Molecular diagnosis for allergen immunotherapy

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:143

Article

Matricardi, Paolo Maria¹  Dramburg, Stephanie¹  Potapova, Ekaterina¹  Skevaki, Chrysanthi²  Renz, Harald² 

[1] Charite Univ Med Berlin, Dept Pediat Pulmonol Immunol & Intens Care Med, Augustenburger Pl 1, D-13353 Berlin, Germany

[2] Philipps Univ Marburg, Inst Lab Med, UGMLC, German Ctr Lung Res DZL, Marburg, Germany

关键词: Allergen;    allergen immunotherapy;    allergic rhinitis;    asthma;    biomarker;    component-resolved diagnostics;    diagnostic algorithm;    IgE;    IgE tests;    molecular allergology;    molecular spreading;   

DOI  :  10.1016/j.jaci.2018.12.1021

来源: Elsevier

【 摘 要 】

The extensive use of allergen molecules in birth cohort studies revealed that atopic sensitization is a sequential IgE response to distinct non-cross-reacting molecules from the same allergenic source (ie, molecular spreading), starting with an initiator molecule. This phenomenon reaches different degrees of progression (monomolecular, oligomolecular, and polymolecular) according to the individual atopic propensity and allergen exposure, thus producing an extreme heterogeneity of IgE sensitization profiles in patient populations. In patients with allergic rhinitis, the broader the IgE molecular sensitization profile, the greater is the risk of asthma and other allergic comorbidities, such as oral allergy syndrome. Hence it has been proposed to anticipate immunologic intervention at disease onset (early allergen immunotherapy) or even earlier during the preclinical sensitization stage (allergen immunoprophylaxis). Diagnostic algorithms based on singleplex or multiplex molecular IgE tests allow the discrimination of genuine from cross-reacting sensitization and the selection of the right extracts for allergen immunotherapy composition. Patients with extreme molecular poly-sensitization and greater risk of asthma or other IgE-mediated comorbidities, can be easily identified by means of allergen microarray or macroarray procedures and might benefit from anti-IgE treatment. IgE molecular tests have opened the era of precision allergology, and their routine use should aim at cost-effectiveness, according to the principles of the Choosing Wisely initiative.

【 授权许可】

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