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Nieto-García A, Abel-Fernández E, Nieto-Cid M, Pineda de la Losa F. 360° approach to the patient with mite allergy: from scientific evidence to clinical practice. FRONTIERS IN ALLERGY 2024; 5:1298816. [PMID: 38379594 PMCID: PMC10876833 DOI: 10.3389/falgy.2024.1298816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/23/2024] [Indexed: 02/22/2024] Open
Abstract
In the recent years, several important advances have been made in the diagnosis of allergy using molecular techniques. The aetiological diagnosis of allergy using molecular components of allergens allows a more precise definition of the patient's IgE repertoire. Precision medicine is a structural model aimed at personalising healthcare and places the patient at the centre of the specialist's decision-making process. To this end, an accurate characterisation of the external exposome at a molecular level and their putative role as clinically relevant allergens is essential to elucidate the phenotypic diversity of atopic disease, with a view to personalising diagnosis and therapy. It has been proposed a decision algorithm, the Top-Down approach, where the clinical history is set first and is followed by the use of skin tests or specific IgE techniques, which facilitates the clinicians to make decisions. The therapeutic intervention driven by the standard diagnostic approach, but supported by these innovative tools, can lead to a better phenotyping of highly complex patients, and a more appropriate prescription of AIT. To this end, the allergen extracts used for diagnosis require to be of proven quality and contain the most relevant allergens. Likewise, allergen vaccines must gather efficacy, safety, duration, and patient compliance, hence the demand for new vaccines to overcome these drawbacks.
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Affiliation(s)
- Antonio Nieto-García
- Pediatric Allergy and Pneumology Unit, La Fe Hospital, Valencia, Spain
- La Fe Health Research Institute, Valencia, Spain
| | | | - María Nieto-Cid
- Allergy Service, University Hospital of La Plana, Vila-real, Spain
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Lis K, Bartuzi Z. Selected Technical Aspects of Molecular Allergy Diagnostics. Curr Issues Mol Biol 2023; 45:5481-5493. [PMID: 37504263 PMCID: PMC10378047 DOI: 10.3390/cimb45070347] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 07/29/2023] Open
Abstract
Diagnosis of allergic diseases is a complex, multi-stage process. It often requires the use of various diagnostic tools. The in vitro diagnostics (IVD), which includes various laboratory tests, is one of the stages of this process. Standard laboratory tests include the measurement of the serum concentration of specific immunoglobulin E (sIgE) for selected allergens, full allergen extracts and/or single allergen components (molecules). The measurement of IgE sIgE to the allergen components is called molecular allergy diagnosis. During the standard laboratory diagnostic process, various models of immunochemical tests are used, which enable the measurement of sIgE for single allergens (one-parameter tests, singleplex) or IgE specific for many different allergens (multi-parameter tests, multiplex) in one test. Currently, there are many different test kits available, validated for IVD, which differ in the method type and allergen profile. The aim of the manuscript is to present various technical aspects related to modern allergy diagnostics, especially in the area of molecular allergy diagnostics.
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Affiliation(s)
- Kinga Lis
- Department of Allergology, Clinical Immunology and Internal Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-168 Bydgoszcz, Poland
| | - Zbigniew Bartuzi
- Department of Allergology, Clinical Immunology and Internal Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-168 Bydgoszcz, Poland
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Classification of patients with esophageal eosinophilia by patterns of sensitization revealed by a diagnostic assay for multiple allergen-specific IgEs. J Gastroenterol 2021; 56:422-433. [PMID: 33591429 DOI: 10.1007/s00535-021-01766-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 01/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Eosinophilic esophagitis (EoE) is considered to be an immunoglobulin E (IgE)-mediated allergic disorder. Our goal was to examine IgE-mediated allergic sensitization patterns in patients with esophageal eosinophilia (EE). METHODS We enrolled subjects with EE who underwent evaluation with a diagnostic panel to document multiple allergen-specific IgEs. Statistically significant groups were identified by cluster analysis. We also defined allergens based on their characteristics including outdoor, indoor, plant, and animal allergens. RESULTS We classified patients with EE into 3 distinct groups, including cluster 1 (n = 62) who were minimally sensitized to most allergens except pollen and house dust, cluster 2 (n = 30) who were hypersensitized to outdoor and plant allergens, and cluster 3 (n = 15) who were hypersensitized to most allergens, most notably to indoor and animal allergens. Dysphagia reported among those in clusters 1, 2, and 3 at 35.5%, 46.7%, and 73.3%, respectively, (p = 0.028) and EoE endoscopic reference scores (EREFS) at 3.0, 6.0, and 8.0, respectively, (p < 0.001) differed significantly between the 3 clusters. Those in cluster 3 had a significantly higher prevalence of dysphagia (35.5% vs. 73.3%, p = 0.030), and higher EREFS with respect to rings (0.3 vs. 0.9, p = 0.003) and strictures (0.0 vs. 0.13, p = 0.011) compared to those in cluster 1. CONCLUSIONS IgE-mediated allergic sensitization patterns are associated with clinical features of patients with EE. Use of a diagnostic panel that detects multiple allergen-specific IgEs can help to explain the heterogeneous phenotype of this patient cohort.
