One is perplexed that neither the article titled "Validation of the Diagnostic Criteria for Atopic Dermatitis" by Firooz et al1 nor the accompanying editorial titled "Diagnostic Criteria for Atopic Dermatitis: Where Do We Go From Here?" by Williams2 address an elevated IgE level as a diagnostic criterion for atopic dermatitis. To quote John Hanifin, MD, an internationally renowned expert on atopic dermatitis, "Numerous studies have established the fact that serum IgE levels are elevated in most patients with atopic dermatitis, and that the degree of elevation tends to parallel the extent and severity of the disease in most instances."3 All criteria mentioned are observer-dependent; therefore, at least to some extent, dependent on individual interpretation, and thus potentially subjective. An accurately performed test for an elevated IgE level has a sensitivity for atopic dermatitis of approximately 80%, considerably higher than the 69% of the criteria stated and, in theory, should have a specificity of at least 96% of that criteria.4
Fisher DA. IgE Level and the Validation of the Diagnostic Criteria for Atopic Dermatitis. Arch Dermatol. 1999;135(12):1550–a–1551. doi:10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-135-12-dlt1299
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