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Performance of specific immunoglobulin E tests for diagnosing occupational asthma: a systematic review and meta-analysis
  1. Harald Lux1,2,
  2. Klaus Lenz3,
  3. Lygia Therese Budnik4,
  4. Xaver Baur5
  1. 1 Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Occupational Medicine, Berlin, Germany
  2. 2 Occupational, Social and Environmental Medicine, University Hospital Jena – Friedrich Schiller University Jena, Jena, Germany
  3. 3 Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Biometrics and Clinical Epidemiology, Berlin, Germany
  4. 4 University Medical Center Hamburg-Eppendorf, Institute for Occupational and Maritime Medicine, Translational Toxicology and Immunology Unit, Hamburg, Germany
  5. 5 European Society for Environmental and Occupational Medicine (EOM), Berlin, Germany
  1. Correspondence to Mr. Harald Lux, Institut für Arbeits-, Sozial- und Umweltmedizin, Universitätsklinikum Jena, Erlanger Allee 103, 07747 Jena, Germany; harald.lux{at}


Objectives To determine the test performance parameters for the retrievable range of high-molecular-weight (HMW) and low-molecular-weight (LMW) occupational allergens and to evaluate the impact of allergenic components and the implementation of measures for test validation.

Methods A protocol with predefined objectives and inclusion criteria was the basis of an electronic literature search of MEDLINE and EMBASE (time period 1967–2016). The specific inhalation challenge and serial peak flow measurements were the reference standards for the specific IgE (sIgE) test parameters. All of the review procedures were reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Results Seventy-one studies were selected, and 62 entered meta-analysis. Pooled pairs analysis indicated a sensitivity of 0.74(95% CI 0.66 to 0.80) and specificity of 0.71(95% CI 0.63 to 0.77) for HMW allergens and a sensitivity of 0.28(95% CI 0.18 to 0.40) and specificity of 0.89(95% CI 0.77 to 0.95) for LMW allergens. Component-specific analysis improved the test parameters for some allergens. Test validation was handled heterogeneously among studies.

Conclusion sIgE test performance is rather satisfactory for a wide range of HMW allergens with the potential for component-specific approaches, whereas sensitivity for LMW allergens is considerably lower, indicating methodological complications and/or divergent pathomechanisms. A common standard for test validation is needed.

  • occupational health practice
  • occupational asthma
  • in-vitro
  • sensitizers
  • allergy

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  • Contributors XB and HL conceptualised and designed the study with statistical contributions to methodology by KL. HL performed the searches, screening, study inclusion and data extraction. XB independently performed study inclusion in duplicate and checked the extracted data. HL and XB conducted quality assessment. HL performed the analysis and drafted the manuscript. HL, LTB, KL and XB contributed substantially to the conception of the study and to the manuscript and the interpretation of the results.

  • Funding This separate study is a part of the international task force ’Immunological methods for diagnosis and monitoring of IgE-mediated allergy caused by industrial sensitizing agents' (IMExAllergy), which is partially funded by EU-COST action DiMoPEx, CA-15129 (to LTB). The COST action is supported by the EU Framework Program Horizon 2020.

  • Competing interests The authors declare that they have no conflict of interest. HL conducted this study as part of the requirements for the German medical doctor degree at Charité—Universitätsmedizin Berlin, Berlin, Germany.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.