Background: An increasing number of studies have recently discussed whether provocation tests might be replaced by specific IgE serology in patients sensitized to airborne allergens.
Objective: Our study aimed to analyze the concordance between a nasal provocation test with Dermatophagoides pteronyssinus and specific IgE measurements based on real-life data.
Patients and Methods: We retrospectively analyzed concordance between the result of the provocation test and the IgE titer for house dust mite components and extracts in 223 patients with proven sensitization to D pteronyssinus.
Results: In contrast to findings from other studies, the anti–Der p 1 level alone was not sufficient to distinguish between silent sensitization and allergy to D pteronyssinus. ROC curve analysis revealed that the sum of sIgE against Der p 1 and Der p 2 is—after adjustment for total serum IgE—the best parameter for discriminating between clinically silent and relevant sensitization. However, it does not have sufficient validity to confirm a diagnosis.
Conclusions: Despite the high correlation between sIgE levels and symptoms, no serologic parameter is sufficiently accurate to distinguish between silent sensitization and clinically relevant allergy. Therefore, nasal provocation tests remain the gold standard for assessing clinical relevance in sensitization to D pteronyssinus.

Key words: Correlation, IgE serology, Nasal provocation test, Allergy, Sensitization, House dust mite