117

Rad. Medical Sciences, Zagreb, 2008., str. 117-128
S. Dodig: Current laboratory diagnosis of allergy
CURRLNT LAßÒRATÒRY DIACNÒSIS ÒI ALLLRCY
Slavica Dodig
Srebrn|ak Children's HospiLal, Reference CenLer for Clinical IediaLric Allergology of
Lhe MinisLry of HealLh and Social Welfare, Zagreb, CroaLia
Summary
1ho roquosts íor laboratory dlagnosls oí allorglc dlsoasos roíor to a battory oí tosts that
should þrovldo tho íollowlng. 1) dotormlno tho tyþo oí allorglc roactlon by dotoctlng
humoral (total lgL) and collular (ooslnoþhlllc and basoþhlllc granulocyto count, ooslnoþhll
catlonlc þrotoln) modlators oí allorglc roactlon, 2) ldontlíy trlggors oí allorglc roactlon
(sþoclílc lgL to þartlcular causatlvo allorgons, tosts íor basoþhlllc granulocyto e\ v|vo actlva-
tlon, loukotrlonos, CD63, hlstamlno), 3) assoss tho cllnlcal courso oí allorglc roactlon
(tryþtaso íor lmmodlato roactlon, ooslnoþhll catlonlc þrotoln íor dolayod roactlon), 4)
onablo sþoclílc lmmunothoraþy monltorlng (total and sþoclílc lgL, sþoclílc lgC4 and lgC1,
lgC4/lgC1 ratlo, þroallorglc and þrolnílammatory cytoklnos), and 5) ostlmato dlagnostlc
oíílcloncy oí dotormlnatlon oí þartlcular humoral or collular modlators oí allorglc roactlon
(l.o., sonsltlvlty, sþoclílclty, þosltlvo and nogatlvo þrodlctlvo valuo).
Althouh laboratory lnvostlgatlons aro a usoíul tool ln tho dlagnosls and managomont
oí allorglc dlsoasos many þrobloms romaln unsolvod. 1hoso þrobloms can bo grouþod lnto
throo catogorlos. þroanalytlcal (sþoclmon colloctlon), analytlcal and þost-analytlcal (lntor-
þrotatlon, íollow-uþ, rotostlng) þhasos oí laboratory tostlng.
Kcywords. allorgy, lgL, basoþhlls, loukotrlono, lmmunothoraþy
The requesLs made Lo clinical biochemisLs for laboraLory diagnosis of allergic diseas-
es refer Lo a baLLery of LesLs LhaL should provide Lhe folloving: 1) deLermine Lhe Lype of
allergic reacLion by deLecLing humoral and cellular mediaLors of allergic reacLion, 2)
idenLify Lriggers of allergic reacLion, 3) assess Lhe clinical course of allergic reacLion
(immediaLe, delayed, or prolonged), 4) enable specific immunoLherapy moniLoring,
UDK 616-022.8/.9-07
Review
Received: 14 December 2007
Accepted: 20 February 2008
Correspondence Lo: Doc. dr. sc. Slavica Dodig, Ih. D., Srebrn|ak Children HospiLal, Srebrn|ak 100,
10000 Zagreb, L-mail: slavica_dodig.neL
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S. Dodig: Current laboratory diagnosis of allergy
and 5) esLimaLe diagnosLic efficiency of deLerminaLion of parLicular humoral or cellular
mediaLors of allergic reacLion. The LesLs currenLly used and Lheir diagnosLic value in Lhe
deLecLion and LherapeuLic moniLoring of allergic diseases are briefly described.
1. IDENTIFICATION OF THE TYPE OF ALLERGIC REACTION
IdenLificaLion of Lhe Lype of allergic reacLion implies deLerminaLion of humoral and
cellular allergic reacLion mediaLors, including LoLal immunoglobulin L (IgL) concenLra-
Lion, eosinophilic and basophilic granulocyLe counL |1], eosinophil caLionic proLein
(LCI) concenLraLion |2], idenLificaLion of membrane markers of basophil acLivaLion (CD63),
and hisLamine release from basophilic granulocyLes |3].
