FAQs
Taking a Test
As blood test results are best interpreted with clinical findings and family history, you
should seek your doctor’s advice so relevant tests for your condition are appropriately
prescribed.
After the doctor’s consultation, the clinic will assist in completing the sample laboratory
request form below. You may have your blood samples drawn either directly at the clinic
or by our phlebologists.
If the tests you are doing require fasting, you should fast for at least 12 hours after a
normal meal.
You can drink plain water during the fasting period.
Test Results
Your laboratory report will be sent to your doctor when completed.
Test results will only be released directly to the doctor who ordered the tests. This is
because test results need to be reviewed by your doctor for an in-depth explanation and
interpretation of your results.
Laboratory results should only be interpreted together with clinical findings and family
history. Therefore your doctor is the best person to interpret your laboratory results.
Different tests have different turnaround times for the completion of the tests. It can
range between an hour to 14 days. Please check with your doctor for more information.
To maintain confidentiality, test results will be directly shared only with the physician who
ordered them. However, if the ordering physician requests on the lab request form, we
can also share results with co-managing physicians involved in the patient’s care.
Ordering Tests
This depends on the status of the sample. Please check with the clinic as soon as
possible so that we can conduct the relevant checks on whether we can assist you with
the request.
Yes, if a profile you are looking for is not an existing profile listed in our laboratory
services guide, please email angsana.ops@angsanalabs.com so that we can specially
tailor profiles to cater to your needs.
While we only accept samples during outpatient lab opening hours, samples continue to
be processed after hours. After opening hours, samples will be sent through or collected
by our dispatch. Additional charges will apply.
Molecular Oncology
Tumor specimens are commonly preserved as FFPE samples. Unfortunately formalin fixation can often cause base deamination, resulting in sequencing artifacts. For example, a cytosine on the negative strand is deaminated into a uracil. In traditional opposing primer-based enrichment, the uracil is transcribed into an adenine and the artifact is amplified during PCR. Because amplification occurs before any type of adapters are added to the amplicons, strand specificity is lost, and therefore the sequence analysis will cause a false-positive C to T single nucleotide variant. On the other hand, Anchored Multiplex PCR-based enrichment identifies these deamination events because Molecular Barcode Adapters are ligated to the DNA prior to amplification. Combined with strand- specific primers, AMP maintains the ability to differentiate between positive and negative strand readouts during sequence analysis. So the same C to T transition detected on all negative strands clearly indicates a false-positive SNV, and thus no mutation is called. Let’s take a look at actual sequencing data. If this were data from opposing primer-based enrichment, the prevalence of a C to T transition in an FFPE screen would indicate an NRAS G13D variant prevalent in non-small cell lung cancer. But because AMP preserves strand specificity, all of the C to T transitions were detected on the negative strand, demonstrating with extremely high statistical confidence that this was, in fact, an FFPE deamination. Anchored Multiplex PCR is better than traditional opposing primers because strand-specific priming allows you to identify and correct for deamination events that would otherwise lead to false-positive results.
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Mutations that drive oncogenesis and disease progression come in all forms, including gene fusions, which can be identified and characterized by sequencing a fusion transcript. Traditional opposing primer based library preparation methods require target and fusion specific primers that define the region to be sequenced. After amplification, adapters are then ligated to the DNA for further amplification and sequencing. The problem with detecting fusions this way is that you need primers that flank the target region and the fusion partner, so only known fusions can be detected. Anchored Multiplex PCR enables you to detect the target of interest, plus any known and unknown fusion partners. This is because AMP uses target-specific uni-directional primers, along with reverse primers, that hybridize to the sequencing adapter that is ligated to each fragment prior to amplification. With this approach, your target region, plus any known or novel fusion partners, are selectively amplified for sequencing. This increases the analytical sensitivity of your fusion assay by eliminating false negatives due to novel variants or fusions.
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Allergy and Molecular Allergology
Yes. Reducing exposure to one or more allergic triggers can help reduce symptoms and the need for medication (1). This can only be accomplished by knowing your patient’s unique allergy profile.
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It is common to confuse the terms food allergy and food intolerance. However, they do not mean the same thing. Food intolerance, unlike food allergy, does not involve the immune system and is not life-threatening. Lactose intolerance, trouble digesting the milk sugar lactose, is a common example. Symptoms usually include bloating, abdominal cramps and diarrhea.
Food allergy, on the other hand, does involve the immune system. It occurs when the body produces IgE antibodies to a certain food. Common symptoms are hives and asthma.
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The development of allergy in relation to age can be described as an “allergy march”. This means that there is often a given direction, once atopic immune responses associated with IgE antibodies have been initiated and induced the atopic state.
The manifestation of atopic disease varies considerably with the age of the child, as do the allergens involved. In infancy allergies to foods seem to be the most common, after the age of 3 allergy to inhalant becomes predominant. New causative allergens could be added due to higher concentrations of exposure, or as quite new allergens. However, the immune system tends to be less active in older days (2).
