Even though an IgE level exceeding 100kU/l is highly suggestive of allergy in adults, the total IgE is not an accurate parameter.Total IgE may also be raised in parasitic infections, immune diseases, cigarette smokers, with alcohol consumption, certain cancers...Moreover, frequently, the presence of cross-reactive IgE antibodies is not correlated with the development of clinical respiratory or food allergy. In particular, regarding the clinical relevance of sensitization to cross-reactive carbohydrate determinants (CCD) those sensitize approximately 10-20% of all pollen-allergic patients. Therefore, the diagnosis of type 1 hypersensitivity is mainly based upon an anamnesis and clinical history and in vivo skin prick tests. Then, in vitro detection of specific IgE against sensitizing molecular allergens can be performed using either commercial procedures in single or multi-array (quantitative) or immunoprint after separation of proteins from the suspected allergenic source by electrophoresis (qualitative). Regarding the pollen allergy, the level of specific IgE may considerably increase during the pollen season...

As I know, Thermo has  a new kit to test total serum IgE and allergen specific IgE. Maybe you can get some information from technique supports. Hope this is helpful. 

@xiaoming bai...

Thanks for your reply. In ImmunoCAP allergen systems...can they use only Phadia/Thermo kits or any other company kits also? 

Even though an IgE level exceeding 100kU/l is highly suggestive of allergy in adults, the total IgE is not an accurate parameter.Total IgE may also be raised in parasitic infections, immune diseases, cigarette smokers, with alcohol consumption, certain cancers...Moreover, frequently, the presence of cross-reactive IgE antibodies is not correlated with the development of clinical respiratory or food allergy. In particular, regarding the clinical relevance of sensitization to cross-reactive carbohydrate determinants (CCD) those sensitize approximately 10-20% of all pollen-allergic patients. Therefore, the diagnosis of type 1 hypersensitivity is mainly based upon an anamnesis and clinical history and in vivo skin prick tests. Then, in vitro detection of specific IgE against sensitizing molecular allergens can be performed using either commercial procedures in single or multi-array (quantitative) or immunoprint after separation of proteins from the suspected allergenic source by electrophoresis (qualitative). Regarding the pollen allergy, the level of specific IgE may considerably increase during the pollen season...

I agree with the statements of Shahali

A total IgE level  is not "positive" in the sense of a disease marker, it may, however, not be detectable (< 4 kU/l), values up to 200 kU/l can be found in non-allergic individuals

Atopic- allergic individuals (pollen, mite, food) may have "normal" Levels < 100 kU/l

Therefore  total IgE is not a sensitive and specific tool to detect atopic allergy.or to exclude it

High Levels (1000-2000) are found in atopic dermatitis, parasitic infections, extremely high Levels(> 5000) in very rare immune deficiency syndromes (Hyper IgE, Job Syndrome) or plasmocytoma

To diagnose sensitization in atopic allergy history and prick tests are faster and cheaper.

Any test (skin test or specifi IgE) may be not relevant for the current condtion, many healthy  indivduals, particularly younger ones (up to 30-50%) have latent sensitization.

So if the patient has no signs of respiratory disease or other condiions as mentioned above, do not repeat it

Investigation of total IgE dosage should be always related to clinical symptoms because its value can be very different and variable in different diseases, as Prof Bircher suggests. Furthermore, in patients with pollinosis, the increase of specific IgE to grass after the pollen season affects the total IgE amount, which shows different serum values during the year. In the same way, after a true drug induced IgE mediated anaphylaxis, you can observe in the following days, (usually 2nd or 3rd) a boosted IgE response to the drug, influencing total IgE level too 

Dear Arjun,

testing of total IgE is of low level importance and has very little clinical implications

consequently repetitive total IgE testing does not make sense either. However it may be justified in some conditions like ABPA

indications for IgE testing in general (based on the AWMF guidelines):

1.)In connection with specific IgE measurement:

a.)Supporting evidence for atopic predisposition

b.)To provide supporting interpretation in the interpretation of antigen specific IgE

2.) In specific clinical cases as add on diagnostic tool to link the disease to an atopic phenotype: Urticaria, Quincke´s edema, eosinophilic gastroenteritis, exanthemas of unknown origin, suspicion of drug induced hypersensitivity

3.)Cases with comparable differential diagnosis: Eosinophilic infiltrates, exogen allergic alveolitis, Wegener´s disease, Churg Strauss syndrome, Allergic bronchopulmonary aspergillosis

4.)Diagnosis and therapy control: Parasitic diseases, in particular in if eosinophilia with no evidence for parasitic infestation

Acquired and inheritated immunodeficiency: T-cell defects or hyper-IgE syndrome

Drs Eiwegger, Calogiuri, Bircher, and Shahali are making the important point that measuring total IgE is done for a reason. Knowing the reason for the test will help guide you toward a decision about whether to do the test in the first place and then whether you need to repeat a "positive" test.

There is no clear and simple correlation between the concentration of allergen specific IgE and the degree of clinical allergy.

Sensitivity and specificity are found in several studies to be 85 - 90%, but varies difficult within the individual allergens.