1. 1. Determination of totaI IgE concentration
As a simple and auLomaLed meLhod, deLerminaLion of LoLal IgL concenLraLion in
serum is included in Lhe screening vork-up for aLopy |4]. Serum concenLraLion of IgL
anLibodies varies from very lov levels in infancy Lhrough several-fold levels from Lhe
age of nine years (Table 1). None of oLher immunoglobulins undergoes such an increase
viLhin Lhe normal range during lifeLime.
1ab/e 1. Uþþor llmlts oí lgL concontratlon ln 95° oí chlldron accordlng to ago
Ago (yoars) lgL, 95
th
contllo (klU/L)
<1 20.2
1 30.4
2 38.6
3 57.0
4 57.2
5 65.4
6 73.0
7 82.6
8 76.4
9 98.4
10 102.6
11 104.8
12 101.4
13 97.4
14 94.2
15 105.2
16 100.0
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S. Dodig: Current laboratory diagnosis of allergy
The upper reference limiLs of LoLal IgL concenLraLion in children are consisLenL viLh
cuL-off values beLveen aLopic (n~4520) and nonaLopic (n~3355) sub|ecLs. The values
vere deLermined aL DeparLmenL of Clinical LaboraLory Diagnosis, Srebrn|ak Children's
HospiLal in Zagreb (blood sampling vas performed during Lhe 2001-2004 period) |5].
In addiLion Lo iLs role in deLecLing aLopic disease, deLerminaLion of IgL concenLra-
Lion appears Lo poinL Lo Lhe disease severiLy, in children belov 16 years of age in parLic-
ular |6,7], hovever, some auLhors vould noL agree viLh Lhe laLLer |8,9].
1. 2. Losinophilic and basophilic granulocq!c coun!
AlLhough numerous cell Lypes (lymphocyLes, eosinophilic granulocyLes, masLocyLes,
basophilic granulocyLes, endoLhelial cells, epiLhelial cells of Lhe respiraLory sysLem, neu-
Lrophilic granulocyLes, anLigen-presenLing cells) are involved in allergic reacLion, eosi-
nophilic granulocyLe counL in Lhe blood and nasal svab is mosLly deLermined in daily
rouLine. The advenL of blood counLers offering auLomaLed deLerminaLion of basophilic
granulocyLe counL has enabled Lhe use of Lhis ad|uncL parameLer in Lhe assessmenL of
allergic disease.
Cllnlcal symþtoms oí allorgy
LCl <15 mg/L
(chlldron <20 mg/L)
doos not þolnt to
allorglc lnílammatlon,
contlnuo tostlng
LCl <15 mg/L
(chlldron <20 mg/L)
þolnts to allorglc
lnílammatlon,
antl-lnílammatory thoraþy
↑ lgL
LCl <15 mg/L
(LCl <20 mg/L)
dlscontlnuo thoraþy
LCl <25 mg/L
(20<LCl<30 mg/L)
contlnuo thoraþy
LCl <25 mg/L
(LCl <30 mg/L)
lncroaso drug dosago
A
ß







lig. 1. Assossmont oí LCl valuo ln monltorlng/troatmont oí allorglc lnílammatlon.
09 Dodig.p65 04.02.2008., 11:20 119
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S. Dodig: Current laboratory diagnosis of allergy
1. 3. EosinophiI cationic protein (ECP) concentration
In daily rouLine, deLerminaLion of Lhe concenLraLion of LCI released from eosino-
philic granulocyLe granules allovs for Lhe course of allergic reacLion Lo moniLor, since
an increased LCI concenLraLion (like eosinophilic granulocyLe counL) poinLs Lo acuLe
allergen exposure and Lhus Lo Lhe severiLy of allergic inflammaLion |10,11]. Thus, iL can
be used as a marker in LherapeuLic moniLoring in asLhmaLic paLienLs. The upper refer-
ence limiL is 15 ìg/L for adulLs and 20 ìg/L for children, and levels exceeding Lhese cuL-off
values poinL Lo allergic inflammaLion (Iig. 1).
