Poor association between allergen‐specific serum immunoglobulin E levels, skin sensitivity and basophil degranulation: a study with recombinant birch pollen allergen Bet v 1 and an immunoglobulin E detection system measuring immunoglobulin E capable of binding to FcɛRI

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Abstract
Background Results from several studies indicate that the magnitude of immediate symptoms of type I allergy caused by allergen‐induced cross‐linking of high‐affinity Fcɛ receptors on effector cells (mast cells and basophils) is not always associated with allergen‐specific IgE levels. Objective To investigate the association of results from intradermal skin testing, basophil histamine release and allergen‐specific IgE, IgG1–4, IgA and IgM antibody levels in a clinical study performed in birch pollen‐allergic patients (n=18). Methods rBet v 1‐specific IgEs were measured by quantitative CAP measurements and by using purified FcɛRI‐derived α‐chain to quantify IgE capable of binding to effector cells. Bet v 1‐specific IgG subclasses, IgA and IgM levels were measured by ELISA, and basophil histamine release was determined in whole blood samples. Intradermal skin testing was performed with the end‐point titration method. Results Our study demonstrates on the molecular level that the concentrations of allergen‐specific IgE antibodies capable of binding to FcɛRI and biological sensitivities are not necessarily associated. A moderate association was found between cutaneous and basophil sensitivity. Conclusion Our results highlight the quantitative discrepancies and limitations of the present diagnostic tools in allergy, even when using a single allergenic molecule. The quantity of allergen‐specific serum IgE is only one component of far more complex cellular systems (i.e. basophil‐based tests, skin tests) used as indirect diagnostic tests for IgE‐mediated allergic sensitivity.

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