Mayo Test Catalog, (Sorted By Test Name) - Mayo Medical ...

ADMA
83651
Useful For: Testing for IgE antibodies may be useful to establish the diagnosis of an allergic disease
and to define the allergens responsible for eliciting signs and symptoms. Testing also may be useful to
identify allergens which may be responsible for allergic disease and/or anaphylactic episode, to confirm
sensitization to particular allergens prior to beginning immunotherapy, and to investigate the specificity of
allergic reactions to insect venom allergens, drugs, or chemical allergens.
Interpretation: Detection of IgE antibodies in serum (Class 1 or greater) indicates an increased
likelihood of allergic disease as opposed to other etiologies and defines the allergens that may be
responsible for eliciting signs and symptoms. The level of IgE antibodies in serum varies directly with the
concentration of IgE antibodies expressed as a class score or kU/L.
Reference Values:
Class IgE kU/L Interpretation
0 Negative
1 0.35-0.69 Equivocal
2 0.70-3.49 Positive
3 3.50-17.4 Positive
4 17.5-49.9 Strongly positive
5 50.0-99.9 Strongly positive
6 > or =100 Strongly positive Reference values
apply to all ages.
Clinical References: Homburger HA: Allergic diseases. In Clinical Diagnosis and Management by
Laboratory Methods. 21st edition. Edited by McPherson RA, Pincus MR. WB Saunders, Publ, New York,
Chapter 53, Part VI, pp. 961-971, 2007
Asymmetric Dimethylarginine, Plasma
Clinical Information: The conversion of arginine to nitric oxide (NO) is catalyzed by nitric oxide
synthase (NOS), and asymmetric dimethylarginine (ADMA) is an inhibitor of that enzyme. When NO
synthesis is blocked, a number of regulatory processes are immediately affected, including vasodilation,
platelet aggregation, monocyte adhesion, and the inflammatory pathway, amongst others. ADMA has
been of interest in cardiovascular research for several years. Increased baseline plasma ADMA levels
have been reported to be a predictor of outcomes in various studies including: -In patients with acute
coronary syndrome (ACS), 2 year follow up, the hazard ratio (HR) for all-cause mortality and for
myocardial infarction (MI) was 2.45 and 2.28, respectively.(1) HR is the relative risk of an adverse event.
-In diabetics referred for coronary angiography, 2 year follow up, the HR for all-cause mortality and MI
was 2.63 and 2.44, respectively.(2) -In patients with unstable angina, 1 year follow up, ADMA
persistently elevated was associated with increased cardiac events.(3) -In nonsmoking males with a
previous coronary event, 5 year follow up, 4-fold increase in risk of an adverse event.(4) However, other
studies have been inconclusive or found no association with cardiac events. Furthermore, the cardiac
events may be up to 13 years or more in the future. ADMA may be particularly important in assessing
cardiovascular risk in the setting of renal failure. Patients with chronic renal failure have been shown to
have increased ADMA concentrations compared to healthy controls. The elevated ADMA-associated
inhibition of NO has been identified as a potential causal mechanism for the high mortality rates in
patients with end-stage renal disease.(5,6) The literature data must also be assessed with a cautionary eye
to the methodology used, since the inactive isomer, symmetric dimethylarginine (SDMA), can contribute
to the analytical result in some procedures. Our method measures ADMA without interference from
SDMA. It is important to consider the ADMA level in the context of all other biochemical parameters,
whether it is a cardiac risk marker and/or a representation of an underlying disease process itself. The
NOS pathway is involved in many physiological response mechanisms, and the ADMA levels measured
in plasma samples reflect an integration of the contributions from all of them. Combinations of effects can
blunt or reverse the predictive value of ADMA. Other risk factors, notably smoking, alter ADMA levels
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