1
|
Giusti D, Guemari A, Perotin JM, Fontaine JF, Tonye Libyh M, Gatouillat G, Tabary T, Pham BN, Vitte J. Molecular allergology: a clinical laboratory tool for precision diagnosis, stratification and follow-up of allergic patients. Clin Chem Lab Med 2024; 0:cclm-2024-0305. [PMID: 38815141 DOI: 10.1515/cclm-2024-0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/15/2024] [Indexed: 06/01/2024]
Abstract
Identification of the molecular culprits of allergic reactions leveraged molecular allergology applications in clinical laboratory medicine. Molecular allergology shifted the focus from complex, heterogeneous allergenic extracts, e.g. pollen, food, or insect venom, towards genetically and immunologically defined proteins available for in vitro diagnosis. Molecular allergology is a precision medicine approach for the diagnosis, stratification, therapeutic management, follow-up and prognostic evaluation of patients within a large range of allergic diseases. Exclusively available for in vitro diagnosis, molecular allergology is nonredundant with any of the current clinical tools for allergy investigation. As an example of a major application, discrimination of genuine sensitization from allergen cross-reactivity at the molecular level allows the proper targeting of the culprit allergen and thus dramatically improves patient management. This review aims at introducing clinical laboratory specialists to molecular allergology, from the biochemical and genetic bases, through immunological concepts, to daily use in the diagnosis and management of allergic diseases.
Collapse
Affiliation(s)
- Delphine Giusti
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
- University of Reims Champagne Ardenne, EA7509 IRMAIC, Reims, France
| | - Amir Guemari
- Univ Montpellier, Desbrest Institute of Epidemiology and Public Health (IDESP), INSERM, Montpellier, France
| | - Jeanne-Marie Perotin
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
- University of Reims Champagne Ardenne, INSERM UMR 1250, Reims, France
| | | | - Marcelle Tonye Libyh
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
| | - Gregory Gatouillat
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
| | - Thierry Tabary
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
| | - Bach-Nga Pham
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
- University of Reims Champagne Ardenne, EA7509 IRMAIC, Reims, France
| | - Joana Vitte
- Immunology Laboratory, Biology and Pathology Department, University Hospital of Reims, Reims, France
- University of Reims Champagne Ardenne, INSERM UMR 1250, Reims, France
| |
Collapse
|
2
|
Dimou MV, Xepapadaki P, Lakoumentas J, Mageiros L, Aggelidis X, Antonopoulou M, Bakakos P, Βotskariova S, Chliveros K, Chrysoulakis S, Dimas D, Douladiris N, Gaga M, Grigoreas C, Kalogiros L, Katotomichelakis M, Kompoti E, Constantinidis J, Koutsogianni Z, Loukides S, Makris M, Manousakis E, Marangoudakis P, Marmara M, Mikos N, Mitsakou P, Mitsias D, Pagalos A, Papanikolaou V, Paraskevopoulos I, Pitsios C, Psarros F, Rovina N, Samitas K, Stefanaki E, Vallianatou M, Vourdas D, Tsiligianni I, Bousquet J, Papadopoulos NG. Levels of IgE sensitization drive symptom thresholds in allergic rhinitis. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00274-6. [PMID: 38679157 DOI: 10.1016/j.anai.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Allergic rhinitis (AR) is a common respiratory disease encompassing a variety of phenotypes. Patients can be sensitized to 1 or more allergens. There are indications that polysensitization is associated with more severe disease. However, the extent to which the level of sensitization is associated with clinical disease variability, underlying the distinct nature of AR from AR+ conjunctivitis or AR+ asthma, is not known. OBJECTIVE To evaluate phenotypical differences between monosensitized and polysensitized patients with AR and to quantify their symptomatic variability. METHODS A total of 565 patients with a confirmed diagnosis of AR were included in this cross-sectional study. Of those, 155 were monosensitized and 410 were polysensitized. Interactions between sensitization levels and the reporting of different symptoms of AR and co-morbidities, disease duration, and impact were assessed. Furthermore, patients were stratified into monosensitized, oligosensitized, and polysensitized to assess whether the effect of sensitization on the phenotype was ranked. RESULTS Polysensitized patients reported itchy eyes significantly more often (P = .001) and had a higher number of ocular (P = .005), itch-related (P = .036), and total symptoms (P = .007) than monosensitized patients. In addition, polysensitized adults and children more often reported wheeze (P = .015) and throat-clearing (P = .04), respectively. Polysensitization was associated with more burdensome AR based on a visual analog scale (P = .005). Increased sensitization level was reflected in more itchy eyes, a higher number of ocular, itch-related, and total number of symptoms, and disease burden. CONCLUSION With an increasing number of sensitizations, patients with AR experience an increased diversity of symptoms. Multimorbidity-related symptoms increase with sensitization rank, suggesting organ-specific thresholds.