A - Increased serum LCI concenLraLion (>15µg/L in adulLs and > 20 µg/L in chil-
dren, respeciLvely) provides an addiLional informaLion Lo complemenL Lhe clinical eval-
uaLion of allergic inflammaLion. ß - Since Lherapy viLh corLicosLeroids can reduce aller-
gic inflammaLion, LCI measuremenL can Lherefore be used for guiding Lhe anLi-inflam-
maLory response. The advice is Lo check LCI before considering changing Lhe LreaLmenL
dose. CorLicosLeroid LreaLmenL may be reduced if Lhe paLienL's clinical siLuaLion is sLable
and Lhe LCI level is normal.
2. DETECTION OF THE TRIGGER OF ALLERGIC REACTION
ßlood concenLraLion of specific IgL Lo parLicular causaLive allergens deLecLed by
cuLaneous LesLing is deLermined Lo idenLify Lhe Lrigger of allergic reacLion. In early child-
hood vhen cuLaneous LesLs are less reliable, deLerminaLion of IgL Lo a group of causaLive
allergens (inhalanL or nuLriLional, IhadiaLop Yes or No LesL for IgL, 93% sensiLiviLy and
89% specificiLy) is recommended in screening for causaLive allergens, as an alLernaLive Lo
cuLaneous LesLing |12]. If hypersensiLiviLy is noL demonsLraLed by Lhis procedure, no
furLher LesLing is required (99% negaLive predicLive value), hovever, vhen hypersensi-
LiviLy Lo a group of allergens is proven (89% posiLive predicLive value), Lhe procedure
should be folloved by deLerminaLion of parLicular specific IgL in Lhe same serum sam-
ple. IL should be noLed LhaL Lhe values obLained by IhadiaLop meLhod are expressed in
arbiLrary uniLs seL by Lhe manufacLurer.
2. 1. Determination of aIIergen-specific IgE concentrations
Upon deLecLion of causaLive allergens by Lhe skin prick LesL, Lhe presence of specific
IgL againsL Lhese allergens and Lheir main epiLopes is deLermined in serum of paLienLs
viLh a clinical picLure of allergic disease. DeLerminaLion of specific IgL in serum indi-
caLes currenL immune acLiviLy, vhile skin LesLing reveals IgL local bioacLiviLy mediaLed
by long-living cells |13]. If Lhe concenLraLion of specific IgL is deLermined by Lhe sLan-
dardized meLhod |14] (according Lo Lhe World HealLh ÒrganizaLion Second InLernaLion-
09 Dodig.p65 04.02.2008., 11:20 120
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S. Dodig: Current laboratory diagnosis of allergy
1ab/e 2. Sorum lovols oí sþoclílc lgL antlbodlos (CAl þrocoduro) |15}
Sþoclílc lgL (kU
A
/L) Class kosult lntorþrotatlon
<0.35 0 Unmoasurablo concontratlon oí sþoclílc lgL
0.36-0.7 1 Lowost concontratlon oí sþoclílc lgL
0.71-3.5 2 Low concontratlon oí sþoclílc lgL
3.6-17.5 3 Modorato concontratlon oí sþoclílc lgL
17.6-50.0 4 Hlgh concontratlon oí sþoclílc lgL
51.0-100.0 5 Vory hlgh concontratlon oí sþoclílc lgL
>100.0 6 Lxtromoly hlgh concontratlon oí sþoclílc lgL
1ab/e 3. lntorþrotatlon oí |o v|t|o þrocoduros
1otal lgL (klU/L) Sþoclílc lgL (klU
A
/L)
<0.35 0.36-0.7 0.71-3.5 3.6-17.5 17.6-50.0 51.0-100.0 >100.0
lorhaþs not losslblo losslblo losslblo losslblo losslblo
slgnlílcant, lndlvldual lndlvldual lndlvldual multlþlo multlþlo
Vory low No atoþy roqulros hyþor- hyþor- hyþor- hyþor- hyþor-
roþoat sonsltlvlty, sonsltlvlty sonsltlvlty sonsltlvlty sonsltlvlty
tostlng' roþoat
tostlng'
lorhaþs not Cut-oíí losslblo losslblo losslblo lrobably
