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Hook effect

Immunologic phenomenon occurring in high antigen or antibody levels

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Through Antibody, Graph of a function and Immunization

Also, soluble antibodies that aggregate soluble antigens are referred to as precipitin, while soluble antigens that induces the formation of lattices, cross links, when antigens and antibodies exist in optimal concentrations.

Mechanism and in vitro importance

Prozone – excess antibodies

In an agglutination test, a person's serum (which contains antibodies) is added to a test tube, which contains a particular antigen. If the antibodies interact with the antigen to form immune complexes, called agglutination, then the test is interpreted as positive. However, if too many antibodies that can bind to the antigen are present, then the antigenic sites are coated by antibodies, and few or no antibodies directed toward the pathogen are able to bind more than one antigenic particle. Since the antibodies do not bridge between antigens, no agglutination occurs. Because no agglutination occurs, the test is interpreted as negative. In this case, the result is a false negative. The range of relatively high antibody concentrations within which no reaction occurs is called the prozone.

Postzone – excess antigens

The effect can also occur because of antigen excess, when both the capture and detection antibodies become saturated by the high analyte concentration. In this case, no sandwich can be formed by the capturing antibody, the antigen and the detection antibody. In this case, free antigen is in competition with captured antigen for detection antibody binding. Sequential addition of antigen and antibody, paired with stringent washing, can prevent the effect, as can increasing the relative concentration of antibody to antigen, thereby mediating the effect.

Examples include high levels of syphilis antibodies in HIV patients or high levels of cryptococcal antigen leading to false negative tests in undiluted samples. This phenomenon is also seen in serological tests for Brucellosis. It may be seen in precipitation reactions. The antibody that fails to react is known as the blocking antibody and prevents the precipitating antibody from binding to the antigens. Thus the proper precipitation reaction does not take place. However, when the serum is diluted, the blocking antibody is as well and its concentration decreases enough for the proper precipitation reaction to occur.

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