Donald J. Nalebuff

The study of IgE in the diagnosis of allergic disorders in an otolaryngology practice.

Within months after the identification of IgE as the reaginic antibody and principal trigger of immediate hypersensitivity reactions, several radioimmunoassays were developed for its detection in serum. Observations and results obtained with the use of two commercially available in vitro assays in the screening diagnosis of inhalant allergic disease are reported. Over 80% of suspected atopic patients tested had detectable specific IgE to at least two allergens. Both total and specific IgE determinations served useful roles in the recognition of clinically significant allergic disease. Results obtained with these procedures correlate well with information previously obtained only by skin test endpoint titration.

Determination of initial immunotherapy dose for ragweed hypersensitivity with the modified RAST test.

In this report we describe an immunotherapy regimen used in the management of 200 ragweed-sensitive patients. All patients were treated with immunotherapy doses inversely related to the level of allergen-specific IgE as measured by the modified RAST test. The starting doses that were given were significantly higher than those used with conventional approaches.

An Immunoperoxidase Method for the Demonstration of Allergen-Specific Ige in Serum

A solid-phase immunoenzymatic technique for the detection of allergen-specific IgE antibodies in serum is described. The binding of such antibodies to allergen insolubilized on cyanogen bromide-activated paper discs was detected by a subsequent two-step procedure involving the use of rabbit antihuman IgE and goat antirabbit IgG coupled with peroxidase. A solution of 3-3′ diaminobenzidine and hydrogen peroxide, employed as the color indicator system, turned the discs dark brown in positive cases. Discs carrying 11 different inhalant allergens were tested with sera containing allergen-specific IgE antibodies. Agreement between the results of this technique and the RAST was seen in 85% of 310 tests performed. In the clinical practice of otorhinolaryngologic allergy, this test may prove to be an important laboratory adjunct to clinical history and diagnostic skin test in the identification of the incriminated inhalant allergens.