Collapse
Affiliation(s)
- Maria V Dimou
- Allergy Department, Second Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi Xepapadaki
- Allergy Department, Second Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - John Lakoumentas
- Allergy Department, Second Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonardos Mageiros
- Allergy Department, Second Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Xenophon Aggelidis
- D. Kalogeromitros Allergy Unit, Second Department of Dermatology and Venereology, University General Hospital, National University of Athens Medical School, Attiko, Athens, Greece
| | | | - Petros Bakakos
- First Department of Respiratory Medicine, Medical School, Sotiria Regional Chest Diseases Hospital, National Kapodistrian University of Athens, Athens, Greece
| | - Sophia Βotskariova
- Allergy Department, Second Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Dionysios Dimas
- General Practitioner, Health Centre of Chalastra, Tessaloniki, Greece
| | - Nikolaos Douladiris
- Allergy Department, Second Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Mina Gaga
- Αsthma Center, Athens Chest Hospital, Sotiria, Athens, Greece
| | - Christos Grigoreas
- Former President of Hellenic Society of Allergology and Clinical Immunology
| | | | | | - Evangelia Kompoti
- Department of Allergology and Clinical Immunology, Laikon General Hospital, Athens, Greece
| | - Jannis Constantinidis
- First Academic Otorhinolaryngology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Stelios Loukides
- Second Respiratory Department, Attiko University Hospital, University of Athens Medical School, Athens, Greece
| | - Michael Makris
- D. Kalogeromitros Allergy Unit, Second Department of Dermatology and Venereology, University General Hospital, National University of Athens Medical School, Attiko, Athens, Greece
| | - Emmanouil Manousakis
- Allergy Department, Second Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Pavlos Marangoudakis
- Second Otorhinolaryngology Clinic, Attiko University General Hospital, National University of Athens Medical School, Athens, Greece
| | | | - Nikolaos Mikos
- Department of Allergology and Clinical Immunology, Laikon General Hospital, Athens, Greece
| | | | - Dimitrios Mitsias
- Allergy Department, Second Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Aris Pagalos
- Private Otorhinolaryngologist, Agios Nikolaos, Crete, Greece
| | | | | | | | | | - Nikoletta Rovina
- First Department of Respiratory Medicine, Medical School, Sotiria Regional Chest Diseases Hospital, National Kapodistrian University of Athens, Athens, Greece
| | | | | | - Mina Vallianatou
- Allergy Department, Second Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Ioanna Tsiligianni
- Department of Social Medicine, University of Crete, Heraklion, Crete, Greece
| | - Jean Bousquet
- Montpellier University Hospital, Montpellier, France; MACVIA-France, Contre les Maladies Chroniques pour un Vieillissement Actif en France, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France. INSERM, U1168, Ageing and Chronic Diseases Epidemiological and Public Health Approaches, CHRU Arnaud de Villeneuve, Villejuif, France
| | - Nikolaos G Papadopoulos
- Allergy Department, Second Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.
| |
Collapse
|
3
|
Asthma and Allergy: Unravelling a Tangled Relationship with a Focus on New Biomarkers and Treatment. Int J Mol Sci 2022; 23:ijms23073881. [PMID: 35409241 PMCID: PMC8999577 DOI: 10.3390/ijms23073881] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 12/19/2022] Open
Abstract
Asthma is a major driver of health care costs across ages. Despite widely disseminated asthma-treatment guidelines and a growing variety of effective therapeutic options, most patients still experience symptoms and/or refractoriness to standard of care treatments. As a result, most patients undergo a further intensification of therapy to optimize symptom control with a subsequent increased risk of side effects. Raising awareness about the relevance of evaluating aeroallergen sensitizations in asthmatic patients is a key step in better informing clinical practice while new molecular tools, such as the component resolved diagnosis, may be of help in refining the relationship between sensitization and therapeutic recommendations. In addition, patient care should benefit from reliable, easy-to-measure and clinically accessible biomarkers that are able to predict outcome and disease monitoring. To attain a personalized asthma management and to guide adequate treatment decisions, it is of paramount importance to expand clinicians' knowledge about the tangled relationship between asthma and allergy from a molecular perspective. Our review explores the relevance of allergen testing along the asthma patient's journey, with a special focus on recurrent wheezing children. Here, we also discuss the unresolved issues regarding currently available biomarkers and summarize the evidence supporting the eosinophil-derived neurotoxin as promising biomarker.
