Serum Specific IgE Testing Guidelines

Introduction to Serum Specific IgE Testing

The American Academy of Allergy, Asthma, and Immunology recommends ordering serum specific IgE testing by selecting allergens based on clinical history, using fluorescence enzyme-labeled immunoassays, and understanding that results indicate sensitization rather than clinical allergy, with a strength of evidence level of high 1, 2

The American Academy of Allergy, Asthma, and Immunology suggests ordering serum specific IgE instead of skin testing when extensive dermatitis or dermatographism prevents reliable skin testing, with a sensitivity of 70-75% compared to skin testing 1, 2, 3
The American Academy of Otolaryngology-Head and Neck Surgery recommends ordering serum specific IgE instead of skin testing when antihistamines cannot be discontinued, as serum IgE is unaffected by antihistamines, unlike skin tests, with a strength of evidence level of moderate 4
The American Academy of Pediatrics recommends ordering serum specific IgE instead of skin testing when the patient is uncooperative or a very young child, where blood draw is more practical, with a strength of evidence level of low 3

The American Academy of Dermatology recommends basing allergen selection on clinical history, including age, symptoms, geographic location, and suspected exposures, with a strength of evidence level of high 8
The American Academy of Allergy, Asthma, and Immunology suggests testing for common allergens such as cow's milk, eggs, wheat, soy, and peanut in children under 5 years with moderate-to-severe atopic dermatitis, with a sensitivity of 70.8% and specificity of 90.7% 8

The American Academy of Allergy, Asthma, and Immunology recommends understanding the diagnostic limitations of serum specific IgE testing, including a negative predictive value of >95% and a positive predictive value of 40-60%, with a strength of evidence level of high 1, 2, 8
The American Academy of Dermatology suggests that positive tests require confirmation with supervised oral food challenge, the gold standard, before dietary elimination, with a strength of evidence level of high 1, 2, 8

The American Academy of Otolaryngology-Head and Neck Surgery recommends avoiding ordering testing without clear clinical indication, as testing should confirm suspected allergens, not screen randomly, with a strength of evidence level of moderate 4, 3
The American Academy of Allergy, Asthma, and Immunology suggests avoiding diagnosing allergy based solely on positive serum IgE without clinical correlation, with a strength of evidence level of high 1, 2