Types of sensitization to aeroallergens: definitions, prevalences and impact on the diagnosis and treatment of allergic respiratory disease

Clinical and Translational Allergy

Giorgio Ciprandi²  Cristoforo Incorvaia⁶  Michèle Lhéritier-Barrand¹  Yasmine Jeanpetit¹  Angel Azpeitia⁴  Franco Frati⁵  Ignacio Dávila³  Michel Migueres⁷ 

[1] Stallergenes SA, Antony, France;Department of Medicine, IRCCS-Azienda Ospedaliera Universitaria San Martino, Genoa, Italy;Allergy Department, IBSAL, University Hospital of Salamanca, Salamanca, Spain;Stallergenes Iberica SA, Barcelona, Spain;Stallergenes Italia SRL, Milan, Italy;Allergy/Pulmonary rehabilitation, ICP Hospital, Milan, Italy;Service de Pneumologie et Allergologie, Clinique de L’Union, Saint-Jean, France

关键词: Monosensitization;    Polyallergy;    Cross-sensitization;    Cross-reactivity;    Co-recognition;    Co-sensitization;    Paucisensitization;    Polysensitization;   

Others  :  793938
DOI  :  10.1186/2045-7022-4-16

 received in 2014-01-21, accepted in 2014-03-25,  发布年份 2014

【 摘 要 】

The type of allergic sensitization is of central importance in the diagnosis and treatment of respiratory allergic diseases. At least 10% of the general population (and more than 50% of patients consulting for respiratory allergies) are polysensitized. Here, we review the recent literature on (i) the concepts of polysensitization, paucisensitization, co-sensitization, co-recognition, cross-reactivity, cross-sensitization, and polyallergy, (ii) the prevalence of polysensitization and (iii) the relationships between sensitization status, disease severity and treatment strategies. In molecular terms, clinical polysensitization can be divided into cross-sensitization (also known as cross-reactivity, in which the same IgE molecule binds to several allergens with common structural features) and co-sensitization (the simultaneous presence of different IgEs binding to allergens that may not necessarily have common structural features). There is a strong overall association between sensitization in skin prick tests and total IgE values but there is debate as to whether IgE thresholds are useful guides to the presence or absence of clinical symptoms in individual cases. Molecular information from component-resolved techniques appears to be of value for diagnosis and treatment decisions. Polysensitization develops over time and is a risk factor for respiratory allergy (being associated with disease severity) and therefore has clinical relevance for treatment decisions. The subterm polysensitization has been defined as polysensitization to between two and four allergens. Polyallergy is defined as clinically confirmed allergy to two or more allergens. Single-allergen grass pollen allergen immunotherapy (AIT) is safe and effective in polysensitized patients, whereas multi-allergen AIT requires more supporting evidence. Given that AIT may be more efficacious in moderate-to-severe disease than in mild disease, polysensitization could be an indication for this type of treatment. There is a need for flowcharts or decision trees for choosing the allergens for AIT in polysensitized patients and polyallergic patients.

【 授权许可】

   
2014 Migueres et al.; licensee BioMed Central Ltd.

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