Collapse
|
4
|
Panaitescu C, Haidar L, Buzan MR, Grijincu M, Spanu DE, Cojanu C, Laculiceanu A, Bumbacea R, Agache IO. Precision medicine in the allergy clinic: the application of component resolved diagnosis. Expert Rev Clin Immunol 2022; 18:145-162. [PMID: 35078387 DOI: 10.1080/1744666x.2022.2034501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION A precise diagnosis is key for the optimal management of allergic diseases and asthma. In vivo or in vitro diagnostic methods that use allergen extracts often fail to identify the molecules eliciting the allergic reactions. AREAS COVERED Component-resolved diagnosis (CRD) has solved most of the limitations of extract-based diagnostic procedures and is currently valuable tool for the precision diagnosis in the allergy clinic, for venom and food allergy, asthma, allergic rhinitis, and atopic dermatitis. Its implementation in daily practice facilitates: a) the distinction between genuine multiple sensitizations and cross-reactive sensitization in polysensitized patients; b) the prediction of a severe, systemic reaction in food or insect venom allergy; c) the optimal selection of allergen immunotherapy based on the patient sensitization profile. This paper describes its main advantages and disadvantages, cost-effectiveness and future perspectives. EXPERT OPINION The diagnostic strategy based on CRD is part of the new concept of precision immunology, which aims to improve the management of allergic diseases.
Collapse
Affiliation(s)
- Carmen Panaitescu
- Department of Functional Sciences, Physiology, Center of Immuno-Physiology and Biotechnologies (CIFBIOTEH), "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania.,Centre for Gene and Cellular Therapies in The Treatment of Cancer - OncoGen, "Pius Brinzeu" Clinical Emergency Hospital, Timisoara, Romania
| | - Laura Haidar
- Department of Functional Sciences, Physiology, Center of Immuno-Physiology and Biotechnologies (CIFBIOTEH), "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania
| | - Maria Roxana Buzan
- Department of Functional Sciences, Physiology, Center of Immuno-Physiology and Biotechnologies (CIFBIOTEH), "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania.,Centre for Gene and Cellular Therapies in The Treatment of Cancer - OncoGen, "Pius Brinzeu" Clinical Emergency Hospital, Timisoara, Romania
| | - Manuela Grijincu
- Department of Functional Sciences, Physiology, Center of Immuno-Physiology and Biotechnologies (CIFBIOTEH), "Victor Babeș" University of Medicine and Pharmacy Timișoara, Romania.,Centre for Gene and Cellular Therapies in The Treatment of Cancer - OncoGen, "Pius Brinzeu" Clinical Emergency Hospital, Timisoara, Romania
| | | | - Catalina Cojanu
- Transylvania University Brasov - Faculty of Medicine, Brasov
| | | | - Roxana Bumbacea
- Department of Allergy, "Carol Davila" University of Medicine and Pharmacy Bucharest, Romania
| | | |
Collapse
|
5
|
Escarrer-Jaume M, Juliá-Benito JC, Quevedo-Teruel S, Del Prado AP, Sandoval-Ruballos M, Quesada-Sequeira F, Álvaro-Lozano M. Changes in epidemiology and clinical practice in IgE-mediated Allergy in children. An Pediatr (Barc) 2021; 95:56.e1-56.e8. [PMID: 34183295 DOI: 10.1016/j.anpede.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/30/2021] [Indexed: 11/17/2022] Open
Abstract
In the last decades, allergic diseases have increased exponentially and although pediatric asthma prevalence is stabilizing, it is estimated around 10% in Spain. Not the same with food allergy and anaphylaxis which are clearly increasing, becoming a significant public health problem. Taking into account epidemiological trends, the European Academy of Allergy and Clinical Immunology (EAACI) estimates that in less than 15 years more than half of the European population will suffer from some type of allergic disorder. The advances in diagnostic methods in food allergy, especially component resolved diagnosis, allow us to know the patient's sensitization profile and explain possible cross reactivity, anticipate potential risk of food trangressions, and prescribe correct avoidance diet in each patient. Thus, the development of molecular biology and nanotechnology have led to the appearance of new technologies (microarrays) which facilitate the study, specially of the polysensitized patients, allowing allergen immunotherapy (AIT) to be more personalized. The latest advances in the use of biologics are having an impact, not only in disease evolution, but also in quality of life.