slgnlílcant, valuo, lndlvldual lndlvldual multlþlo multlþlo
Normal No atoþy roqulros roþoat hyþor- hyþor- hyþor- hyþor-
roþoat tostlng' sonsltlvlty sonsltlvlty sonsltlvlty sonsltlvlty
tostlng'
Atoþy not Atoþy not Atoþy not lrobably Multlþlo lrobably lrobably
oxcludod, oxcludod, oxcludod, multlþlo hyþor- multlþlo multlþlo
lncroasod oxþand oxþand oxþand hyþor- sonsltlvlty hyþor- hyþor-
sþoclílc lgL sþoclílc lgL sþoclílc lgL sonsltlvlty sonsltlvlty sonsltlvlty
sþoctrum sþoctrum sþoctrum, hlstory
Vory
lncroasod
↓ ↓ ↓ ↓ ↓ ↓ ↓
'thoso ílndlngs may bo duo to tho þatlont´s þollon hyþorsonsltlvlty, thoroíoro roþoat tostlng uþon comþlotlon oí þolllnatlon may þrovo usoíul
al Reference IreparaLion for Human IgL, WHÒ 2
nd
IRI 75/502), resulLs can be quanLiLa-
Lively expressed viLhin a range from 0.36 Lo 100 kU
A
/L, excepL for IgL classes 1-6 (Table 2).
Table 3 shovs correlaLion of Lhe resulLs obLained by deLerminaLion of LoLal and spe-
cific IgL in serum and can be used a guide in inLerpreLaLion of resulLs.
2. 2. Activation of basophiIic granuIocytes
This group of LesLs also includes deLerminaLion of Lhe concenLraLions of released
hisLamine (radioimmunology, LLISA), leukoLrienes (LLISA) |16,17] and surface CD mark-
ers (flov cyLomeLry) folloving basophilic granulocyLe acLivaLion by Lhe causaLive aller-
09 Dodig.p65 04.02.2008., 11:20 121
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S. Dodig: Current laboratory diagnosis of allergy
gen cx titc (Iig. 2) |18]. Cellular in tiirc diagnosis has greaLly improved viLh Lhe inLro-
ducLion of Lhe meLhod of flov cyLomeLry. In allergic diseases, Lhe diagnosis based on
flov cyLomeLry is for Lhe Lime being mosLly employed in research sLudies |19]. The role
of LesLs for basophilic granulocyLe acLivaLion in Lhe diagnosis of allergies remains Lo be
deLermined.
3. ASSESSMENT OF THE CLINICAL COURSE OF ALLERGIC REACTION
LvaluaLion of Lhe clinical course of allergic reacLion, i.e. immediaLe, delayed or pro-
longed hypersensiLiviLy, can LheoreLically be done by deLerminaLion of Lhe exisLing me-
diaLors such as LrypLase (a marker of anaphylaxis, immediaLe reacLion) or LCI (delayed
reacLion), or by deLerminaLion of synLhesized mediaLors of allergic reacLion such as leu-
koLrienes folloving basophilic granulocyLe exposure Lo causaLive allergens. Ior Lhe Lime
being, Lhese LesLs are only performed in research. TrypLase is a serine proLease LhaL is
released, along viLh hisLamine, from masLocyLes upon Lhe allergen-IgL complex forma-
Lion, and represenLs a marker of anaphylacLic reacLion |20]. As hisLamine concenLraLion
rises viLhin 15-30 minuLes and reLurns Lo normal values viLhin one hour, iL is quiLe
difficulL Lo measure. Therefore, Lhe measuremenL of LrypLase is used as a more reliable
laboraLory parameLer. Increased LrypLase concenLraLion (>13.5 ìg/L) can be demonsLraL-
ed viLhin 3-6 hours of anaphylacLic reacLion, Lhen iL reLurns Lo cuL-off values in Lhe nexL
12-14 hours.
lig. 2. 1ho þrlnclþlo oí mothods oí basoþhlllc granulocyto actlvatlon. ßasoþhlllc granulocytos
dorlvod írom þatlont blood aro actlvatod by tho causatlvo allorgon e\ v|vo, thon varlous markors oí
tholr actlvatlon can bo dotormlnod (CAS1 ~ Collular Allorgon Stlmulatlon 1ost).