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Arasi S, Castelli S, Di Fraia M, Villalta D, Tripodi S, Perna S, Dramburg S, Brighetti MA, Conte M, Martelli P, Sfika I, Travaglini A, Verardo PL, Villella V, Matricardi PM. @IT2020: An innovative algorithm for allergen immunotherapy prescription in seasonal allergic rhinitis. Clin Exp Allergy 2021; 51:821-828. [DOI: 10.1111/cea.13867] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Stefania Arasi
- Allergy Unit ‐ Area of Translational Research in Pediatric Specialities Bambino Gesù Children's HospitalIRCCS Rome Italy
- Department of Pediatric Pneumology, Immunology and Critical Care Medicine Charité Universitätsmedizin ‐ Berlin Berlin Germany
- Department of Pediatrics Unit of Allergy University of Messina Messina Italy
| | - Sveva Castelli
- Department of Pediatric Pneumology, Immunology and Critical Care Medicine Charité Universitätsmedizin ‐ Berlin Berlin Germany
| | - Marco Di Fraia
- Department of Pediatric Pneumology, Immunology and Critical Care Medicine Charité Universitätsmedizin ‐ Berlin Berlin Germany
| | - Danilo Villalta
- Immunology and Allergy Unit “S. Maria degli Angeli” Hospital Pordenone Italy
| | | | - Serena Perna
- Department of Pediatric Pneumology, Immunology and Critical Care Medicine Charité Universitätsmedizin ‐ Berlin Berlin Germany
| | - Stephanie Dramburg
- Department of Pediatric Pneumology, Immunology and Critical Care Medicine Charité Universitätsmedizin ‐ Berlin Berlin Germany
| | | | | | - Paola Martelli
- Immunology and Allergy Unit “S. Maria degli Angeli” Hospital Pordenone Italy
| | - Ifigenia Sfika
- Pediatric Allergology Unit Sandro Pertini Hospital Rome Italy
| | | | | | | | - Paolo Maria Matricardi
- Department of Pediatric Pneumology, Immunology and Critical Care Medicine Charité Universitätsmedizin ‐ Berlin Berlin Germany
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Incorvaia C, Al‐Ahmad M, Ansotegui IJ, Arasi S, Bachert C, Bos C, Bousquet J, Bozek A, Caimmi D, Calderón MA, Casale T, Custovic A, De Blay F, Demoly P, Devillier P, Didier A, Fiocchi A, Fox AT, Gevaert P, Gomez M, Heffler E, Ilina N, Irani C, Jutel M, Karagiannis E, Klimek L, Kuna P, O'Hehir R, Kurbacheva O, Matricardi PM, Morais‐Almeida M, Mosges R, Novak N, Okamoto Y, Panzner P, Papadopoulos NG, Park H, Passalacqua G, Pawankar R, Pfaar O, Schmid‐Grendelmeier P, Scurati S, Tortajada‐Girbés M, Vidal C, Virchow JC, Wahn U, Worm M, Zieglmayer P, Canonica GW. Personalized medicine for allergy treatment: Allergen immunotherapy still a unique and unmatched model. Allergy 2021; 76:1041-1052. [PMID: 32869882 DOI: 10.1111/all.14575] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 12/17/2022]
Abstract
The introduction of personalized medicine (PM) has been a milestone in the history of medical therapy, because it has revolutionized the previous approach of treating the disease with that of treating the patient. It is known today that diseases can occur in different genetic variants, making specific treatments of proven efficacy necessary for a given endotype. Allergic diseases are particularly suitable for PM, because they meet the therapeutic success requirements, including a known molecular mechanism of the disease, a diagnostic tool for such disease, and a treatment blocking the mechanism. The stakes of PM in allergic patients are molecular diagnostics, to detect specific IgE to single-allergen molecules and to distinguish the causative molecules from those merely cross-reactive, pursuit of patient's treatable traits addressing genetic, phenotypic, and psychosocial features, and omics, such as proteomics, epi-genomics, metabolomics, and breathomics, to forecast patient's responsiveness to therapies, to detect biomarker and mediators, and to verify the disease control. This new approach has already improved the precision of allergy diagnosis and is likely to significantly increase, through the higher performance achieved with the personalized treatment, the effectiveness of allergen immunotherapy by enhancing its already known and unique characteristics of treatment that acts on the causes.
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Affiliation(s)
| | - Mona Al‐Ahmad
- Microbiology Department Faculty of Medicine Kuwait University Kuwait
- Drug Allergy Unit Department of Allergy Al‐Rashed Allergy Center Kuwait
| | | | - Stefania Arasi
- Department of Allergy Bambino Gesu' Childrens' Hospital IRCCS Rome Italy
| | - Claus Bachert
- Upper Airways Research Laboratory ENT Dept Ghent University Hospital Ghent Belgium
- Karolinska Institutet Stockholm Sweden
- Department of ENT Diseases Karolinska University Hospital Stockholm Sweden
| | - Catherine Bos
- Stallergenes Greer Medical Affairs Department Antony France
| | - Jean Bousquet
- University Hospital Montpellier France – MACVIA‐France Montpellier France
| | - Andrzéj Bozek
- Clinical Department of Internal Disease, Dermatology and Allergology Medical University of Silesia Katowice Poland
| | - Davide Caimmi
- Department of Pulmonology and Addictology Arnaud de Villeneuve Hospital Montpellier University Montpellier France
| | - Moises A. Calderón
- Imperial College London – National Heart and Lung Institute Royal Brompton Hospital NHS London UK
| | - Thomas Casale
- Division of Allergy/Immunology University of South Florida Tampa FL USA
| | - Adnan Custovic
- Centre for Respiratory Medicine and Allergy Institute of Inflammation and Repair University of Manchester and University Hospital of South Manchester Manchester UK
| | - Frédéric De Blay
