oa Current Allergy & Clinical Immunology - Clinical indications and interpretation of the cast : review article

Volume 19, Issue 1
  • ISSN : 1609-3607



Non-IgE-mediated reactions to foods and drugs account for the majority of adverse reactions encountered in clinical practice. Until recently sensitivity to many environmental agents could only be confirmed by challenge tests, which are usually tedious and in some instances could be dangerous. The cellular antigen stimulation test (CAST) is useful for detecting non-IgE-mediated sensitivity to food additives, preservatives and drugs. It can also confirm IgE-mediated sensitivity, but in general, specific IgE tests, such as skin-prick tests and the CAP RASTs are more efficient in this regard. Cut-off values for the CAST for sulphites have been confirmed by double-blind placebo-controlled food challenges in the Allergy Diagnostic and Clinical Research Unit at the University of Cape Town. If selected by careful history taking CASTs can be a cost-effective diagnostic clinical tool.

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