Jiwon Lee, M.D.
Department of Laboratory Medicine
The MAST allergy Plus panel 54 is a test that enhances the diagnostic accuracy of allergic diseases by adding 54 additional allergens to the existing MAST allergy panel 108 test. This test includes rare and component-specific allergens that were not identified in the existing MAST allergy panel 108 test, thereby detecting allergenic factors that may have been overlooked. It provides more detailed information depending on the patient’s condition. It allows for component-specific allergen analysis of major food allergens such as egg, milk, and wheat, which helps identify the exact cause of allergic symptoms and aids in setting appropriate treatment directions.
The MAST allergy Plus panel 54 tests three categories of allergens: food, environmental and others, and animal allergens. Food allergens include egg, milk, gluten, melon, grape, lemon, oyster, etc. Environmental allergens include storage mite, Malassezia spp., Trichophyton rubrum, olive tree, ragweed, etc. Animal allergens include mosquito, cockroach, chicken feathers, and fire ant — these are allergens that can be analyzed exclusively in domestic MAST tests.
Test Principle
The MAST allergy Plus panel 54 is based on the principle of the multiple allergen simultaneous test using immunoblotting technology. It detects specific IgE antibodies in serum to evaluate the degree of response to allergens. All processes from specimen distribution to result analysis are fully automated.
The test is conducted by collecting a blood specimen, which is then processed using automated equipment. The total test duration is approximately 3.5 to 4.1 hours.
When specific IgE or total IgE is present in the specimen, it binds to a specific allergen or anti-hlgE immobilized on the allergen strip. The bound IgE then reacts with biotinylated anti-hlgE in the antibody solution, which then binds with streptavidin alkaline phosphatase in the enzyme solution. In the final step, alkaline phosphatase reacts with the chromogenic solution p-nitro blue tetrazolium chloride (NBT) and 5-bromo-4-chloro-3-indolyl phosphate (BCIP) to produce a purple insoluble product at the allergen band fixed on the membrane of the strip. Once the reaction is complete, the instrument calculates the intensity of the color as the amount of IgE antibody in the specimen. Specific IgE is semi-quantitatively reported in Class 0 to 6, and total IgE is qualitatively reported.
The final test result includes the strength of the IgE response and the positivity for each allergen, allowing the identification of allergen types and IgE response intensity. This is particularly useful for evaluating the effectiveness of allergy treatment or conducting follow-up testing in relation to the patient's clinical symptoms.
Fig. 1. Principle of the MAST allergy Plus panel
Ref) Invitros AlloScreen Max Plus Panel test guide
Allergen List
Table 1. Allergen list of MAST allergy Plus panel 54
Component-specific Allergens
Component-specific allergen analysis for egg, milk, and wheat is one of the major strengths of the MAST Allergy Plus Panel 54. Egg component allergens include ovalbumin and ovomucoid. Ovomucoid is heat-stable and and has a significant impact on the severity and persistence. Milk component allergens include lactalbumin and casein. Casein accounts for 80% of milk protein, is heat-resistant, and may cause persistent milk allergy. Gluten, the main wheat component allergen, is formed by the combination of glutenin and gliadin, which are found in wheat, barley, and oats. It can trigger symptoms not only from wheat but also when consuming other grains such as rye and barley. Gluten is insoluble and does not easily pass through the intestinal mucosa, but after exercise, increased blood flow may allow temporary absorption through the intestinal mucosa. This can be a major cause of food-dependent exercise-induced anaphylaxis. Therefore, special caution is needed in patients with wheat allergy.
Fig. 2. Component-specific allergens in the MAST Allergy Plus Panel
Ref) Invitros AlloScreen Max Plus Panel test guide
Test Subjects and Utility
The test is applicable to a wide range of patients, including those with respiratory and skin allergic conditions such as asthma, allergic rhinitis, atopic dermatitis, and chronic urticaria, as well as patients with food allergies who experience urticaria, digestive symptoms, or anaphylaxis following the ingestion of specific foods. It is also suitable for patients who have persistent allergic symptoms despite negative results from the existing MAST allergy panel 108 test, or for those with elevated total IgE levels. This allows the identification of additional allergenic causes not detectable through conventional testing and provides detailed diagnostic insight into the patient’s allergic condition.
The MAST allergy Plus panel 54 complements the limitations of the conventional MAST allergy panel 108 and serves as an important tool in allergy diagnosis and in the formulation of treatment strategies. Its in-depth analysis, including component-specific and rare allergens, enables precise identification of allergenic triggers, which holds great potential for significantly improving the patient’s quality of life.
Cautions in Interpreting Test Results
While the MAST test provides the advantage of testing multiple allergens from a single blood draw, it has lower sensitivity and specificity compared to the single-allergen quantitative ImmunoCAP (Phadia, Sweden) test. Cross-reactivity can occur between geographically or biologically similar allergens, so careful interpretation is required. If a positive result is obtained in the MAST test, or if the result does not align with the clinical picture (such as the patient's medical history), confirmation with ImmunoCAP testing is recommended. Additionally, the total IgE value reported in the MAST test is qualitative, and may differ from the quantitative result obtained through ImmunoCAP total IgE testing. Therefore, it is recommended to use it for reference purposes only.
References
01. Invitros. AlloScreen Max Plus Panel test brochure. Invitros; 2024.
02. Invitros. AdvanSure AlloScreen Max Plus Panel [package insert]. Invitros; 2024.
03. The Korean Academy of Asthma, Allergy and Clinical Immunology. Asthma and allergic diseases. Seoul: Yeomungak; 2012. p. 171–203.
04. Clinical and Laboratory Standards Institute (CLSI). Analytical performance characteristics and clinical utility of immunological assays
for human immunoglobulin (IgE) antibodies and defined allergen specificities; approved guidelines. 2nd ed.
Wayne (PA): Clinical and Laboratory Standards Institute; 2009. (CLSI document I/LA20-A2).
05. Chung SJ, Shim J, Kim HJ, Sohn KH, Kang SY, Kang MG, et al. Analysis of clinical characteristics of food-dependent exercise-induced anaphylaxis at a single tertiary hospital. Allergy Asthma Respir Dis. 2016 Nov;4(6):436–441.
06. Gantulga P, Lee J, Jeong K, Jeon SA, Lee S. Variation in the allergenicity of scrambled, boiled, short-baked and long-baked egg white proteins. J Korean Med Sci. 2024 Jan;39(6):e54.
Test Information
GC Labs code | Test item |
Q498 |