- Allergy Division Chest Diseases Department Strasbourg University Hospital Strasbourg France
| | - Pascal Demoly
- Department of Pulmonology and Addictology Arnaud de Villeneuve Hospital Montpellier University Montpellier France
- Sorbonne Université UMR‐S 1136 INSERM IPLESP EPAR Team Paris France
| | - Philippe Devillier
- Laboratoire de Recherche en Pharmacologie Respiratoire Pôle des Maladies des Voies Respiratoires Hôpital Foch Université Paris‐Saclay Suresnes France
| | - Alain Didier
- Respiratory Disease Dept Larrey Hospital University Hospital of Toulouse Paul Sabatier University Toulouse France
| | - Alessandro Fiocchi
- Department of Allergy Bambino Gesu' Childrens' Hospital IRCCS Rome Italy
| | - Adam T. Fox
- Department of Paediatric Allergy Guy's & St Thomas' Hospitals NHS Foundation Trust London UK
| | - Philippe Gevaert
- Upper Airways Research Laboratory ENT Dept Ghent University Hospital Ghent Belgium
| | | | - Enrico Heffler
- Personalized Medicine, Asthma & Allergy – Humanitas Clinical and Research Center IRCCS Rozzano Italy
- Department of Biomedical Science Humanitas University Pieve Emanuele Italy
| | - Natalia Ilina
- Federal Institute of Immunology of Russia Moscow Russia
| | - Carla Irani
- Department of Internal Medicine and Clinical Immunology Faculty of Medicine Hotel Dieu de France Hospital Saint Joseph University Beirut Lebanon
| | - Marek Jutel
- Department of Clinical Immunology Wrocław Medical University Wrocław Poland
| | | | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy Barlicki University Hospital Medical University of Lodz Lodz Poland
| | - Robin O'Hehir
- Alfred Hospital and Monash University Melbourne Australia
| | - Oxana Kurbacheva
- National Research Center – Institute of Immunology Federal Medical‐Biological Agency of Russia Moscow Russia
| | - Paolo M. Matricardi
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine Charité – University Medicine Berlin Berlin Germany
| | - Mario Morais‐Almeida
- Immunoallergy Department of CUF‐Descobertas Hospital Lisbon Portugal
- CUF‐Infante Santo Hospital Lisbon Portugal
| | - Ralph Mosges
- Faculty of Medicine Institute of Medical Statistics and Computational Biology University of Cologne Cologne Germany
- CRI – Clinical Research International Ltd. Cologne Germany
| | - Natalija Novak
- Department of Dermatology and Allergy University Hospital Bonn Bonn Germany
| | - Yoshitaka Okamoto
- Department of Otorhinolaryngology Chiba University Hospital Chiba Japan
| | - Petr Panzner
- Department of Immunology and Allergology Faculty of Medicine in Pilsen Charles University in Prague Pilsen Czech Republic
| | - Nikolaos G. Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine Royal Manchester Children's Hospital University of Manchester Manchester UK
- Allergy Department 2nd Pediatric Clinic Athens General Children's Hospital "P&A Kyriakou" University of Athens Athens Greece
| | - Hae‐Sim Park
- Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon South Korea
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases Ospedale Policlino San Martino – University of Genoa Genoa Italy
| | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | | | - Silvia Scurati
- Stallergenes Greer Medical Affairs Department Antony France
| | - Miguel Tortajada‐Girbés
- Pediatric Pulmonology and Allergy Unit Department of Pediatrics Dr. Peset University Hospital Valencia Spain
- Department of Pediatrics, Obstetrics and Gynecology University of Valencia Valencia Spain
- IVI Foundation Valencia Spain
| | - Carmen Vidal
- Allergy Service Complejo Hospitalario Universitario de Santiago Santiago de Compostela Spain
| | - J. Christian Virchow
- Department of Pneumology/Intensive Care Medicine University of Rostock Rostock Germany
| | - Ulrich Wahn
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine Charité – University Medicine Berlin Berlin Germany
| | - Margitta Worm
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine Charité – University Medicine Berlin Berlin Germany
| | | | - Giorgio W. Canonica
- Personalized Medicine, Asthma & Allergy – Humanitas Clinical and Research Center IRCCS Rozzano Italy
- Department of Biomedical Science Humanitas University Pieve Emanuele Italy
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Ferrante G, Licari A, Fasola S, Marseglia GL, La Grutta S. Artificial intelligence in the diagnosis of pediatric allergic diseases. Pediatr Allergy Immunol 2021; 32:405-413. [PMID: 33220121 DOI: 10.1111/pai.13419] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022]
Abstract
Artificial intelligence (AI) is a field of data science pertaining to advanced computing machines capable of learning from data and interacting with the human world. Early diagnosis and diagnostics, self-care, prevention and wellness, clinical decision support, care delivery, and chronic care management have been identified within the healthcare areas that could benefit from introducing AI. In pediatric allergy research, the recent developments in AI approach provided new perspectives for characterizing the heterogeneity of allergic diseases among patients. Moreover, the increasing use of electronic health records and personal healthcare records highlighted the relevance of AI in improving data quality and processing and setting-up advanced algorithms to interpret the data. This review aimed to summarize current knowledge about AI and discuss its impact on the diagnostic framework of pediatric allergic diseases such as eczema, food allergy, and respiratory allergy, along with the future opportunities that AI research can offer in this medical area.
