Systematic review finds moderate to substantial concordance among fungal sIgE detection kits for asthma

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Frontiers in Medicine Published April 8, 2026 Medically reviewed May 26, 2026 DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Note variability in performance and thresholds among commercial fungal sIgE kits for asthma.

This systematic review analyzed 16 eligible human studies evaluating fungal allergens in asthma-related diseases. It examined 32 commercial fungal-specific IgE (sIgE) detection kits, which used various methods including enzyme immunoassays, immunoblots, and microarrays, and compared them to the ImmunoCAP reference method. The kits employed positivity thresholds ranging from 0.1 to 0.35 kUA/L.

The review found Aspergillus and Alternaria-specific IgE were the fungal allergens most commonly identified, while Cladosporium, Candida, or Trichophyton were less commonly detected. Concordance with ImmunoCAP ranged from moderate to substantial, with the strongest agreement reported for Alternaria. ImmunoCAP demonstrated the highest sensitivity and specificity among the methods analyzed. Emerging systems like the GOLD chip and MeDALL microarray showed promising improvements in multiplex capacity and detection limits. However, the review noted that several commercial assays have no publications documenting their diagnostic performance.

Safety and tolerability data were not reported. Key limitations of the evidence were not explicitly detailed in the provided data. The practice relevance suggests that standardizing cutoff thresholds and incorporating recombinant fungal allergens are crucial for strengthening diagnostic precision and improving the clinical management of fungal asthma. The findings highlight significant variability in available diagnostic tools.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedApr 2026

View Original Abstract ↓

Documenting fungal sensitization plays a pivotal diagnostic role in asthma endotypes. Diagnosis relies heavily on detecting fungal-specific immunoglobulin E (sIgE), yet variability in allergen representation, cross-reactivity, and assay performance complicates standardization. Although ImmunoCAP is regarded as the reference method, many commercial kits are available worldwide, with varying accuracy. A scoping review was conducted using Arksey and O'Malley's five-stage framework. Literature searches in PubMed, Scopus, and ProQuest MEDLINE identified studies comparing fungal sIgE detection kits. Inclusion criteria required human studies evaluating fungal allergens in asthma-related diseases. Data from 16 eligible studies and 32 diagnostic kits were analyzed, focusing on assay characteristics, concordance, sensitivity, and specificity. There are 32 commercial kits available, which vary in detection principles, including enzyme immunoassays, immunoblots, and microarrays, with positivity thresholds ranging from 0.1 to 0.35 kUA/L. Most assays identified Aspergillus and Alternaria-specific IgE, while fewer detected Cladosporium, Candida, or Trichophyton. Concordance with ImmunoCAP ranged from moderate to substantial, with the strongest agreement reported for Alternaria. ImmunoCAP demonstrated the highest sensitivity and specificity; however, emerging systems, such as the GOLD chip and MeDALL microarray, showed promising improvements in multiplex capacity and detection limits. Meanwhile, several commercial assays have no publications documenting their diagnostic performance. Fungal sIgE detection remains heterogeneous. Newer microarray-based assays offer enhanced sensitivity and broader allergen profiling. Standardizing cutoff thresholds and incorporating recombinant fungal allergens are crucial for strengthening diagnostic precision and improving the clinical management of fungal asthma.