR) of 10.08 set for grass allergy. Olea sIgE showed the best AUC for the diagnosis (0.950). The optimal cut-off for diagnosis was 2.41 kUA/L. A value of 6.49 kUA/L was associated with a positive LR of 9.98 to confirm olive pollen allergy. In regard to immunotherapy, Ole e 1 sIgE showed the best AUC (0.860). The optimal cut-off was 14.05 kUA/L. Ole e 1 sIgE value of 4.8 kUA/L was associated with a 0.09 negative LR to exclude olive AIT indication.

Conclusions: The sIgE cut-offs found in this population under high olive and grass allergenic pressure reduce the gap between sensitization and clinical allergy, providing a new tool for the diagnosis of seasonal allergic rhinitis/asthma and helping to discriminate patients who will benefit from AIT.

Keywords: Olea; Poaceae; allergen immunotherapy; cut-off values; likelihood ratios; seasonal allergic rhinitis/asthma.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Diagnostic algorithm used to rule in grass and/or olive pollen sensitization. When sIgE to grass (rPhl p 1,5) and olive (ole e 1, ole e 7, and ole e 9) pollens molecular components were negative, sIgE to Phleum polcalcin (rPhl p 7) and Phleum profilin (rPhl p 12) (cross-reactive markers) were determined. If positive results were obtained, patients were excluded from the study.
Figure 2
Figure 2
Sensitization profiles were found in the study group according to the serum sIgE levels to whole extract of olea europaea pollen and its molecular components, considering 0.35 kUA/L as the positive cut-off value.
Figure 3
Figure 3
Relationship between specific IgE levels and the degree of rhino-conjunctivitis categorised according to the ARIA guidelines (Kruskal–Wallis test).
Figure 4
Figure 4
Relationship between specific IgE levels and the degree of asthma categorised according to the GEMA guidelines (Kruskal–Wallis test).
Figure 5
Figure 5
Relationship between specific IgE levels and the presence of asthma (Mann–Witney test).
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Chronic respiratory diseases: asthma. World health organization. (2020). Available at: https://www.who.int/es/news-room/questions-and-answers/item/chronic-resp... (Accessed January 12, 2022).
    1. Steering Committee Authors; Review Panel Members. A WAO - ARIA - GA2LEN consensus document on molecular-based allergy diagnosis (PAMD@): update 2020. World Allergy Organ J. (2020) 13:100091. 10.1016/j.waojou.2019.100091 - DOI - PMC - PubMed
    1. Ansotegui IJ, Melioli G, Canonica GW, Caraballo L, Villa E, Ebisawa M, et al. IgE allergy diagnostics and other relevant tests in allergy, a world allergy organization position paper. World Allergy Organ J. (2020) 13:100080. 10.1016/j.waojou.2019.100080 - DOI - PMC - PubMed
    1. Castro Neves A, Romeira AM, Marques JG, Matos V, Leiria Pinto P. Blood or skin: what is best in predicting cow’s milk allergy diagnosis? Eur Ann Allergy Clin Immunol. (2020) 52:160���4. 10.23822/EurAnnACI.1764-1489.123 - DOI - PubMed
    1. Pascal M, Moreno C, Dávila I, Tabar AI, Bartra J, Labrador M, et al. Integration of in vitro allergy test results and ratio analysis for the diagnosis and treatment of allergic patients (INTEGRA). Clin Transl Allergy. (2021) 11:e12052. 10.1002/clt2.12052 - DOI - PMC - PubMed

Grants and funding

The first author has been awarded a contract funded by Thermofisher Scientific to conduct the study (Research project number CCB.0160). Thermofisher Scientific did not have any role in the study design; collection, analysis, and interpretation of data; in the writing of the report; nor in the decision to submit the article for publication.