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Affiliation(s)
- Giuliana Ferrante
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Amelia Licari
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Salvatore Fasola
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), Palermo, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Stefania La Grutta
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), Palermo, Italy
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Hazelnut Allergy. ACTA ACUST UNITED AC 2021; 57:medicina57010067. [PMID: 33466577 PMCID: PMC7828647 DOI: 10.3390/medicina57010067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/08/2021] [Accepted: 01/10/2021] [Indexed: 01/14/2023]
Abstract
Background and Objectives: Hazelnuts are frequently involved in IgE-mediated reactions and represent the main culprit of nut allergy in Europe. The clinical presentation varies from mild symptoms limited to the oropharynx [oral allergy syndrome (OAS)], due to the cross-reaction with homologues in pollen allergens and more severe events caused by the primary sensitization to highly stable molecules contained in hazelnuts. The aim of this review is to summarize the most relevant concepts in the field of hazelnut allergy and to provide a practical approach useful in the clinical practice Materials and Methods: References were identified by PubMed searches dating from January 2000 up to November 2020 using the search terms: “component resolved diagnosis” and “Hazelnut allergy. Results: The storage proteins Cor a 9 and Cor a 14 resulted highly specific for primary hazelnut allergy and strongly associated with severe reactions, while the cross reactive Cor a 1, an homolog of the birch Bet v1, were related to OAS. Any cut-off has shown a specificity and sensitivity pattern as high as to replace the oral food challenge (OFC), which still remains the gold standard in the diagnosis of hazelnut allergy. To date there is still no definitive treatment. Hazelnut free-diet and treatment of symptoms with emergency management, including the prescription of auto-injective epinephrine, still represent the main approach. Oral allergen immunotherapy (AIT) appears a promising therapeutic strategy and the definition of individual clinical threshold would be useful for sensitized individuals, caregivers, and physicians to reduce social limitation, anxiety, and better manage food allergy. Conclusions: An accurate diagnostic work-up including clinical history, in vivo and in vitro test including component resolved diagnosis and OFC are essential to confirm the diagnosis, to assess the risk of a severe reaction, and to prescribe an adequate diet and treatment.
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Abstract
PURPOSE OF REVIEW Aim of this review is the description of the medical conditions in which the support of molecular allergy diagnostics (MAD) has an impact on the clinical outcomes, such as laboratory diagnostics, prognosis, and therapy of allergic diseases. RECENT FINDINGS The review of the literature of the last 2 years generated a wide number of results on this topic. As expected, not all were obtained by the use of MAD, but, in general, a clear trend is evident. SUMMARY Within the large number of works available, laboratory allergy diagnostics seems to be the most frequently discussed topic, in particular considering the complexity of the biological environment where these assays are used. Some interesting news arrive from the prognostic potential of MAD, whereas for allergen immunotherapy, waiting for a well-conducted prospective randomized clinical study, data from retrospective studies still confirms the added values of MAD in the management of the allergic patients.
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A WAO - ARIA - GA 2LEN consensus document on molecular-based allergy diagnosis (PAMD@): Update 2020. World Allergy Organ J 2020; 13:100091. [PMID: 32180890 PMCID: PMC7062937 DOI: 10.1016/j.waojou.2019.100091] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Precision allergy molecular diagnostic applications (PAMD@) is increasingly entering routine care. Currently, more than 130 allergenic molecules from more than 50 allergy sources are commercially available for in vitro specific immunoglobulin E (sIgE) testing. Since the last publication of this consensus document, a great deal of new information has become available regarding this topic, with over 100 publications in the last year alone. It thus seems quite reasonable to publish an update. It is imperative that clinicians and immunologists specifically trained in allergology keep abreast of the new and rapidly evolving evidence available for PAMD@. PAMD@ may initially appear complex to interpret; however, with increasing experience, the information gained provides relevant information for the allergist. This is especially true for food allergy, Hymenoptera allergy, and for the selection of allergen immunotherapy. Nevertheless, all sIgE tests, including PAMD@, should be evaluated within the framework of a patient's clinical history, because allergen sensitization does not necessarily imply clinical relevant allergies.
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Ansotegui IJ, Melioli G, Canonica GW, Caraballo L, Villa E, Ebisawa M, Passalacqua G, Savi E, Ebo D, Gómez RM, Luengo Sánchez O, Oppenheimer JJ, Jensen-Jarolim E, Fischer DA, Haahtela T, Antila M, Bousquet JJ, Cardona V, Chiang WC, Demoly PM, DuBuske LM, Ferrer Puga M, Gerth van Wijk R, González Díaz SN, Gonzalez-Estrada A, Jares E, Kalpaklioğlu AF, Kase Tanno L, Kowalski ML, Ledford DK, Monge Ortega OP, Morais Almeida M, Pfaar O, Poulsen LK, Pawankar R, Renz HE, Romano AG, Rosário Filho NA, Rosenwasser L, Sánchez Borges MA, Scala E, Senna GE, Sisul JC, Tang ML, Thong BYH, Valenta R, Wood RA, Zuberbier T. IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper. World Allergy Organ J 2020; 13:100080. [PMID: 32128023 PMCID: PMC7044795 DOI: 10.1016/j.waojou.2019.100080] [Citation(s) in RCA: 210] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/08/2019] [Indexed: 02/06/2023] Open
Abstract
Currently, testing for immunoglobulin E (IgE) sensitization is the cornerstone of diagnostic evaluation in suspected allergic conditions. This review provides a thorough and updated critical appraisal of the most frequently used diagnostic tests, both in vivo and in vitro. It discusses skin tests, challenges, and serological and cellular in vitro tests, and provides an overview of indications, advantages and disadvantages of each in conditions such as respiratory, food, venom, drug, and occupational allergy. Skin prick testing remains the first line approach in most instances; the added value of serum specific IgE to whole allergen extracts or components, as well as the role of basophil activation tests, is evaluated. Unproven, non-validated, diagnostic tests are also discussed. Throughout the review, the reader must bear in mind the relevance of differentiating between sensitization and allergy; the latter entails not only allergic sensitization, but also clinically relevant symptoms triggered by the culprit allergen.
