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Molecular allergology and its impact in specific allergy diagnosis and therapy

Barber, Domingo, Diaz‐Perales, Araceli, Escribese, Maria M., Kleine‐Tebbe, Jörg, Matricardi, Paolo M., Ollert, Markus, Santos, Alexandra F., Sastre, Joaquin·2021·Allergy
DOI 10.1111/all.14969
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Abstract

Progressive knowledge of allergenic structures resulted in a broad availability of allergenic molecules for diagnosis. Component‐resolved diagnosis allowed a better understanding of patient sensitization patterns, facilitating allergen immunotherapy decisions. In parallel to the discovery of allergenic molecules, there was a progressive development of a regulation framework that affected both in vitro diagnostics and Allergen Immunotherapy products. With a progressive understanding of underlying mechanisms associated to Allergen immunotherapy and an increasing experience of application of molecular diagnosis in daily life, we focus in analyzing the evidences of the value provided by molecular allergology in daily clinical practice, with a focus on Allergen Immunotherapy decisions.

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FIGURE 1 Diagnostic algorithm and decision tree for AIT using CRD in Grass pollen allergy. Grass pollen allergy is one of the most studied allergy models. Major allergen sensitization is required before considering AIT. The combination of major allergens and pan-­ allergens provides the necessary tools for AIT decisions. Profilin allergy might be a contraindication only in severe food allergic patients, while double sensitization to both pan-­ allergens is associated to many years of disease evolution, poly-­ sensitization, and poor intervention outcome
FIGURE 1 Diagnostic algorithm and decision tree for AIT using CRD in Grass pollen allergy. Grass pollen allergy is one of the most studied allergy models. Major allergen sensitization is required before considering AIT. The combination of major allergens and pan-­ allergens provides the necessary tools for AIT decisions. Profilin allergy might be a contraindication only in severe food allergic patients, while double sensitization to both pan-­ allergens is associated to many years of disease evolution, poly-­ sensitization, and poor intervention outcomeCC-BY-NC · From the PDF
FIGURE 2 Diagnostic algorithm and decision tree for AIT using CRD in Olive pollen allergy. Olive pollen allergies are one of the most complex allergy models. Usually olive cultivars cover homogeneous areas and present acute differences in allergen pollen content. In dense pollen areas, patients are exposed to the highest pollen counts recorded. Th existing of complex profiles, marked by minor allergens sensitization, makes CRD a fundamental tool for patient management and AIT decisions
FIGURE 2 Diagnostic algorithm and decision tree for AIT using CRD in Olive pollen allergy. Olive pollen allergies are one of the most complex allergy models. Usually olive cultivars cover homogeneous areas and present acute differences in allergen pollen content. In dense pollen areas, patients are exposed to the highest pollen counts recorded. Th existing of complex profiles, marked by minor allergens sensitization, makes CRD a fundamental tool for patient management and AIT decisionsCC-BY-NC · From the PDF
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FIGURE 4 Diagnostic algorithm for in vitro diagnostics and Decision tree for AIT using CRD in pollen allergies. Discrimination of primary sensitizers and pan-­ allergens positivity is needed. AIT guidelines do not recommend AIT for poly-­ sensitized patients
FIGURE 4 Diagnostic algorithm for in vitro diagnostics and Decision tree for AIT using CRD in pollen allergies. Discrimination of primary sensitizers and pan-­ allergens positivity is needed. AIT guidelines do not recommend AIT for poly-­ sensitized patientsCC-BY-NC · From the PDF
FIGURE 5 Diagnostic algorithm for in vitro diagnostics in epithelia allergy and associated decision tree for AIT using CRD. The proposed algorithm discriminates between primary sensitization and cross-­ reactive sIgE response. Only patients sensitized to major allergens should be eligible for AIT
FIGURE 5 Diagnostic algorithm for in vitro diagnostics in epithelia allergy and associated decision tree for AIT using CRD. The proposed algorithm discriminates between primary sensitization and cross-­ reactive sIgE response. Only patients sensitized to major allergens should be eligible for AITCC-BY-NC · From the PDF
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FIGURE 7 Diagnostic algorithm for in vitro diagnostics of (A) HBV and YJV allergy and (B) YJV and PDV allergy. The diagnostic algorithm shown in (A), with the corresponding PDV allergens Pol d 1 and Pol d 5, can also be used to discriminate between HBV and PDV allergy. In addition, to discriminate in the case of double-­ positive test results, CRD might also be useful in cases of negative results despite a convincing history of venom allergy or in cases of discrepancies between history, skin tests and venom extract-­ based testing. A plus indicates a positive and a minus a negative test result. Of note, the allergens Api m 4 and Pol d 1 (in brackets) are only available for selected multiplex sIgE test platforms. *The allergens Api m 2 and Api m 5 are potentially cross-­ reactive with their homologues from YJV and PDV (not available for CRD) and, hence, a positive test results do not necessarily exclude allergy to vespid venom
FIGURE 7 Diagnostic algorithm for in vitro diagnostics of (A) HBV and YJV allergy and (B) YJV and PDV allergy. The diagnostic algorithm shown in (A), with the corresponding PDV allergens Pol d 1 and Pol d 5, can also be used to discriminate between HBV and PDV allergy. In addition, to discriminate in the case of double-­ positive test results, CRD might also be useful in cases of negative results despite a convincing history of venom allergy or in cases of discrepancies between history, skin tests and venom extract-­ based testing. A plus indicates a positive and a minus a negative test result. Of note, the allergens Api m 4 and Pol d 1 (in brackets) are only available for selected multiplex sIgE test platforms. *The allergens Api m 2 and Api m 5 are potentially cross-­ reactive with their homologues from YJV and PDV (not available for CRD) and, hence, a positive test results do not necessarily exclude allergy to vespid venomCC-BY-NC · From the PDF
FIGURE 8 Diagnostic algorithm for in vitro diagnostics in peanut allergy oriented to make POIT decision. Discriminant analysis between storage allergens and cross-­ reactive to pollen and nsLTPs is proposed. Only patients with positive sIgE to any of the Ara h 1, 2, 3, 6 should be eligible for POIT
FIGURE 8 Diagnostic algorithm for in vitro diagnostics in peanut allergy oriented to make POIT decision. Discriminant analysis between storage allergens and cross-­ reactive to pollen and nsLTPs is proposed. Only patients with positive sIgE to any of the Ara h 1, 2, 3, 6 should be eligible for POITCC-BY-NC · From the PDF
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Metadata