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Around 35% of the population have allergic symptoms, although the frequency of allergy may vary from one country to another.
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Genetic factors determine how easily and how strongly the individual will become sensitized and how much IgE antibodies will be produced. Sensitization, inflammation and irritation of tissue may develop differently in individual patients, subsequent to different exposures.
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The child usually grows out of milk and egg white allergy, while allergies to foods such as nuts and fish tend to remain in later years. Specific IgE-antibodies to food allergens in younger years constitute an early predictor for developing atopic disease and for IgE production to inhalant allergens later in life.
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The incidence of adverse reactions to drugs of the overall adult population is estimated to be around 15%. Numerous mechanisms are implicated in drug allergy and the incidence of immediate drug reactions (Type I) seems to be very low in comparison with allergy to more common allergens such as pollens and pets. The incidence of allergy to penicillins is 1/1000 administrations, i.e. 0.7 to 10% of treatments (3).
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Yes, one can become allergic throughout life, but the symptoms more often occur early in life. However, it could happen later in life due to the introduction of new allergens or an increased allergen load.
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Skin tests and blood tests are both used to diagnose IgE-mediated reactions to allergens. A positive test depends not only on IgE antibodies, but also on mast cell integrity and vascular and neural responsiveness. Under ideal conditions, skin prick/puncture testing provides results concordant with optimized in vitro IgE antibody tests. However, skin tests are not quantitative, and the result cannot be compared between clinics. In contrast to in vitro tests, skin tests depend on the status of the skin, and are influenced by medication and by the way the test is performed. There is a small but definite risk of systemic reactions induced by skin tests (4).
Another difference is the standardization. SPT results depend on the quality of the extract, the skill of the person performing the test, the location of the skin test site, and on medical treatment. To achieve good standardization, all these parameters must be well controlled, which is not easy. In contrast, ImmunoCAP IgE determinations are standardized by the test manufacturer and the testing laboratory is assessed by means of international or national quality assessment programs such as NEQAS in the UK. This ensures excellent standardization.
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Over 30% of children with atopic dermatitis may have food allergy (5). In adults the figure is somewhat lower (6).
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It is particularly important for children and adolescents to be aware of “hidden allergens” in different foods, i.e. allergens in foods that are not visually seen or fully declared. This group of young people is especially vulnerable to commercially prepared foods where the risk of hidden allergens is greatest. It is therefore important to educate patients to read and understand food labels. Unfortunately, there are examples of misleading food labels and incomplete lists of ingredients.
There are also examples of cross-contamination of food. Since accurate labels alone will not suffice, patients (and others responsible for caring for the young) must be equipped and taught to manage their acute, unexpected anaphylactic allergic reactions to ingested allergens. Peanut, nuts, milk, egg, and seafood are the foods most often implicated in unexpected anaphylactic reactions.
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If patients are allergic to one food, they may also show reactivity to other foods belonging to the same biological family. Foods contain a lot of different allergens, and a patient may be sensitized to one or a few of these. Furthermore, one food might contain the same allergen as another, although it is never certain that a patient will react clinically to both foods.
The most well-documented cross-reactivity is the one which occurs between apple and birch pollen. Nevertheless, all apple allergics are not necessarily allergic to birch pollen. Cross-reactivity can never be assumed. Under no circumstances should important foods be eliminated from the diet without appropriate testing and clinical diagnosis.
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Studies have shown that IgE antibodies are stable in serum samples after storage at -20º C for years.
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Studies have been performed of EDTA-, heparin-, and citrate-plasma, as well as of hemolytic, icteric, and lipemic samples. No significant difference in the results was found using these types of samples, compared to serum.
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Yes, serum from capillary blood and serum from venous blood will give identical results when testing for total IgE, specific IgE and Phadiatop in ImmunoCAP (7, 8, 9).
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Most wood dusts contain a variety of chemicals causing irritation and, presumably, type IV (T-cell) sensitization, but are not generally known to be involved in IgE mediated reactions. There are some exceptions, however. Some types of tropical wood have for instance been shown to cause IgE mediated reactions.
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When samples are heat-treated, some proteins undergo steric changes that can be irreversible or partly irreversible. Very high temperatures (boiling) can destroy the proteins completely.
It is known that some parts of the IgE molecule (e.g. the receptor binding part) change their conformation during heat-treatment (56° C for 30 minutes).
In ImmunoCAP tests for total IgE (tIgE) and allergen specific IgE (sIgE) stable epitopes of the IgE molecule are used for the anti-IgE antibody conjugate attachment. Mild heat treatment therefore has no influence on the IgE test results.
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IgE is present in the circulation at birth, although normally in very low concentrations. In some countries total IgE screening programs, for detection of children at risk for future allergy problems, are carried through on newborn babies. Expected values for children from the age of 6 weeks have been determined for ImmunoCAP Total IgE.
Capillary blood can be used for testing.