Repeated measuremets is rarely relevant.

Differential Diagnosis by allergy can be difficult because symptoms are often the same as banal ordinary conditions. A thorough medical history is always the gateway to an allergy study. Based on a history supplemented primarily with DOT test and any specific IgE. Provocation / elimination; history and prick test is usually more kliniskt useful than measurement of specific IgE.

Revealing a history of apparent exposure to allergens (eg,. Animals), it is most appropriate to test for these.

Year-round symptoms

airways is recommended depending on the history of study of relevant dust mites, skimmelsvam¬pe, animal allergens or Poland / mold & House dust / Pet panel containing: t3, g6, w6, e1, e3, e5, E82, d1, m2, m6.

Reel food allergy is rare and the study of specific IgE is largely indicated in children.

Cross-reactions:

There are varying cross-reaction between related allergens (see front page), and positive IgE response within the same group can be expected. Among grass species is pronounced cross-reaction. Detection of meadow rat tail allergies will be equal to the "grass-allergy". The same trend is seen in "mite allergy."

When pollen allergies are often cross-react with foods; e.g.. birch pollen allergy sufferers can get itching and swelling in and around the mouth by ingestion of nuts. Therefore there is no need for further studies because of antigenic community.

There is a log-normal distribution of total IgE in the general population. Levels well above 100 ku/l by no means indicate pathology. Moreover, specific allergy for single allergens ( as in ocupational allergy) can be found with total igE levels well below 50 ku/l. Therefore, the level of total igE should not be considered as a screening test for allergy. It is, however, a valuable monitoring parameter for the treatment of Allergic Broncho Pulmonary Aspergillosis.

If the total IgE is higher than normal, no need to repeat it  until you have an atopic  or other symptoms. And if you have a symptoms such as asthma, allergic rhinitis, rhino-conjunctivitis which are considered to be mediated by IgE etc., you need to go for an allergens specific test either in vivo or in vitro. The issue is to treat the symptoms. Further tests are considered for higher IgE in order to treat  other  symptoms as  well.

total IgE is not epecific and it is not important. but specific IgE from skin prick test ot immunoCAP is important , of course, when it is related to clinical manifestation. because  a many person have positive test ( senetive) but they don`t have allergy.

You can repeat the Total IgE dosage as a parameter for disease treatment. ABPA (allergic bronchopulmonary aspergilosis) is a classical indication, but it is a rare condition. In my practice I use to repeat Total and specific IgE to follow the efficacy of group-specific multi-allergen desensitization immunotherapy. The normalization of total and specific IgE is a sensitive indicator of cure and allows the safety discontinuation of desensitization terapy in an asymptomatic patient..

The information of high IgE is very important considering the clinical situation, There is no indication to perform another test post some months.

Total IgE is indicative but not conclusive of atopic sensitization, but says nothing about possible allergic disease in a patient. Specific IgE (sIgE) is much better for this purpose, and high figures are to som extent  associated with clinical disease. In primary care sIgE is often more convenient than SPT, as SPT requiers some experience and are subject to methodologic bias. Importantly both sIgE and SPT both only indicate sensitization and NOT allergic disease unless evaluated together with a thorough anamnestic examination of the patient.

Total IgE is virtually useless in this respect and should not unless in very few conditions (like aspegillosis) be repeated.

I have nothing to add to the excellent and similar responses by people much more knowledgeable than I in this area

even specific IgE needs to expert physician for analysis. every positive specific IgE is not significant.

Agree with the answers above.  The measurement of total IgE has limited value in most instances.

we ask the patient for relation between positive skin or RAST test with clinical manifestations.

The short answer is NO.

Total IgE have limited clinical use and even levels of allergen specific IgE do not reflect clinical symptoms.

So measure total IgE seldom, and certainly not repeatedly.

hope this link is useful

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206235/

regards

Я згідна з Ола Скрро , що рівень цього імуноглдобуліну не є показовим щодо алергічних реакцій. Це переконання мені дає мій власний клінічний досвід з лікування алергій. Швидше це показник глистної інвазії. Але повторнін дослідження в динаміці щодо вмісту IgE необхідно вивчати в динаміці.

You see, IgE is a difficult antibody to deal with. We know that high levels of IgE is related to allergy, and this is because we have a minor concentration of this antibody, so if they are higher, seems that some antigen could promote that and, not only just an antigen, but an allergen. But, the best is to relate this to the clinical history and also do more tests, for, i.e., prick test.

Total IgE is of limited value, and should in allergolgy either be excluded, or if taken always be combined with specific IgE (sIgE) based in probable causes for allergy in each individual patient from history taking and clinical exammination. The predictive value of a positive sIgE is dependent on the concentration of sIgE for each separate allergen (and you need to know the levels of sIgE with a positive predictive value of approx 95% to give your patient a meaningful interpretation of the test results) . This means that there are very little association between a low level positive sIgE and clinical allergy. Remember that sIgE is exclusively an indication of sensitisation to an allergen (at some time in life), and NOT allergic disease. Allergic disease is a clinical diagnosis.