Authors
Barber, D., Diaz‐Perales, A., Escribese, M. M., Kleine‐Tebbe, J., Matricardi, P. M., Ollert, M., Santos, A. F., & Sastre, J.
Affiliations
  • Departamento de Ciencias Médicas Básicas Facultad de Medicina IMMA, Universidad San Pablo CEU, CEU Universities Madrid Spain
  • ARADyAL‐RD16/0006/0015 RD16/0006/0003 Thematic Network and Cooperative Research Centers ISCIII Madrid Spain
  • Allergy and Asthma Center Westend Berlin Germany
  • Department of Pediatric Pneumology and Immunology Charitè Medical University of Berlin Berlin Germany
  • Department of Infection and Immunity Luxembourg Institute of Health Esch‐sur‐Alzette Luxembourg
  • Department of Women and Children's Health (Pediatric Allergy School of Life Course Sciences Faculty of Life Sciences and Medicine King's College London London UK
  • Fundación Jiménez Diaz AllergyDepartment Universidad Autonomade Madrid, CIBERES, Instituto de Salud Carlos III Madrid Spain
ORCID
Venue
Allergy
Publisher
Wiley
Published
2021-06-22
Volume
76
Issue
12
Pages
3642-3658
ISSN
  • 0105-4538
  • 1398-9995
DOI
10.1111/all.14969
Cited by
59
References
3
Language
en
Licence
creativecommons.org/licenses/by-nc/4.0/ (vor)
Funders
  • Instituto de Salud Carlos III (PI19/00044, PI18/01467)
  • Ministerio de Ciencia e Innovación (RTI2018‐095166‐B‐100)

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