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Key Words
- AAAAI, American Academy of Allergy Asthma and Immunology
- ABA, Allergen Bead Array
- ACAAI, American College of Allergy Asthma and Immunology
- AEC, Allergen Exposure Chambers
- AIT, allergen immunotherapy
- AP, Alkaline Phosphatase
- AU/mL, Allergenic Units milliLiter
- Allergy
- Anti-IgE, Antibody against IgE
- BAT, Basophil Activation Test
- BAU/mL, Biologic Allergenic Units milliLiter
- CBA, Cytometric Bead Array
- CCD, Cross-reactive Carbohydrate Determinants
- CDER, Center for Drug Evaluation and Research (USA)
- CL, Chemiluminescence
- CaFE, Calibrated Fluorescence Enhancement
- DBPCFC, Double-Blind Placebo-Controlled Food Challenge
- Diagnostic strategies
- EAACI, European Academy of Allergy and Immunology
- EIA, Enzyme Immune Assay
- ELISA, Enzyme Linked Immuno Sorbent Analysis
- EMEA, European MEdicine Agencies
- ENPP-3, EctoNucleotide Pyrophosphatase/Phosphodiesterase 3
- FACS, Fluorescence-Activated Cell Sorting
- FDA, Food and Drug Administration (U.S. Department of Health and Human Services)
- FEIA, Fluorescent Enzyme Immunoassays
- FcεRI, High affinity IgE receptor
- H1, Histamine 1 receptor
- H2, Histamine 2 receptor
- HPO, Horseradish Peroxidase
- IDT, Intradermal Test
- ISAC, Immuno-Solid phase Allergen Chip
- IUIS, International Union of Immunological Societies
- IVD, in vitro diagnostic tool
- IgE
- IgE, immunoglobulin E
- In vitro tests
- LAMP-3, Lysosomal-Associated Membrane Protein
- MBAD, Molecule Based Allergy Diagnostics
- MRGPRX2, Mas-related G protein receptor 2
- NIH, National Institutes of Health (USA)
- NMBAs, NeuroMuscular Blocking Agents
- NPA, Negative Percent Agreement
- NSAIDs, Non-Steroidal Anti-Inflammatory Drugs
- PPA, Positive Percent Agreement
- PPT, Prick-Prick Test
- RAST, Radio Allergo Sorbent Test
- SCAR, severe cutaneous adverse drug reactions
- SPT, Skin prick test
- Skin tests
- kUA/L, kilo Units of Allergen/Liter for allergen-specific IgE antibody assays
- mAb, Monoclonal Antibody
- pNPP, p-Nitrophenylphosphate
- sIgE, specific IgE
- w/v, weight /volume
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Affiliation(s)
| | - Giovanni Melioli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | - Elisa Villa
- Azienda Sanitaria Locale di Vercelli, S.C. Pneumologia, Vercelli, Italia
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | | | - Didier Ebo
- Department of Immunology - Allergology - Rheumatology, Antwerp University Hospital, Antwerp University, Department Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
| | | | - Olga Luengo Sánchez
- Allergy Section, Department of Internal Medicine, Vall d’Hebron University Hospital, Barcelona, Spain
| | | | - Erika Jensen-Jarolim
- Institute for Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, The Interuniversity Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University Vienna, Vienna, Austria
| | - David A. Fischer
- Fischer Medicine Professional Corporation, Barrie, Ontario, Canada
| | - Tari Haahtela
- Skin and Allergy Hospital, University of Helsinki, Helsinki, Finland
| | | | - Jean J. Bousquet
- MACVIA-France, Montpellier, France
- INSERM, Villejuif, France
- Université Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France
- Euforea, Brussels, Belgium
- CHU Montpellier, France
| | - Victoria Cardona
- Universitat Autónoma de Barcelona, Hospital Universitario Vall d'Hebron, Servicio de Medicina Interna, Sección de Alergología, Barcelona, Spain
| | - Wen Chin Chiang
- Mount Elizabeth Medical Centre, Chiang Children's Allergy & Asthma Clinic, Singapore, Singapore
| | - Pascal M. Demoly
- University Hospital Montpellier, Montpellier, France
- Sorbonne Université, Paris, France
| | | | - Marta Ferrer Puga
- The Unidad de Educación Médica, Department of Medical Education, School of Medicine, Clinica Universitad de Navarra, Navarra, Spain
| | | | | | | | | | | | | | - Marek L. Kowalski
- Faculty of Medicine, Department of Clinical Immunology & Allergy, Medical University of Łódź, Łódź, Poland
| | | | | | | | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Lars K. Poulsen
- Gentofte University Hospital, Lab for Allergology, Allergy Clinic, Hellerup, Denmark
| | - Ruby Pawankar
- Nippon Medical School, Dept. of Otolaryngology, Tokyo, Japan
| | - Harald E. Renz
- University Hospital GI & MR GmbH, Institute of Laboratory Medicine & Pathology, Standort Marburg, Marburg, Germany
| | | | | | - Lanny Rosenwasser
- University of Missouri at Kansas City, School of Medicine, Kansas City, MO, USA
| | | | - Enrico Scala
- Experimental Allergy Unit, Istituto Dermopatico dell'Immacolata, Rome, Italy
| | | | | | - Mimi L.K. Tang
- Royal Children's Hospital, Department of Allergy & Immunology, Parkville, Victoria, Australia
| | - Bernard Yu-Hor Thong
- Tan Tock Seng Hospital, Deptartment of Rheumatology, Allergy & Immunology, Singapore, Singapore
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
- NRC Institute of Immunology FMBA of Russia, Moscow, Russia
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Robert A. Wood
- Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Torsten Zuberbier
- Campus Charite Mitte, Klinik fur Dermatologie & Allergologie, Berlin, Germany
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11
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Heffler E, Puggioni F, Descalzi D, Racca F, Canonica GW, Melioli G. Microarray Immunodiagnostics for Aeroallergens. Curr Allergy Asthma Rep 2019; 19:10. [PMID: 30771109 DOI: 10.1007/s11882-019-0832-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW The impact of new technologies, especially multiplexed molecular allergy diagnostics based on allergen arrays, on the management of complex patients with respiratory allergies has been important. RECENT FINDINGS Currently, the detailed characteristics of the IgE profile of the patient, such as sensitization to genuine or cross-reacting components or the sensitization to potentially harmful allergens, allow an allergist to tailor treatment in the context of precision medicine rules. A number of relevant articles have been published in recent years on this topic, and, in this review, the new added values of allergen array-based diagnostics are reported.