Collapse
Affiliation(s)
- Mercedes Escarrer-Jaume
- Unidad de Alergología y Neumología Pediátrica Clínica Juaneda, Palma de Mallorca, Spain; Centro de Salud San Agustín, Palma de Mallorca, Spain.
| | - Juan Carlos Juliá-Benito
- Centro de Salud República Argentina, Valencia, Spain; Unidad de Alergología y Neumología Pediátrica, Hospital IMED, Valencia, Spain
| | - Sergio Quevedo-Teruel
- Unidad de Alergia y Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Severo Ochoa, Leganés, Spain; Universidad Alfonso X el Sabio, Villanueva de la Cañada, Spain
| | - Ana Prieto Del Prado
- Unidad de Alergia Pediátrica, Hospital Regional Universitario de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga, IBIMA, Málaga, Spain
| | - Mónica Sandoval-Ruballos
- Servicio de Alergia y Inmunología Clínica Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - Montserrat Álvaro-Lozano
- Servicio de Alergia y Inmunología Clínica Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
6
|
Escarrer-Jaume M, Juliá-Benito JC, Quevedo-Teruel S, Prieto Del-Prado A, Sandoval-Ruballos M, Quesada-Sequeira F, Álvaro-Lozano M. [Changes in epidemiology and clinical practice in IgE-mediated allergy in children]. An Pediatr (Barc) 2021. [PMID: 34119433 DOI: 10.1016/j.anpedi.2021.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In the last decades, allergic diseases have increased exponentially and although pediatric asthma prevalence is stabilizing, in Spain is estimated around 10%. Not the same with food allergy and anaphylaxis which are clearly increasing, becoming a public health problem of the first magnitude. Considering epidemiological trends, the European Academy of Allergy and Clinical Immunology (EAACI) estimates that in less than 15 years more than half of European population will suffer from some type of allergy. The advances in diagnostic methods in food allergy, especially component resolved diagnosis, allow us to know the patient's sensitization profile and explain the possible cross reactivity, anticipate potential risk of food transgressions, and prescribe the correct avoidance diet in each patient. Thus, the development of molecular biology and nanotechnology have led to the appearance of new technologies (microarrays) which facilitate the study, specially of the polysensitized patients, allowing allergen immunotherapy (AIT) to be more personalized. The latest advances in the use of biologics are having an impact, not only in disease evolution, but also in patients quality of life.
Collapse
Affiliation(s)
- Mercedes Escarrer-Jaume
- Unidad de Alergología y Neumología pediátrica Clínica Juaneda, Palma de Mallorca, España; Centro de salud San Agustín, Palma de Mallorca, España.
| | - Juan Carlos Juliá-Benito
- Centro de salud República Argentina, Valencia, España; Unidad de alergología y neumología pediátrica, Hospital IMED, Valencia, España
| | - Sergio Quevedo-Teruel
- Unidad de Alergia y Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Severo Ochoa, Leganés, España; Universidad Alfonso X el Sabio, Villanueva de la Cañada, España
| | - Ana Prieto Del-Prado
- Unidad de Alergia Pediátrica, Hospital Regional Universitario de Málaga, Málaga, España; Instituto de Investigación Biomédica de Málaga. IBIMA, Málaga, España
| | - Mónica Sandoval-Ruballos
- Servicio de Alergia e Inmunología Clínica Pediátrica, Hospital Sant Joan de Déu, Barcelona, España
| | | | - Montserrat Álvaro-Lozano
- Servicio de Alergia e Inmunología Clínica Pediátrica, Hospital Sant Joan de Déu, Barcelona, España; Institut de Recerca Sant Joan de Déu, Barcelona, España; Universitat de Barcelona, Barcelona, España
| |
Collapse
|
7
|
Darnhofer B, Tomin T, Liesinger L, Schittmayer M, Tomazic PV, Birner‐Gruenberger R. Comparative proteomics of common allergenic tree pollens of birch, alder, and hazel. Allergy 2021; 76:1743-1753. [PMID: 33301602 PMCID: PMC8248232 DOI: 10.1111/all.14694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/26/2020] [Accepted: 11/14/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND In addition to known allergens, other proteins in pollen can aid the development of an immune response in allergic individuals. The contribution of the "unknown" protein allergens is apparent in phylogenetically related species where, despite of high homology of the lead allergens, the degree of allergenic potential can vary greatly. The aim of this study was to identify other potentially allergenic proteins in pollen of three common and highly related allergenic tree species: birch (Betula pendula), hazel (Corylus avellana) and alder (Alnus glutinosa). METHODS For that purpose, we carried out a comprehensive, comparative proteomic screening of the pollen from the three species. In order to maximize protein recovery and coverage, different protein extraction and isolation strategies during sample preparation were employed. RESULTS As a result, we report 2500-3000 identified proteins per each of the pollen species. Identified proteins were further used for a number of annotation steps, providing insight into differential distribution of peptidases, peptidase inhibitors and other potential allergenic proteins across the three species. Moreover, we carried out functional enrichment analyses that, interestingly, corroborated high species similarity in spite of their relatively distinct protein profiles. CONCLUSION We provide to our knowledge first insight into proteomes of two very important allergenic pollen types, hazel and alder, where not even transcriptomics data are available, and compared them to birch. Datasets from this study can be readily used as protein databases and as such serve as basis for further functional studies.
