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April 6, 2017

Serum specific antibodies for dust mites

Question

“The patient is a 25 year old with history of perennial allergic rhinitis. The patient also complains of itchy eyes. He was allergic to Dust mite (D. Pteroynssinus and D. Farinae) - 4 mm and 6 mm respectively on Skin orick test a year back. He tried dust mite control measures but still persists to have symptoms, also using intransal steriosd spray daily for one year. He has asked for immunotherapy. Current, skin prick test shows 3 mm for D. Pteronyssinus and 2 mm for D. Farinae. The rest of the SPT is normal except 5 mm for cockroach. Should I order for serum specific IgE antibodies for dust mites? Is he a candidate for immunotherapy to dust mites?”

Answers

By Prof Luis Caraballo

Skin tests results can vary because of several factors such as extracts composition, antihistamines medication and test performance, but also by a true decrease of allergic reactivity. Since the patient currently has allergy symptoms further steps should be done to define the diagnosis. Therefore the answer is yes, you should order for serum specific antibodies to dust mites and cockroaches extracts because he is a candidate for mite specific immunotherapy. In addition, specific IgE to Der p 1, Der p 2, Der p 10 and Bla g 7 will also help to define cross reactivity between mites and cockroaches. If testing for IgE reactivity to mite allergens are positive, immunotherapy could be useful. Sensitization to other allergens such as Blomia tropicalis should be considered if the patient lives in a tropical region. 

References

1. Fatteh S, et al. Skin Prick testing in North America: a call for standards and consistency. Allergy, Asthma & Clinical Immunology 2014;10:44
2. Matricardi P, et al. EAACI Molecular Allergology User´s Guide. Pediatr Allergy Immunol 2016;27(Suppl 23):1-250

Luis Caraballo, MD, PhD
Professor of Immunology and Allergology
Institute for Immunological Research
University of Cartagena
Cartagena de Indias, Colombia


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