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Affiliation(s)
- Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy
| | - Desideria Descalzi
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Francesca Racca
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Giovanni Melioli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
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12
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Popescu FD, Vieru M. Precision medicine allergy immunoassay methods for assessing immunoglobulin E sensitization to aeroallergen molecules. World J Methodol 2018; 8:17-36. [PMID: 30519536 PMCID: PMC6275558 DOI: 10.5662/wjm.v8.i3.17] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/17/2018] [Accepted: 10/09/2018] [Indexed: 02/06/2023] Open
Abstract
Molecular-based allergy diagnosis for the in vitro assessment of a patient immunoglobulin E (IgE) sensitization profile at the molecular level uses allergen molecules (also referred to as allergen components), which may be well-defined, highly purified, natural allergen components or recombinant allergens. Modern immunoassay methods used for the detection of specific IgE against aeroallergen components are either singleplex (such as the fluorescence enzyme immunoassay with capsulated cellulose polymer solid-phase coupled allergens, the enzyme-enhanced chemiluminescence immunoassay and the reversed enzyme allergosorbent test, with liquid-phase allergens), multiparameter (such as the line blot immunoassay for defined partial allergen diagnostics with allergen components coating membrane strips) or multiplex (such as the microarray-based immunoassay on immuno solid-phase allergen chip, and the two new multiplex nanotechnology-based immunoassays: the patient-friendly allergen nano-bead array, and the macroarray nanotechnology-based immunoassay used as a molecular allergy explorer). The precision medicine diagnostic work-up may be organized as an integrated “U-shape” approach, with a “top-down” approach (from symptoms to molecules) and a “bottom-up” approach (from molecules to clinical implications), as needed in selected patients. The comprehensive and accurate IgE sensitization molecular profiling, with identification of the relevant allergens, is indicated within the framework of a detailed patient’s clinical history to distinguish genuine IgE sensitization from sensitization due to cross-reactivity (especially in polysensitized patients), to assess unclear symptoms and unsatisfactory response to treatment, to reveal unexpected sensitizations, and to improve assessment of severity and risk aspects in some patients. Practical approaches, such as anamnesis molecular thinking, laboratory molecular thinking and postmolecular anamnesis, are sometimes applied. The component-resolved diagnosis of the specific IgE repertoire has a key impact on optimal decisions making for prophylactic and specific immunotherapeutic strategies tailored for the individual patient.
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Affiliation(s)
- Florin-Dan Popescu
- Department of Allergology, “Carol Davila” University of Medicine and Pharmacy, Bucharest 022441, Romania
- Department of Allergology and Clinical Immunology, “Nicolae Malaxa” Clinical Hospital, Bucharest 022441, Romania
| | - Mariana Vieru
- Department of Allergology, “Carol Davila” University of Medicine and Pharmacy, Bucharest 022441, Romania
- Department of Allergology and Clinical Immunology, “Nicolae Malaxa” Clinical Hospital, Bucharest 022441, Romania
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13
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Braido F, Santus P, Corsico AG, Di Marco F, Melioli G, Scichilone N, Solidoro P. Chronic obstructive lung disease "expert system": validation of a predictive tool for assisting diagnosis. Int J Chron Obstruct Pulmon Dis 2018; 13:1747-1753. [PMID: 29881264 PMCID: PMC5978461 DOI: 10.2147/copd.s165533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose The purposes of this study were development and validation of an expert system (ES) aimed at supporting the diagnosis of chronic obstructive lung disease (COLD). Methods A questionnaire and a WebFlex code were developed and validated in silico. An expert panel pilot validation on 60 cases and a clinical validation on 241 cases were performed. Results The developed questionnaire and code validated in silico resulted in a suitable tool to support the medical diagnosis. The clinical validation of the ES was performed in an academic setting that included six different reference centers for respiratory diseases. The results of the ES expressed as a score associated with the risk of suffering from COLD were matched and compared with the final clinical diagnoses. A set of 60 patients were evaluated by a pilot expert panel validation with the aim of calculating the sample size for the clinical validation study. The concordance analysis between these preliminary ES scores and diagnoses performed by the experts indicated that the accuracy was 94.7% when both experts and the system confirmed the COLD diagnosis and 86.3% when COLD was excluded. Based on these results, the sample size of the validation set was established in 240 patients. The clinical validation, performed on 241 patients, resulted in ES accuracy of 97.5%, with confirmed COLD diagnosis in 53.6% of the cases and excluded COLD diagnosis in 32% of the cases. In 11.2% of cases, a diagnosis of COLD was made by the experts, although the imaging results showed a potential concomitant disorder. Conclusion The ES presented here (COLDES) is a safe and robust supporting tool for COLD diagnosis in primary care settings.