09 Dodig.p65 04.02.2008., 11:20 122
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S. Dodig: Current laboratory diagnosis of allergy
4. SPECIFIC IMMUNOTHERAPY MONITORING
Specific immunoLherapy (SIT) in tiirc moniLoring is burdened viLh a number of
problems, from Lhose relaLed Lo Lhe paLienL himself and Lhe immune paLhomechanisms
LhaL have led Lo Lhe developmenL of allergic disease, coadminisLraLion of sympLomaLic
and anLi-inflammaLory Lherapy, long-Lerm SIT (currenLly, no parameLers are available Lo
predicL viLh cerLainLy in Lhe early sLage of disease vheLher Lherapy vill evenLually
prove useful for Lhe paLienL), choice of biomarkers and defining Lheir cuL-off values
above or belov vhich Lhere is or Lhere is no proLecLive acLion of an immune sysLem
segmenL, Lhrough laboraLory procedures LhaL undergo rapid modificaLions and advanc-
es, Lhus Lhe resulLs obLained aL Lhe beginning of some longiLudinal sLudies cannoL be
reliably compared viLh Lhe resulLs recorded aL Lhe end of Lhe same sLudies or viLh Lhe
resulLs reporLed from oLher sLudies, in addiLion, many of Lhe laboraLory procedures LhaL
could be used Lo deLermine some key biomarkers (e.g., immunoglobulin subclasses, cell
subpopulaLions, cyLokines, eLc.) cannoL be employed in daily rouLine buL remain re-
served for scienLific research. ßesides clinical sympLoms, some sLudies also moniLored
resulLs of in titc (cuLaneous LesLing) and in tiirc LesLs |21,22], e.g., deLerminaLion of Lhe
concenLraLion of LoLal IgL and specific IgL |23], specific IgC |24,25], specific IgC4 and
IgC1 (IgC4/IgC1 raLio) |26], IgC2, lymphocyLe T subpopulaLion |27], proallergic cyLok-
ines (IL-4, IL-13 and IL-5), proinflammaLory cyLokines (IIN-γ, IL-2 and IL-12) |28], and
leukoLrienes |29]. IL should noL be forgoLLen LhaL moniLoring of Lhe severiLy of clinical
sympLoms in each individual paLienL is of paramounL imporLance in Lhe overall immu-
noLherapy moniLoring in paLienLs viLh allergic diseases.
LaLely, recombinanL allergens have been used vorldvide in Lhe diagnosis and in
SIT, enabling deLerminaLion of paLienL profile and use of individualized SIT, i.e. only
Lhose allergen deLerminanLs (epiLopes) Lo vhich hypersensiLiviLy has developed in Lhe
respecLive paLienL. AssessmenL of specific IgL and specific IgC4 concenLraLions during
immunoLherapy yields beLLer resulLs viLh Lhe use of recombinanL allergens Lhan viLh
Lhe usual allergen preparaLions |30].
lig. 3. Antl-lgL (a-lgL) blnds íroo lgL.
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S. Dodig: Current laboratory diagnosis of allergy
The adminisLraLion of monoclonal anLi-IgL (omalizumab) resulLs in free IgL block-
ing, Lhus reducing Lhe level of free IgL capable of binding Lo masLocyLes and basophilic
granulocyLes (Iig. 3) |31]. Therefore, deLerminaLion of LoLal IgL concenLraLion on Lhe
very firsL day of omalizumab adminisLraLion is useful Lo moniLor free IgL concenLraLion.
