A Novel Veterinary Molecular Multiplex Microarray Serological Allergen Test (Pet Allergy Xplorer; Nextmune) Versus Conventional Extract-Based Serological (Idexx; Stallergenes Greer Laboratories) Versus Intradermal Allergen Testing in 59 Dogs With Atopic Dermatitis: Evaluation of Agreement Between Allergy Testing Platforms.

The erSAT multiplex microarray test agrees best with eSAT at higher cut-offs; platform choice significantly impacts allergen positivity decisions.

This prospective study evaluated agreement between three allergy testing platforms in 59 dogs with atopic dermatitis: intradermal allergen testing (IDAT), a conventional extract-based serum allergy test (eSAT; Stallergenes Greer Laboratories), and the novel extract and recombinant-containing multiplex molecular microarray serum allergy test (erSAT; Pet Allergy Xplorer, Nextmune). Testing was performed simultaneously, with two independent investigators recording IDAT results. Agreement was assessed using Cohen's kappa (κ) and prevalence-adjusted bias-adjusted kappa (PABAK). Inter-investigator agreement for IDAT was almost perfect (κ = 0.81; PABAK = 0.87), confirming IDAT reproducibility when performed by trained clinicians. Agreement between erSAT and eSAT at the 300 ELISA absorbance unit cut-off (eSAT300) was moderate by κ (0.58) but almost perfect by PABAK (0.84). IDAT showed strongest agreement with eSAT300 (κ = 0.44; PABAK = 0.75) compared to erSAT (κ = 0.29; PABAK = 0.64) and eSAT80 (κ = 0.13; PABAK = 0.11). The discrepancy between κ and PABAK values reflects the influence of prevalence and bias on agreement statistics, with low κ largely driven by disagreements on positivity thresholds. The eSAT300 cut-off consistently outperformed eSAT80 in agreement with other platforms. Clinicians should be aware that the choice of cut-off value significantly impacts test agreement and allergen selection for immunotherapy. The new erSAT platform demonstrated moderate to almost perfect agreement with eSAT300, supporting its potential clinical utility, though further validation studies are warranted.

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