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Affiliation(s)
- Fulvio Braido
- Department of Internal Medicine, IRCCS San Martino di Genova University Hospital, Genoa, Italy
| | - Pierachille Santus
- Department of Biomedical and Clinical Sciences, University of Milan, Division of Respiratory Diseases, "L. Sacco" University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Angelo Guido Corsico
- Department of Internal Medicine and Therapeutics, Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy
| | - Fabiano Di Marco
- Department of Health Sciences, University of Milan, San Paolo Hospital, Milan, Italy
| | - Giovanni Melioli
- Center for Precision Medicine, Asthma, and Allergy, Humanitas University, Milan, Italy
| | - Nicola Scichilone
- Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Paolo Solidoro
- Unit of Pulmonology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
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14
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Jensen-Jarolim E, Jensen AN, Canonica GW. Debates in allergy medicine: Molecular allergy diagnosis with ISAC will replace screenings by skin prick test in the future. World Allergy Organ J 2017; 10:33. [PMID: 28959378 PMCID: PMC5604284 DOI: 10.1186/s40413-017-0162-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/07/2017] [Indexed: 02/06/2023] Open
Abstract
In today's clinical practice patients' skin is used as screening organ for diagnosing type 1 allergy. According to European guidelines skin prick testing with a panel of 18 allergen extracts is recommended, in the US between 10 to 50 allergens are used. The specificity and sensitivity of skin testing is individually highly variable depending on age, body mass, and skin barrier status. In atopic inflammation skin testing gives more false positive results. Smaller skin area and strain limits prick testing in small children. Although the risk for systemic reactions in skin prick testing is very small, emergency medications must be available. Considering the fact that IgE is the only reliable biomarker for type I allergy, upfront IgE screening with ISAC, followed by fewer skin tests to approve positive sensitizations, is proposed. It is time to arrive in the age of molecular allergy diagnosis in daily patient care.
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Affiliation(s)
- E. Jensen-Jarolim
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
- The interuniversity Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University Vienna, University of Vienna, Vienna, Austria
| | - A. N. Jensen
- AllergyCare, Allergy Diagnosis and Study Center, Vienna, Austria
| | - G. W. Canonica
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University & Research Hospital, Rozzano, Milan, Italy
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15
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Melioli G, Savi E, Crivellaro MA, Passalacqua G. Potential of molecular based diagnostics and its impact on allergen immunotherapy. Asthma Res Pract 2016; 2:9. [PMID: 27965777 PMCID: PMC5142326 DOI: 10.1186/s40733-016-0024-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 04/14/2016] [Indexed: 12/21/2022] Open
Abstract
Molecular based in vitro technologies greatly changed the diagnostic approaches in allergy. At present, sensitization profiles can be dissected according to IgE subsets, which are specific for genuine or cross-reacting components and potentially dangerous or virtually harmless components. The identification of IgE in components with specific characteristics has a direct impact on the accuracy of the diagnosis (indeed, it is possible at present to not only identify the allergen derived from a given allergen source but also the family of molecules to which the patient is sensitized), on the prognosis of the patient’s allergy, and on the prevention activities to be implemented. More interestingly, during the last few years, and thanks to the tools of molecular diagnostics, the indications for Allergen Immunotherapy (AIT) have also be modified, and novel strategies for the selection of the allergens to be administered have been better defined. Indeed, protocols indicating how Molecular Based Diagnosis (MBD) can be used to identify the best AIT approach have been recently published. In this review, the rationale for the use of MBD tools is discussed, and the recent strategies for the choice of allergens to be used in AIT are reported.
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Affiliation(s)
- Giovanni Melioli
- Allergy and Respiratory Diseases, Department of Internal Medicine, IRCCS San Martino-IST-University of Genoa, L. go R. Benzi 10, 16132 Genoa, Italy
| | - Eleonora Savi
- Allergology Unit, Ospedale A. Da Saliceto, Piacenza, Italy
| | - Maria Angiola Crivellaro
- Allergology Service, Department of Medicine and Public Health, University of Padua, Padova, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, Department of Internal Medicine, IRCCS San Martino-IST-University of Genoa, Genova, Italy
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17
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Jakob T, Forstenlechner P, Matricardi P, Kleine-Tebbe J. Molecular allergy diagnostics using multiplex assays: methodological and practical considerations for use in research and clinical routine: Part 21 of the Series Molecular Allergology. ACTA ACUST UNITED AC 2015; 24:320-332. [PMID: 27069843 PMCID: PMC4792369 DOI: 10.1007/s40629-015-0087-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 08/26/2015] [Indexed: 01/07/2023]
Abstract
The availability of single allergens and their use in microarray technology enables the simultaneous determination of specific IgE (sIgE) to a multitude of different allergens (> 100) in a multiplex procedure requiring only minute amounts of serum. This allows extensive individual sensitization profiles to be determined from a single analysis. Combined with a patient’s medical history, these profiles simplify identification of cross-reactivity; permit a more accurate estimation of the risk of severe reactions; and enable the indication for specific immunotherapy to be more precisely established, particularly in cases of polysensitization. Strictly speaking, a multiplex assay is not a single test, but instead more than 100 simultaneous tests. This places considerable demands on the production, quality assurance, and interpretation of data. The following chapter describes the multiplex test systems currently available and discusses their characteristics. Performance data are presented and the sIgE values obtained from multiplex and singleplex assays are compared. Finally, the advantages and limitations of molecular allergy diagnostics using multiplex assays in clinical routine are discussed, and innovative possibilities for clinical research are described. The multiplex diagnostic tests available for clinical routine have now become well established. The interpretation of test results is demanding, particularly since all individual results need to be checked for their plausibility and clinical relevance on the basis of previous history (patient history, clinical symptoms, challenge test results). There is still room for improvement in certain areas, for example with respect to the overall test sensitivity of the method, as well as the availability and quality of particular allergens. The current test systems are just the beginning of a continuous development that will influence and most likely change clinical allergology in the coming years.