Collapse
Affiliation(s)
- Barbara Darnhofer
- Diagnostic and Research Institute of PathologyMedical University of GrazGrazAustria
- Omics Center GrazBiotechMed‐GrazGrazAustria
| | - Tamara Tomin
- Diagnostic and Research Institute of PathologyMedical University of GrazGrazAustria
- Omics Center GrazBiotechMed‐GrazGrazAustria
- Faculty of Technical ChemistryInstitute of Chemical Technologies and AnalyticsTechnische Universität Wien (TU Wien)ViennaAustria
| | - Laura Liesinger
- Diagnostic and Research Institute of PathologyMedical University of GrazGrazAustria
- Omics Center GrazBiotechMed‐GrazGrazAustria
| | - Matthias Schittmayer
- Diagnostic and Research Institute of PathologyMedical University of GrazGrazAustria
- Omics Center GrazBiotechMed‐GrazGrazAustria
- Faculty of Technical ChemistryInstitute of Chemical Technologies and AnalyticsTechnische Universität Wien (TU Wien)ViennaAustria
| | - Peter Valentin Tomazic
- Division of PhoniatricsDepartment of OtorhinolaryngologyMedical University of GrazGrazAustria
| | - Ruth Birner‐Gruenberger
- Diagnostic and Research Institute of PathologyMedical University of GrazGrazAustria
- Omics Center GrazBiotechMed‐GrazGrazAustria
- Faculty of Technical ChemistryInstitute of Chemical Technologies and AnalyticsTechnische Universität Wien (TU Wien)ViennaAustria
| |
Collapse
|
8
|
Salvermoser M, Zeber K, Boeck A, Klucker E, Schaub B. Childhood asthma: Novel endotyping by cytokines, validated through sensitization profiles and clinical characteristics. Clin Exp Allergy 2021; 51:654-665. [PMID: 33650157 DOI: 10.1111/cea.13858] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/03/2021] [Accepted: 02/19/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Specific allergy sensitization pattern, using "component-resolved diagnosis" (CRD), is a central component of allergy and asthma in childhood. Besides this, allergic asthma has been characterized by a Th2-shifted endotype with elevation of classical Th2 cytokines. Recently, other endotypes with distinct mechanisms focusing on cytokine regulation evolved, yet those pathways are still not well understood. OBJECTIVE (a) To define reproducible immunological endotypes using cytokine expression in an asthma cohort and (b) to characterize their sensitization profile and clinical phenotype. METHODS Supernatants from PBMCs of 234 children (median age 10 years) of an asthma cohort were analysed for cytokine expressions. The children were split into a training (n = 49) and validation (n = 185) group. The training group was used to identify immunological endotypes by clustering cytokine expressions, which were then assessed regarding clinical characteristics and specific IgE of recombinant allergen components. Next, our findings were validated in the validation group. RESULTS We identified novel endotypes based on primarily unstimulated cytokine expression. One endotype showed an IFN-γ/Interleukin (IL)-17/IL-5 predominance, a different sensitization pattern (high in birch/apple; p < .01), and inferior lung function (p < .01). A second endotype grouped young children with food allergy and reduced lung function. Our findings were reproducible in the validation group. CONCLUSION AND CLINICAL RELEVANCE We identified two novel clinical asthma endotypes via cytokine expression pattern with distinct sensitization patterns. These novel findings are critical for clinical guidance and open avenues for identifying underlying mechanisms and more patient-specific therapies.