Cow’s milk is a major cause of adverse reaction in infants. Reports of the prevalence of IgE-mediated reactions to milk in infants range from 0.5–7.5 %.
Allergy to egg is also very common in infants.Egg-specific IgE antibodies are usually the earliest antibodies appearing in children developing atopic disease . Measurement of egg white specific IgE (Pharmacia CAP System) at 6 months of age has been shown to be a very effective predictor of allergy to house dust mite during the first 5 years of life.
Expected values for specific IgE are not age-dependent.
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The detection of IgE antibodies indicates that the sensitization process has been initiated. Along with symptoms and a positive case history it confirms the causative allergen, but without symptoms it may predict later development of allergic disease. It is often seen that specific IgE antibody responses are preceding the symptoms, but the symptoms catch up with time. In children it could also be seen that the IgE antibodies, i.e. to cow’s milk, remain in the serum for a period after tolerance has been induced.
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Standardization is based on the use of a panel of patient sera for which IgE antibody screening and immunoblotting have been performed. A reference source material is chosen after comparison of at least 5 different lots against these sera. Whenever a new lot of source material shall be taken in use, it must meet the specifications of the reference source material. Thus, in combination with ImmunoCAP quality control specifications for performance, maximal reproducibility is obtained.
Reference
- NIH. Guidelines for the Diagnosis and Management of Asthma, 2007. NIH publication 08-4051.
- Niemeier NR, de Monchy JG. Age-dependency of sensitization to aero-allergens in asthmatics. Allergy 1992;47:431-5.
- Daniel Vervloet, Michel Pradal. Drug Allergy. Sundbyberg: S-M Ewert AB, 1992:4, 55.
- Nelson HS. Variables in allergy skin testing. Allergy Proc 1994;15(6):265-8
- Sampson HA. The role of food allergy and mediator release in atopic dermatitis. J Allergy Clin Immunol 1988;81:635-645.
- Ring J. Nahrungsmittelallergie und atopische Ekzem. Allergologie 1984;7:300-306.
- Liappis, N; Berdel, B. Determination of total IgE and of specific IgE in the serum of capillary blood. Allergologie;1998;11:10-12.
- Lilja, G; Magnusson C G; et al. Neonatal IgE levels and three different blood sampling techniques. Allergy;1992;47:522-526.
- Bauer, C; Atopy screening in children: Total IgE, Phadiatop, and RAST multiple food allergen disc performed on capillary blood samples. Allergologia e Immunologia Clinica; 1987; 2:95.
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Fetal Maternal Health
The Panorama prenatal screen is designed for women of any age and ethnicity who are at least 9 weeks pregnant. It cannot currently be used by women carrying three or more babies (triplets and above), women who have used an egg donor or surrogate carrying more than one baby (twins or triplets), or those who have received a bone marrow transplant.
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Panorama can be performed as early as 9 weeks into the pregnancy.
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As early as nine weeks into your pregnancy, a simple blood draw can tell you if your baby is at higher risk for having Down syndrome and other common genetic conditions, as well as the sex of your baby. Non-invasive and highly accurate, Panorama identifies more than 99% of pregnancies affected with Down syndrome and has the lowest reported false positive rate of any prenatal screening test for the commonly screened chromosomal abnormalities: trisomy 21, trisomy 18, and trisomy 13.
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If you are interested in obtaining the Panorama test, you can start a conversation about non-invasive prenatal testing with your doctor on your first prenatal visit.
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Panorama only requires a simple blood draw from the mom.
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Panorama is able to determine the likelihood that the pregnancy could be affected with chromosome abnormalities including Down syndrome (trisomy 21), trisomy 18, trisomy 13, monosomy X and triploidy. Your doctor may also recommend additional chromosomal conditions (microdeletions) be screened for using Panorama. Microdeletion conditions on Panorama’s extended panel include 22q11.2 deletion syndrome, 1p36 deletion, Cri-du-chat syndrome, Prader-Willi syndrome and Angelman syndrome. While it is not the sole purpose of the test, the sex of the baby can also be screened for using Panorama.
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Most results will be returned to your doctor within 10 – 14 working days.
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You will receive your results from your doctor’s office.
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When you get your Panorama results, your report may state the following:
- Low Risk: A Low Risk result indicates that it is unlikely that your baby is affected by one of the conditions on the Panorama panel.
- High Risk: A High Risk result does not mean the baby is affected; rather, it indicates a higher than average chance that the baby has a chromosome abnormality. Your healthcare provider may recommend that you speak with a genetic counselor and or maternal fetal medicine specialist. You may be offered invasive diagnostic testing such as amniocentesis or CVS. No irreversible pregnancy decisions should ever be made based on a Panorama result alone.
- No Result: In a small percentage of cases, Panorama may not be able to obtain sufficient information from your blood sample to determine an accurate result. If this occurs, a second blood sample may be requested.
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Typically, you will receive your Panorama screen results from the healthcare provider who ordered the test. If you have specific question about your results, we encourage you to speak with your healthcare provider.
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