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An Introduction to Metabolic Medicine
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Another category involves patients who are less seriously ill. This includes those with defined food allergies, in particular, celiac and other forms of gluten sensitivity. We perform radioallergosorbent test (RAST) testing and other laboratory measurements through the hospital lab or LabCorp, Quest, etc. We generally do not draw labs in our office for the proprietary facilities and do not use unproven methods. Our office does not perform allergy skin testing although this is a popular choice for other weight loss practices.
In vitro Laboratory Tests for the Diagnosis of Allergy
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Vijaya Knight, Preveen Ramamoorthy, Ronald J Harbeck
Shortly after the discovery of IgE, the radioallergosorbent test (RAST) was introduced for the detection of allergen specific IgE in patient’s serum (Wide et al. 1967). As originally described this non-competitive, solid phase assay consisted of incubating a patient’s serum with an allergen that is conjugated to a cellulose paper disk that has been activated with cyanogen bromide (Ceska and Lundkvist 1972). If allergen-specific IgE is present, it binds to the paper disk and unbound antibodies are washed away after the incubation period. IgE bound to the allergen is then detected by the addition of a radiolabeled (typically 125I) antihuman IgE directed toward the Fc region. The amount of bound radiolabeled antihuman IgE is measured in a gamma counter and the radioactivity measured is proportional to the amount of allergen specific IgE present in the initial serum sample.
Nutrition as treatment
Published in Geoffrey P. Webb, Nutrition, 2019
Skin prick tests are now widely used to identify causes of food allergy; small amounts of potential allergens are injected into the skin and the extent of any inflammatory skin reaction is then used to assess sensitivity. A positive skin test does not automatically mean that a person will have an allergic reaction to that substance when it is given by mouth although a negative response means that the substance is an unlikely cause of allergic symptoms. Skin prick tests are useful in confirming a suspected allergy and in deciding which foods might need to be considered in challenge tests. The radioallergosorbent test (RAST) is a more expensive alternative to skin prick tests; it assesses the amount of specific IgE present in a patient’s blood. The patient’s serum is reacted with an allergen which is adsorbed onto a solid paper matrix and the specific IgE in the serum will compete with added radioactive IgE for binding to this antigen. The more specific IgE there is in the patient’s blood the less radioactivity will remain on the paper.
The role of supervised school therapy in poorly controlled asthma in children
Published in Baylor University Medical Center Proceedings, 2023
Muppala Raju, Malvika Sagar, Andrew Bush, Eugene Quaye, Shekhar Ghamande, Sonal Malhotra, Mercedes E. Arroliga
Thirty-four patients were included in the study. Two patients were excluded from final statistical analysis: one did not start the prescribed ICS at school, and the other was diagnosed with anxiety disorder and had several admissions to the hospital likely from panic attacks. Our final analysis included 32 patients. Sixty-five percent of the children were African American, and 68% were male. Most patients (68%) had Medicaid insurance. The median age was 11 years (range 4–16) (Table 1). The median Asthma Control Test score was 18 (range 3–22). Most patients (72%) had a positive skin test for allergies, and 47% had a positive radioallergosorbent test for >3 allergens. The median IgE was 764 kU/L (range 6–6543). Median exhaled nitric oxide was 29 ppb (range 5–96) (Table 2). Eight patients were on biologics therapy. Allergic allergen immunotherapy was not possible for many of these patients with poorly controlled asthma due to an increased risk of severe allergic reactions to it and other social factors like scheduling conflicts for parents, since those shots require frequent administration in the clinic.
Allergy and Dry Eye Disease
Published in Ocular Immunology and Inflammation, 2021
Andrea Leonardi, Rocco Luigi Modugno, Elena Salami
In vitro assays such as radioallergosorbent test (RAST), capture or reverse enzyme-linked immunosorbent test (ELISA), or allergen microarrays are used in daily practice since they allow to search for a large number of allergen-specific IgE and results, presented in a semi-quantitative fashion, are more easily interpreted by non-allergy experts. However, in vitro assays are limited by the fact that only nanograms of specific IgE are present in the serum and allergen-specific serum IgG compete with IgE for allergen binding. Therefore, false-negative results are common.60,61 The skin prick test (SPT) is still considered the gold-standard for allergen-specific IgE detection. SPT false negatives are uncommon; so that negative results make the presence of IgE-mediated allergic reactivity unlikely. Similarly, positive results must always be interpreted in conjunction with the clinical findings. Differently from in vitro assays, SPT also allows for the measurement of IgE biological activity.62–64
Association of upper and lower airway eosinophilic inflammation with response to omalizumab in patients with severe asthma
Published in Journal of Asthma, 2020
Makoto Kurokawa, Toshiyuki Koya, Hiroyuki Takeuchi, Masachika Hayashi, Takuro Sakagami, Kojiro Ishioka, Yasuhiro Gon, Takashi Hasegawa, Toshiaki Kikuchi
The study participants included 16 patients (12 women and 4 men) diagnosed with severe asthma and perennial allergies, as determined by the radioallergosorbent test (RAST). These patients were treated with omalizumab in combination with high dose ICS and a long-acting β-agonist at the Niigata University Medical and Dental Hospital from September 2011 to August 2015. The criteria for severe asthma have been reported previously [3]. Omalizumab doses were calculated, based on the total serum IgE levels and the patients’ body weight, based on the manufacturer’s instructions. This study was conducted in accordance with the Ethical Principles for Medical Research Involving Human Subjects, the Declaration of Helsinki, and with the approval of the Ethics Committee of Niigata University (approval no. 956). All participants provided written informed consent before enrollment.