Collapse
Affiliation(s)
- Michael Salvermoser
- Department of Pulmonary and Allergy, Dr. von Hauner Children's Hospital, LMU University of Munich, Munich, Germany
| | - Kathrin Zeber
- Department of Pulmonary and Allergy, Dr. von Hauner Children's Hospital, LMU University of Munich, Munich, Germany
| | - Andreas Boeck
- Department of Pulmonary and Allergy, Dr. von Hauner Children's Hospital, LMU University of Munich, Munich, Germany
| | - Elisabeth Klucker
- Dr. von Hauner Children's Hospital, LMU University of Munich, Munich, Germany
| | - Bianca Schaub
- Department of Pulmonary and Allergy, Dr. von Hauner Children's Hospital, LMU University of Munich, Munich, Germany.,German Centre of Lung Research, Munich, Germany
| |
Collapse
|
9
|
Allergen Preparation in AIT, Now and in the Future. CURRENT TREATMENT OPTIONS IN ALLERGY 2021. [DOI: 10.1007/s40521-021-00281-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
10
|
Huang HJ, Campana R, Akinfenwa O, Curin M, Sarzsinszky E, Karsonova A, Riabova K, Karaulov A, Niespodziana K, Elisyutina O, Fedenko E, Litovkina A, Smolnikov E, Khaitov M, Vrtala S, Schlederer T, Valenta R. Microarray-Based Allergy Diagnosis: Quo Vadis? Front Immunol 2021; 11:594978. [PMID: 33679689 PMCID: PMC7928321 DOI: 10.3389/fimmu.2020.594978] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/08/2020] [Indexed: 12/24/2022] Open
Abstract
More than 30% of the world population suffers from allergy. Allergic individuals are characterized by the production of immunoglobulin E (IgE) antibodies against innocuous environmental allergens. Upon allergen recognition IgE mediates allergen-specific immediate and late-phase allergic inflammation in different organs. The identification of the disease-causing allergens by demonstrating the presence of allergen-specific IgE is the key to precision medicine in allergy because it allows tailoring different forms of prevention and treatment according to the sensitization profiles of individual allergic patients. More than 30 years ago molecular cloning started to accelerate the identification of the disease-causing allergen molecules and enabled their production as recombinant molecules. Based on recombinant allergen molecules, molecular allergy diagnosis was introduced into clinical practice and allowed dissecting the molecular sensitization profiles of allergic patients. In 2002 it was demonstrated that microarray technology allows assembling large numbers of allergen molecules on chips for the rapid serological testing of IgE sensitizations with small volumes of serum. Since then microarrayed allergens have revolutionized research and diagnosis in allergy, but several unmet needs remain. Here we show that detection of IgE- and IgG-reactivity to a panel of respiratory allergens microarrayed onto silicon elements is more sensitive than glass-based chips. We discuss the advantages of silicon-based allergen microarrays and how this technology will allow addressing hitherto unmet needs in microarray-based allergy diagnosis. Importantly, it described how the assembly of silicon microarray elements may create different microarray formats for suiting different diagnostic applications such as quick testing of single patients, medium scale testing and fully automated large scale testing.
Collapse
Affiliation(s)
- Huey-Jy Huang
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Raffaela Campana
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Oluwatoyin Akinfenwa
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Mirela Curin
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Eszter Sarzsinszky
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Antonina Karsonova
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Ksenja Riabova
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alexander Karaulov
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Katarzyna Niespodziana
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Olga Elisyutina
- Department of Allergology and Clinical Immunology, NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Elena Fedenko
- Department of Allergology and Clinical Immunology, NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Alla Litovkina
- Department of Allergology and Clinical Immunology, NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Evgenii Smolnikov
- Department of Allergology and Clinical Immunology, NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Musa Khaitov
- Department of Allergology and Clinical Immunology, NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Susanne Vrtala
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Thomas Schlederer
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.,Laboratory of Immunopathology, Department of Clinical Immunology and Allergology, Sechenov First Moscow State Medical University, Moscow, Russia.,Department of Allergology and Clinical Immunology, NRC Institute of Immunology FMBA of Russia, Moscow, Russia.,Karl Landsteiner University of Health Sciences, Krems, Austria
| |
Collapse
|
11
|
Dezfouli SG, Mothes-Luksch N, Jensen AN, Untersmayr E, Kundi M, Jensen-Jarolim E. Linking cross-reactivity clusters of food and respiratory allergens in PAMD@ to asthma and duration of allergy. World Allergy Organ J 2020; 13:100483. [PMID: 33294115 PMCID: PMC7691607 DOI: 10.1016/j.waojou.2020.100483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Component resolved diagnosis, recently redefined as precision allergy medicine diagnosis - PAMD@, may help understanding allergic cross-reactivity patterns among polysensitized patients and their clinical implication. OBJECTIVE We aimed to investigate similarities among allergens by empirically determining the occurrence of co-sensitization patterns and to relate them to clinical features, in particular to asthma. METHODS A retrospective cohort study in 1057 participants suspected to have allergic sensitization was performed in Vienna. To define cross-reactivity patterns, cluster analysis for 671 patients who showed reaction to at least one of the allergens in ISAC112 was performed and followed by multivariate logistic regression analysis to relate clusters and clinical symptoms, in particular current asthma. RESULTS We determined 18 cross-reactivity clusters, comprising of 6 food, 10 respiratory, and 2 other clusters of allergens. Overall, 14% of the cohort patients were positive for 1 cross-reactivity cluster and 23% to 2 or more clusters. Multisensitized patients who were sensitized to PR-10 allergen proteins in addition to Bermuda timothy grass pollen clusters showed the highest association with asthma (odds ratio, 4.22 and 95% CI: 2.32-7.68) and an increase of 10 years of the duration of allergy increased the odds for a combined sensitization to PR-10 cluster and Bermuda-timothy cluster by 1.27 (95% CI: 1.06-1.53). CONCLUSION Similarities among IgE positivity patterns determined by ISAC112 revealed 18 cross-reactivity clusters. This PAMD@ approach allowed prediction of clinical features and revealed that certain cross-reactivity patterns are related to duration of allergic symptoms.