5. ASSESSMENT OF DIAGNOSTIC EFFICIENCY
DiagnosLic procedures are expecLed Lo be accuraLe, precise, sensiLive, specific, reli-
able, reproducible, and viLh minimal inLerfering facLors |32,33]. A prerequisiLe for Lhe
mosL efficienL use of diagnosLic LesLs is Lo knov Lheir limiLaLions, Lheir analyLical, prean-
alyLical and posLanalyLical inLerferences, and Lheir diagnosLic efficiency (i.e. sensiLiviLy,
specificiLy, posiLive and negaLive predicLive value, Lable 4). Lach healLhcare insLiLuLion
should deLermine diagnosLic value of every diagnosLic procedure in titc or in tiirc.
1ab/e 4. Dlagnostlc oíílcloncy oí total and sþoclílc lgL (lncludlng lhadlatoþ) and LCl dotormlna-
tlon (adaþtod írom 34, 35)
Analyto Sonsltlvlty Sþoclílclty losltlvo Nogatlvo
(°) (°) þrodlctlvo þrodlctlvo
valuo (°) valuo (°)
1otal lgL 97.1 93.3 94.5 96.6
lhadlatoþ - adults 70.8 90.7 72.6 89.9
lhadlatoþ - lníants 65.0 100.0 100.0 93.0
Sþoclílc lgL, asthmatlc chlldron
(De|natoµ|ago|oes µte|oojss|ous) 100.0 96.7 97.3 100.0
LCl, asthmatlc chlldron 97.4 100.0 100.0 96.8
6. PROBLEMS IN DIAGNOSIS OF ALLERGY
AlLhouh laboraLory invesLigaLions are a useful Lool in Lhe diagnosis and manage-
menL of allergic diseases many problems remain unsolved. Those problems can be
grouped inLo Lhree caLegories: preanalyLical (specimen collecLion), analyLical (LesLing)
and posL-analyLical (inLerpreLaLion, follov-up, reLesLing) phases of laboraLory LesLing.
6. 1. PreanaIyticaI probIems
Time of blood collecLion for deLerminaLion of LoLal IgL, specific IgL, LCI and eosi-
nophil counL, respecLively, could be imporLanL in cases of hypersensiLiviLy Lo:
º seasonal allergens (level of selecLed analyLes is greaLer in pollen season),
º insecL sLing allergens (vaning of allergen-specific IgL viLh Lime folloving expo-
sure), and
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S. Dodig: Current laboratory diagnosis of allergy
º drug allergens (long Lime elapsed beLveen Lhe adminisLraLion of Lhe drug and
specific IgL deLerminaLion vill resulL viLh negaLive specific IgL).
The eosiniphil release of LCI in viLro during cloLLing is Lime- and LemperaLure-
dependenL. LCI levels in serum increase viLh Lime as Lhe LCI release from Lhe
eosinophils vill conLinue unLil serum is separaLed from Lhe cells. Therefore Lhe
blood collecLion Lube, coagulaLion Lime and LemperaLure musL be kepL viLhin spec-
ified limiLs during cloLLing.
Increased concenLraLion of LoLal LrypLase acLiviLy can be deLecLed up Lo Lhree Lo six
hours afLer Lhe anaphylacLic reacLion. IL reLurns Lo normal value viLhin 12-14 hours
afLer release. Samples should preferably be collecLed beLveen 15 minuLes and 3
hours afLer Lhe suspecLed evenL causing masL cell acLivaLion |20].
6. 2. AnaIyticaI probIems
ToLal and specific IgL anLibody deLerminaLion in serum can produce differenL re-
sulLs depending on Lhe meLhod. Therefore sLandardized meLhods should be used.
6. 3. Post-anaIyticaI probIems
CorrelaLion of in tiirc LesLing viLh in titc LesLing as vell as viLh clinical finding is
Lhe mosL imporLanL for diagnosis and moniLoring of allergic disease |8,15]. Some prob-
lems can be specialized:
Under ideal condiLions, specific IgL deLerminaLion should provide resulLs concor-
danL viLh skin prick LesLing. Hovever, common allergen exLracLs are noL used in
Lhese Lvo meLhods.
