Comparative Evaluation of Four Multiple Allergen Simultaneous Test (MAST) Systems in Clinical Practice

Abstract

Purpose: Multiple allergen simultaneous tests (MASTs) are widely used for screening allergen-specific immunoglobulin E owing to their convenience and cost-effectiveness. Recently, several automated MAST analyzers with expanded allergen panels have become available in Korea; however, comparative evaluations remain limited. Patients and Methods: In this retrospective study, 200 residual serum samples from patients tested for suspected allergic diseases at a single tertiary hospital were analyzed. Each sample was tested using AdvanSure Alloscreen, AdvanSure Alloscreen Max108, SGTi-Allergy Screen, and PROTIA Allergy-Q. Semi-quantitative results (classes 0-6) were interpreted as positive at class >= 2. Concordance rates and Cohen's kappa coefficients were calculated. Results: Overall agreement between the MAST systems was high (91-93%), with Cohen's kappa values indicating substantial to almost perfect agreement (kappa = 0.67-0.76). The agreement between AdvanSure Alloscreen and its upgraded version, AdvanSure AlloScreen Max108, was the highest. For common allergens in the Korean population, Dermatophagoides pteronyssinus and Dermatophagoides farinae showed moderate agreement (kappa = 0.47-0.82, respectively) between the MAST systems. Re-testing of discrepant samples (n = 78; 31 allergens) using ImmunoCAP-often considered the gold standard for allergy testing-demonstrated the highest concordance for the SGTi Allergy Screen (76.39%). Conclusion: All four MAST systems demonstrated substantial to near-perfect qualitative agreement. The SGTi-Allergy Screen showed the best concordance with ImmunoCAP, whereas AdvanSure Alloscreen Max108 offered a balanced performance with broader allergen coverage. These findings indicate that laboratories should select a MAST system based on local needs, weighing analytical accuracy, allergen panel breadth, and overall testing efficiency. Plain Language Summary: Allergies are becoming more common around the world, and laboratory tests are commonly used to support the evaluation of allergic sensitization in clinical practice. One of these tests is called the Multiple Allergen Simultaneous Test (MAST), which can detect antibodies in the blood that react to many different allergens at once. Because several different MAST systems are used in clinical practice, it is important to understand how similar their results are and how they compare with one another. In this study, we compared four commonly used MAST systems by testing blood samples for common airborne and food allergens, such as house dust mites, pollen, and nuts. We examined how closely the test results agreed across systems and rechecked some inconsistent results using another laboratory method called ImmunoCAP, which is often used as a reference test. We found that the four MAST systems produced broadly similar results overall, although differences were observed for certain plant-based allergens. Among the systems, the SGTi-Allergy Screen showed the closest agreement with the reference test, while the AdvanSure Alloscreen Max108 offered a wider range of allergens in a single test. These findings can help clinicians better understand the strengths of each system and make informed choices when selecting a MAST system for routine testing.