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Test Code RPR16 Respiratory Profile, Region 16, Inland Northwest (OR, Central and Eastern WA), Serum

Useful For

Assessing sensitization to various inhalant allergens commonly found in the inland Northwest region, including Oregon and central and east Washington

 

Defining the allergen responsible for eliciting signs and symptoms

 

Identifying allergens:

-Responsible for allergic response 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

Profile Information

Test ID Reporting Name Available Separately Always Performed
IGE Immunoglobulin E (IgE), S Yes Yes
DP House Dust Mites/D.P., IgE Yes Yes
DF House Dust Mites/D.F., IgE Yes Yes
CAT Cat Epithelium, IgE Yes Yes
DOGD Dog Dander, IgE Yes Yes
TIMG Timothy Grass, IgE Yes Yes
COCR Cockroach, IgE Yes Yes
PENL Penicillium, IgE Yes Yes
CLAD Cladosporium, IgE Yes Yes
ASP Aspergillus Fumigatus, IgE Yes Yes
ALTN Alternaria Tenuis, IgE Yes Yes
ALDR Grey Alder, IgE Yes Yes
CED Mountain Cedar, IgE Yes Yes
OAK Oak, IgE Yes Yes
ELM Elm, IgE Yes Yes
BXMPL Box Eld/Maple, S, IgE Yes Yes
CTWD Cottonwood, IgE Yes Yes
BIR Silver Birch, IgE Yes Yes
SORR Red Sorrel, IgE Yes Yes
MUG Mugwort, IgE Yes Yes
RUSS Russian Thistle, IgE Yes Yes
RRRP Rough Pigweed, IgE Yes Yes

Reporting Name

Resp Profile, Reg 16, Inland NW

Specimen Type

Serum


Ordering Guidance


For a listing of allergens available for testing, see Allergens - Immunoglobulin E (IgE) Antibodies.



Specimen Required


Collection Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 1.6 mL

Collection Instructions: Centrifuge and aliquot serum into a plastic vial.


Specimen Minimum Volume

1.4 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 14 days
  Frozen  90 days

Reject Due To

Gross hemolysis OK
Gross lipemia OK

Clinical Information

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 the 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 helminths.

 

The function of IgE is 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 IgE 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 mites, mold, and pollen inhalants) primarily occurs in older children, adolescents, and adults and usually manifests as respiratory disease (rhinitis and asthma).

Reference Values

Specific IgE:

Class

IgE kU/L

Interpretation

0

<0.10

Negative

0/1

0.10-0.34

Borderline/equivocal

1

0.35-0.69

Equivocal

2

0.70-3.49

Positive

3

3.50-17.4

Positive

4

17.5-49.9

Strongly positive

5

50.0-99.9

Strongly positive

6

≥100

Strongly positive

Reference values apply to all ages.

 

Total IgE:

Age

Reference interval (in kU/L)

0-5 months

≤13

6-11 months

≤34

1 and 2 years

≤97

3 years

≤199

4-6 years

≤307

7 and 8 years

≤403

9-12 years

≤696

13-15 years

≤629

16 and 17 years

≤537

18 years and older

≤214

Interpretation

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.

Cautions

An elevated concentration of total IgE is not diagnostic for allergic disease, and it must be interpreted in the clinical context of the patient, including age, sex, 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 IgE 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 test 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.

Clinical Reference

1. Homburger HA, Hamilton RG: Allergic diseases. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 23rd ed. Elsevier; 2017:1057-1070

2. Bernstein IL, Li JT, Bernstein DI, et al: Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol. 2008 Mar;100(3 Suppl 3):S1-148

Method Description

Specific IgE:

Specific IgE from the patient's serum reacts with the allergen of interest, which is covalently coupled to an ImmunoCAP. After washing away nonspecific IgE, enzyme-labeled anti-IgE antibody is added to form a complex. After incubation, unbound anti-IgE is washed away, and the bound complex incubated with a developing agent. After stopping the reaction, the fluorescence of the eluate is measured. Fluorescence is proportional to the amount of specific IgE present in the patient's sample (ie, the higher the fluorescence value, the more IgE antibody is present).(Package insert: ImmunoCAP System Specific IgE FEIA. Phadia; Rev 06/2020)

 

Total IgE:

Anti-IgE, covalently coupled to ImmunoCAP, reacts with the IgE in a serum specimen. After washing, enzyme-labeled anti-IgE antibodies are added to form a complex. After incubation, unbound enzyme-labeled anti-IgE is washed away, and the bound complex incubated with a developing agent. After stopping the reaction, fluorescence of the eluate in the well is measured. The fluorescence is directly proportional to the concentration of IgE in the test specimen.(Package insert: Phadia CAP System IgE FEIA. Phadia; Rev 10/2019)

Day(s) Performed

Monday through Friday

Report Available

Same day/1 to 3 days

Specimen Retention Time

14 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

CPT Code Information

82785-IgE

86003 x 21-Each individual allergen

LOINC Code Information

Test ID Test Order Name Order LOINC Value
RPR16 Resp Profile, Reg 16, Inland NW 51991-8

 

Result ID Test Result Name Result LOINC Value
ALDR Grey Alder, IgE 15284-3
ALTN Alternaria Tenuis, IgE 6020-2
ASP Aspergillus Fumigatus, IgE 6025-1
BIR Silver Birch, IgE 15283-5
BXMPL Box Eld/Maple, S, IgE 7155-5
CAT Cat Epithelium, IgE 6833-8
CED Mountain Cedar, IgE 6178-8
CLAD Cladosporium, IgE 53760-5
COCR Cockroach, IgE 6078-0
CTWD Cottonwood, IgE 6090-5
DF House Dust Mites/D.F., IgE 6095-4
DOGD Dog Dander, IgE 6098-8
DP House Dust Mites/D.P., IgE 6096-2
ELM Elm, IgE 6109-3
IGE Immunoglobulin E (IgE), S 19113-0
MUG Mugwort, IgE 6183-8
OAK Oak, IgE 6189-5
PENL Penicillium, IgE 6212-5
RRRP Rough Pigweed, IgE 6233-1
RUSS Russian Thistle, IgE 6234-9
SORR Red Sorrel, IgE 6244-8
TIMG Timothy Grass, IgE 6265-3

Method Name

Fluorescence Enzyme Immunoassay (FEIA)

Forms

If not ordering electronically, complete, print, and send an Allergen Test Request (T236) with the specimen.

Test Classification

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.