In spiLe of Lhe facL LhaL reference inLervals for LoLal IgL are defined, 5 % of non-aLopic
sub|ecLs have increased LoLal IgL concenLraLion, and up Lo 10% of aLopic sub|ecLe
mighL have IgL concenLraLion inside Lhe reference inLervals |5].
SensiLisaLion alone does noL indicaLe clinically significanL hypersensiLiviLy. Con-
versely, a negaLive resulL does noL necessarily exclude clinically significanL allergy.
No single Lype of in tiirc LesL should be used as Lhe only diagnosLic LesL for food
allergy.
No biomarker can assess clinical course of allergic disease.
AlLhough effecLive SIT is accompanied by increase of allergen specific IgC/IgC4
anLibodies and decrease of LoLal/specific IgL anLibodies |24-26], as yeL, no early mark-
er can predicL Lhe final ouLcome of SIT.
In conclusion, iL should be noLed LhaL clinical biochemisLry laboraLories in CroaLia
included in Lhe CroaLian InsLiLuLe of HealLh Insurance sysLem perform mosL diagnosLic
procedures in Lhe field of allergology (e.g., eosinophilic granulocyLe counL, LoLal and
specific IgL concenLraLion, LCI, LrypLase) by use of sLandardized meLhods, Lhus making
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Rad. Medical Sciences, Zagreb, 2008., str. 117-128
S. Dodig: Current laboratory diagnosis of allergy
Lhe values obLained aL differenL laboraLories comparable. In addiLion, Lhese clinical bio-
chemisLry laboraLories are included in inLernaLional performance qualiLy assessmenL,
e.g., QualiLy Club (Iharmacia DiagnosLics), Lhus receiving reporLs on performance qual-
iLy in each individual laboraLory for parLicular analyLes on a monLhly basis.
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Sazotak
Suvrcmcna Iaboratorijska dijagnostika aIcrgijc
Zaht|ovl laboratorl|sko dl|agnostlko alorgl|sklh bolostl odnoso so na odablr anallza ko|o bl
trobalo. 1. odrodltl vrstu alorgl|sko roakcl|o otkrlvan|om humoralnlh (ukuþnl lgL) l stanlcnlh (bro|
oozlnoíllnlh odnosno bazoíllnlh granuloclta, oozlnoíllnl katlonskl þrotoln), 2. otkrltl þokrotaco
alorgl|sko roakcl|o (sþoclílcnl lgL na þo|odlnacno uzrocno alorgono, tostovl e\ v|vo aktlvacl|o bazo-
íllnlh granuloclta loukotrl|onl, CD63, hlstamln), 3. þrocl|onltl kllnlckl tl|ok roakcl|o (trlþtaza za
ranu roakcl|u, oozlnoíllnl katlonskl þrotoln za kasnu roakcl|u), 4. omogucltl þracon|o usþ|osnostl
sþoclílcno lmunotoraþl|o (ukuþnl l sþoclílcnl lgL, sþoclílcnl lgC4 l lgC1, om|or lgC4/lgC1, þroal-
orgl|skl l þrouþalnl cltoklnl), 5. odrodltl dl|agnostlcku d|olotvornost odrodlvan|a þo|odlnlh hu-
moralnlh lll stanlcnlh þosrodnlka alorgl|sko roakcl|o (os|otl|lvost, sþoclílcnost, þozltlvna l nogatlv-
na, þrodvldl|lva vrl|odnost).
lako su laboratorl|ska lstrazlvan|a korlsna u dl|agnozl l ll|ocon|u alorgl|sklh bolostl, bro|nl
þrobloml |os su norl|osonl. 1l so þrobloml mogu svrstatl u trl glavno katogorl|o. þroanalltlcka
(uzorkovan|o), analltlcka l þosll|oanalltlcka (tumacon|o, þracon|o, þonavl|no tostlran|o) íaza labo-
ratorl|skog odrodlvan|a.
KIjucnc rijcci. alorgl|a, lgL, bazoíllnl granulocltl, loukotrl|onl, lmunotoraþl|a
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