Collapse
Affiliation(s)
- Shadan Ghandizadeh Dezfouli
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria
- Center for Public Health, Medical University Vienna, Austria
| | - Nadine Mothes-Luksch
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria
- AllergyCare® - Allergy Diagnosis, Vienna, Austria
| | | | - Eva Untersmayr
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria
| | - Michael Kundi
- Center for Public Health, Medical University Vienna, Austria
| | - Erika Jensen-Jarolim
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria
- AllergyCare® - Allergy Diagnosis, Vienna, Austria
- Comparative Medicine, The Interuniversity Messerli Research Institute, Vienna, Austria
| |
Collapse
|
12
|
Kleine-Tebbe J. Molekulare Allergiediagnostik. Drug Res (Stuttg) 2020; 70:S17-S21. [PMID: 33202472 DOI: 10.1055/a-1119-2751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
13
|
Kalli M, Blok A, Jiang L, Starr N, Alcocer MJC, Falcone FH. Development of a protein microarray-based diagnostic chip mimicking the skin prick test for allergy diagnosis. Sci Rep 2020; 10:18208. [PMID: 33097775 PMCID: PMC7584649 DOI: 10.1038/s41598-020-75226-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/12/2020] [Indexed: 01/16/2023] Open
Abstract
Protein microarrays have been successfully used for detection of allergen-specific IgE in patient sera. Here, we demonstrate proof-of-concept of a solid-phase technique coupling the high-throughput potential of protein microarrays with the biologically relevant readout provided by IgE reporter cells, creating a novel allergic sensitization detection system. Three proteins (κ-casein, timothy grass pollen extract, polyclonal anti-human IgE) were printed onto three different polymer-coated surfaces (aldehyde-, epoxy- and NHS ester-coated). ToF-SIMs analysis was performed to assess printed protein stability and retention during washing steps. NFAT-DsRed rat basophil leukemia cell attachment and retention during washing steps was assessed after treatment with various extracellular matrix proteins. NFAT-DsRed IgE reporter cells were sensitized with serum of an allergic donor, incubated on the printed slides, and cell activation determined using a microarray laser scanner. NFAT DsRed IgE reporter cell binding was significantly increased on all polymer surfaces after incubation with fibronectin and vitronectin, but not collagen or laminin. All surfaces supported printed protein stability during washing procedure, with epoxy- and NHS ester-coated surfaces showing best protein retention. Cell activation was significantly higher in NHS ester-coated slides after timothy grass pollen extract stimulation appearing a suitable substrate for further development of an automated allergy diagnosis system.
Collapse
Affiliation(s)
- Marina Kalli
- Molecular Therapeutics and Formulation Division, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Andrew Blok
- Advanced Materials and Healthcare Technologies Division, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Long Jiang
- Advanced Materials and Healthcare Technologies Division, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Nichola Starr
- Advanced Materials and Healthcare Technologies Division, School of Pharmacy, University of Nottingham, Nottingham, UK
| | | | - Franco H Falcone
- Molecular Therapeutics and Formulation Division, School of Pharmacy, University of Nottingham, Nottingham, UK.
- Institute for Parasitology, Justus-Liebig-University of Giessen, Biomedizinisches Forschungszentrum Am Seltersberg, Schubertstr. 81, 35392, Giessen, Germany.