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Affiliation(s)
- Thilo Jakob
- />Department of Dermatology and Allergology, University Medical Center Gießen and Marburg, Justus Liebig University Gießen, Gaffkystrasse 14, 35385 Gießen, Germany
| | | | - Paolo Matricardi
- />Department of Pediatric Pneumonology and Immunology, Charité University Hospital, Berlin, Germany
| | - Jörg Kleine-Tebbe
- />Westend Allergy and Asthma Center, Hanf, Ackermann-Simon, and Kleine-Tebbe Specialist Allergy Practice, Berlin, Germany
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Guidelines for the use and interpretation of diagnostic methods in adult food allergy. Clin Mol Allergy 2015; 13:27. [PMID: 26441488 PMCID: PMC4593201 DOI: 10.1186/s12948-015-0033-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 09/15/2015] [Indexed: 12/27/2022] Open
Abstract
Food allergy has an increasing prevalence in the general population and in Italy concerns 8 % of people with allergies. The spectrum of its clinical manifestations ranges from mild symptoms up to potentially fatal anaphylactic shock. A number of patients can be diagnosed easily by the use of first- and second-level procedures (history, skin tests and allergen specific IgE). Patients with complex presentation, such as multiple sensitizations and pollen-food syndromes, frequently require a third-level approach including molecular diagnostics, which enables the design of a component-resolved sensitization profile for each patient. The use of such techniques involves specialists' and experts' skills on the issue to appropriately meet the diagnostic and therapeutic needs of patients. Particularly, educational programs for allergists on the use and interpretation of molecular diagnostics are needed.
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Popescu FD. Cross-reactivity between aeroallergens and food allergens. World J Methodol 2015; 5:31-50. [PMID: 26140270 PMCID: PMC4482820 DOI: 10.5662/wjm.v5.i2.31] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/25/2015] [Accepted: 04/16/2015] [Indexed: 02/07/2023] Open
Abstract
In patients with respiratory allergy, cross-reactivity between aeroallergens and foods may induce food allergy, symptoms ranging from oral allergy syndrome to severe anaphylaxis. Clinical entities due to IgE sensitization to cross-reactive aeroallergen and food allergen components are described for many sources of plant origin (pollen-food syndromes and associations, such as birch-apple, cypress-peach and celery-mugwort-spice syndromes, and mugwort-peach, mugwort-chamomile, mugwort-mustard, ragweed-melon-banana, goosefoot-melon associations), fungal origin (Alternaria-spinach syndrome), and invertebrate, mammalian or avian origin (mite-shrimp, cat-pork, and bird-egg syndromes). Clinical cases of allergic reactions to ingestion of food products containing pollen grains of specific plants, in patients with respiratory allergy to Asteraceae pollen, especially mugwort and ragweed, are also mentioned, for honey, royal jelly and bee polen dietary supplements, along with allergic reactions to foods contaminated with mites or fungi in patients with respiratory allergy to these aeroallergens. Medical history and diagnosis approach may be guided by the knowledge about the diverse cross-reacting allergens involved, and by the understanding of these clinical entities which may vary significantly or may be overlapping. The association between primary IgE sensitization with respiratory symptoms to inhaled allergens and food allergy due to cross-reactive allergen components is important to assess in allergy practice. The use of molecular-based diagnosis improves the understanding of clinically relevant IgE sensitization to cross-reactive allergen components from aeroallergen sources and foods.
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Melioli G, Passalacqua G, Canonica GW. Novel in silico technology in combination with microarrays: a state-of-the-art technology for allergy diagnosis and management? Expert Rev Clin Immunol 2014; 10:1559-61. [PMID: 25370475 DOI: 10.1586/1744666x.2014.978761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
'Allergen microarrays, in poly-sensitized allergic patients, represent a real value added in the accurate IgE profiling and in the identification of allergen(s) to administer for an effective allergen immunotherapy.' Allergen microarrays (AMA) were developed in the early 2000s to improve the diagnostic pathway of patients with allergic reactions. Nowadays, AMA are constituted by more than 100 different components (either purified or recombinant), representing genuine and cross-reacting molecules from plants and animals. The cost of the procedure had suggested its use as third-level diagnostics (following in vivo- and in vitro-specific IgE tests) in poly-sensitized patients. The complexity of the interpretation had inspired the development of in silico technologies to help clinicians in their work. Both machine learning techniques and expert systems are now available. In particular, an expert system that has been recently developed not only identifies positive and negative components but also lists dangerous components and classifies patients based on their potential responsiveness to allergen immunotherapy, on the basis of published algorithms. For these characteristics, AMA represents the state-of-the-art technology for allergy diagnosis in poly-sensitized patients.
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Affiliation(s)
- Giovanni Melioli
- Allergy and Respiratory Diseases, Department of Internal Medicine, IRCCS S.Martino-IST-University of Genoa, Largo Rosanna Benzi 10,16132, Genova, Italy
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