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Baker’s Asthma: Is the Ratio of Rye Flour-Specific IgE to Total IgE More Suitable to Predict the Outcome of Challenge Test Than Specific IgE Alone

  • V. van Kampen
  • I. Sander
  • R. Merget
  • T. Brüning
  • M. Raulf
Part of the Advances in Experimental Medicine and Biology book series


Usually the diagnosis of baker’s asthma is based on specific inhalation challenge with flours. To a certain extent the concentration of specific IgE to flour predicts the outcome of challenge test in bakers. The aim of this study was to evaluate whether the ratio of specific IgE (sIgE) to total IgE (tIgE) improves challenge test prediction in comparison to sIgE alone. Ninety-five bakers with work-related respiratory symptoms were challenged with rye flour. Total IgE, sIgE, and the sIgE/tIgE ratio were determined. Receiver operator characteristic (ROC) plots including the area under the curve (AUC) were calculated using the challenge test as gold-standard. Total IgE and sIgE concentrations, and their ratio were significantly higher in bakers with a positive challenge test than in those with a negative one (p < 0.0001, p < 0.0001, and p = 0.023, respectively). In ROC analysis, AUC was 0.83 for sIgE alone, 0.79 for tIgE, and 0.64 for the ratio. At optimal cut-offs, tIgE, sIgE, and the ratio reached a positive predicted value (PPV) of 95%, 84% and 77%, respectively. In conclusion, calculating the ratio of rye flour-sIgE to tIgE failed to improve the challenge test prediction in our study group.


Allergy Baker’s asthma Immunoglobulin E Inhalation challenge Occupational allergy Rye flour 



We gratefully acknowledge Ursula Meurer who performed the IgE measurements.

Conflicts of Interest

The authors declare no conflicts of interest in relation to this article.


  1. Ahmad Al Obaidi AH, Mohamed Al Samarai AG, Yahya Al Samarai AK, Al Janabi JM (2008) The predictive value of IgE as biomarker in asthma. J Asthma 45:654–663CrossRefPubMedGoogle Scholar
  2. Buslau A, Voss S, Herrmann E, Schubert R, Zielen S, Schulze J (2014) Can we predict allergen-induced asthma in patients with allergic rhinitis? Clin Exp Allergy 44:1494–1502CrossRefPubMedGoogle Scholar
  3. Chang M-L, Cui C, Liu Y-H, Pei L-C, Shao B (2015) Analysis of total immunoglobulin E and specific immunoglobulin E of 3,721 patients with allergic disease. Biomed Rep 3:573–577CrossRefPubMedPubMedCentralGoogle Scholar
  4. DGUV (2015) Deutsche Gesetzliche Unfallversicherung Statistics, Sankt Augustin (in German)Google Scholar
  5. Douglas TA, Kusel M, Pascoe EM, Loh RK, Holt PG, Sly PD (2007) Predictors of response to bronchial allergen challenge in 5- to 6-year-old atopic children. Allergy 62:401–407CrossRefPubMedGoogle Scholar
  6. Fernández C, Cárdenas R, Martín D, Garcimartín M, Romero S, de La Cámara AG, Vives R (2007) Analysis of skin testing and serum-specific immunoglobulin E to predict airway reactivity to cat allergens. Clin Exp Allergy 37:391–399CrossRefPubMedGoogle Scholar
  7. Grabenhenrich L, Lange L, Härtl M, Kalb B, Ziegert M, Finger A, Harandi N, Schlags R, Gappa M, Puzzo L, Stephan V, Heigele T, Büsing S, Ott H, Niggemann B, Beyer K (2016) The component-specific to total IgE ratios do not improve peanut and hazelnut allergy diagnoses. J Allergy Clin Immunol 137:1751–1760CrossRefPubMedGoogle Scholar
  8. Gupta RS, Lau CH, Hamilton RG, Donnell A, Newhall KK (2014) Predicting outcomes of oral food challenges by using the allergen-specific IgE-total IgE ratio. J Allergy Clin Immunol Pract 2:300–305CrossRefPubMedGoogle Scholar
  9. Horimukai K, Hayashi K, Tsumura Y, Nomura I, Narita M, Ohya Y, Saito H, Matsumoto K (2015) Total serum IgE level influences oral food challenge tests for IgE-mediated food allergies. Allergy 70:334–337CrossRefPubMedGoogle Scholar
  10. Jarvis D, Luczynska C, Chinn S, Potts J, Sunyer J, Janson C, Svanes C, Künzli N, Leynaert B, Heinrich J, Kerkhof M, Ackermann-Liebrich U, Antó JM, Cerveri I, de Marco R, Gislason T, Neukirch F, Vermeire P, Wjst M, Burney P (2005) Change in prevalence of IgE sensitization and mean total IgE with age and cohort. J Allergy Clin Immunol 116:675–682CrossRefPubMedGoogle Scholar
  11. Kerkhof M, Dubois AE, Postma DS, Schouten JP, de Monchy JG (2003) Role and interpretation of total serum IgE measurements in the diagnosis of allergic airway disease in adults. Allergy 58:905–911CrossRefPubMedGoogle Scholar
  12. Kleine-Tebbe J (2012) Old questions and novel clues. Complexity of IgE repertoires. Clin Exp Allergy 42:1142–1145CrossRefPubMedGoogle Scholar
  13. Mehl A, Verstege A, Staden U, Kulig M, Nocon M, Beyer K, Niggemann B (2005) Utility of the ratio of food-specific IgE/total IgE in predicting symptomatic food allergy in children. Allergy 60:1034–1039CrossRefPubMedGoogle Scholar
  14. Muñoz X, Cruz MJ, Bustamante V, Lopez-Campos JL, Barreiro E (2014) Work-related asthma. Diagnosis and prognosis of immunological occupational asthma and work-exacerbated asthma. J Investig Allergol Clin Immunol 24:396–405PubMedGoogle Scholar
  15. Soares-Weiser K, Takwoingi Y, Panesar SS, Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Halken S, Poulsen L, van Ree R, Vlieg-Boerstra BJ, Sheikh A (2014) The diagnosis of food allergy. A systematic review and meta-analysis. Allergy 69:76–86CrossRefPubMedGoogle Scholar
  16. van Kampen V, Rabstein S, Sander I, Merget R, Brüning T, Broding HC, Keller C, Müsken H, Overlack A, Schultze-Werninghaus G, Walusiak J, Raulf-Heimsoth M (2008) Prediction of challenge test results by flour-specific IgE and skin prick test in symptomatic bakers. Allergy 63:897–902CrossRefPubMedGoogle Scholar
  17. Vandenplas O, Froidure A, Meurer U, Rihs H-P, Rifflart C, Soetaert S, Jamart J, Pilette C, Raulf M (2016) The role of allergen components for the diagnosis of latex-induced occupational asthma. Allergy 71:840–849CrossRefPubMedGoogle Scholar
  18. Vandenplas O, Suojalehto H, Cullinan P (2017) Diagnosing occupational asthma. Clin Exp Allergy 47:6–18CrossRefPubMedGoogle Scholar
  19. Vultaggio A, Virgili G, Gaeta F, Romano A, Maggi E, Matucci A (2015) High serum β-lactams specific/total IgE ratio is associated with immediate reactions to β-lactams antibiotics. PLoS One 10(4):e0121857CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG  2018

Authors and Affiliations

  • V. van Kampen
    • 1
  • I. Sander
    • 1
  • R. Merget
    • 1
  • T. Brüning
    • 1
  • M. Raulf
    • 1
  1. 1.Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA)BochumGermany

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