| |
Collapse
|
14
|
Tripodi S, Giannone A, Sfika I, Pelosi S, Dramburg S, Bianchi A, Pizzulli A, Florack J, Villella V, Potapova E, Matricardi PM. Digital technologies for an improved management of respiratory allergic diseases: 10 years of clinical studies using an online platform for patients and physicians. Ital J Pediatr 2020; 46:105. [PMID: 32711557 PMCID: PMC7382563 DOI: 10.1186/s13052-020-00870-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/16/2020] [Indexed: 12/18/2022] Open
Abstract
Background Digital health technologies carry the great potential of assisting physicians in making well-informed diagnostic and therapeutic decisions. In allergy care, electronic clinical diaries have been recently used to prospectively collect patient data and improve diagnostic precision. Objective This review summarizes the clinical and scientific experience we gathered over 10 years of using a digital platform for patients suffering from seasonal allergic rhinitis. Methods The mobile application and back-office of AllergyMonitor (TPS software production, Rome, Italy) enable patients to record their daily allergy symptoms as well as drug and immunotherapy intake plus possible side effects in a customizable way. The results can be accessed by the patient and attending physician as concise reports via a smartphone or computer. This technology has been used in several clinical studies and routine practice since 2009. Results Our studies showed that A) the etiological diagnosis of SAR may be supported by matching prospectively registered symptoms with pollen counts; B) it is possible to perform a short-term prediction of SAR-symptoms at individual level; C) the adherence to daily symptom monitoring can remain high (> 80%) throughout several weeks when prescribed and thoroughly explained by the treating doctor; D) the use of mobile technology can improve adherence to symptomatic drugs as well as allergen-specific immunotherapy and E) the choice of the correct symptom-severity-score is critical at patient level, but not at group level. Conclusion The studies and clinical practice based on the use of AllergyMonitor have proven the reliability and positive impact of a digital platform including an electronic diary (eDiary) on the diagnostic precision of SAR in poly-sensitized patients as well as patient adherence to both, drug therapy and allergen immunotherapy.
Collapse
Affiliation(s)
- Salvatore Tripodi
- Allergology Service Policlinico Casilino, Via Casilina, 1049, 00169, Rome, Italy. .,TPS software solutions, Rome, Italy. .,Pediatric Allergology Service Sandro Pertini Hospital, Rome, Italy.
| | - Andrea Giannone
- Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ifigenia Sfika
- Pediatric Allergology Service Sandro Pertini Hospital, Rome, Italy
| | | | - Stephanie Dramburg
- Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Jakob Florack
- Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Valeria Villella
- Pediatric Allergology Service Sandro Pertini Hospital, Rome, Italy
| | - Ekaterina Potapova
- Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Paolo Maria Matricardi
- Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
15
|
Allergen Immunotherapy in Pediatric Asthma: A Pragmatic Point of View. CHILDREN-BASEL 2020; 7:children7060058. [PMID: 32521598 PMCID: PMC7346201 DOI: 10.3390/children7060058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/18/2020] [Accepted: 06/02/2020] [Indexed: 01/29/2023]
Abstract
To date, the only disease-modifying treatment strategy for allergic rhinitis and asthma is allergen immunotherapy (AIT). There is evidence that AIT improves allergic rhinitis and asthma, such as reducing symptom severity and medication use and improving of quality of life, with a long-lasting effect after the end of the course. The recent clinical trials evidenced AIT effectiveness and safety in allergic asthma. Consequently, the current version of the GINA (Global Initiative for Asthma) guidelines recommend AIT as an add-on therapy for asthma. There is also evidence that AIT may exert preventive activity on the possible progression from allergic rhinitis to asthma in children and the onset of new sensitizations. The present review provides a pragmatic summary of the clinical indications of AIT in pediatric asthma, including the immunological mechanisms, the predictive biomarkers, and the safety issues in clinical practice.
Collapse
|
16
|
Ebo DG, Bridts CH, Rihs HP. Hevea latex-associated allergies: piecing together the puzzle of the latex IgE reactivity profile. Expert Rev Mol Diagn 2020; 20:367-373. [PMID: 32056456 DOI: 10.1080/14737159.2020.1730817] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: IgE-mediated Hevea latex allergy and associated food-allergies constitute a significant health issue with serious consequences of diagnostic error. Hence, there is a need for more reliable confirmatory diagnostics.Areas covered: Here, we summarize the major limitations of conventional tests using native extracts and describe how piecing together the IgE reactivity profile can benefit correct diagnosis in difficult cases in whom conventional tests yield equivocal or negative results. A diagnostic algorithm integrating traditional sIgE and component-resolved diagnosis (CRD) is presented.Expert opinion: Moreover, it is clear that the discoveries in the field of the Hevea latex proteome will contribute to our understandings and accurate approach of sometimes complex cross-reactivity phenomena that extend beyond the 'latex-fruit syndrome.'
Collapse
Affiliation(s)
- Didier G Ebo
- University of Antwerp - University Hospital of Antwerp, Immunology-Allergology-Rheumatology, Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium.,Department of Immunology and Allergology, Jan Palfijn Ziekenhuis Gent, Ghent, Belgium
| | - Chris H Bridts
- University of Antwerp - University Hospital of Antwerp, Immunology-Allergology-Rheumatology, Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Hans-Peter Rihs
- Ruhr-University Bochum, IPA - Institute for Prevention and Occupational Medicine, Bochum, Germany
| |
Collapse
|