Molecular diagnosis of allergy and microarray technology have opened a completely new avenue of insight into sensitization profiles from both the clinical and the epidemiological point of view. We used this innovative tool in the description of sensitization patterns in pollen-sensitized patients in Middle Europe. Immunoglobulin E detection using 112 different allergenic molecules was carried out employing the ImmunoCAP ISAC microarray system. Sera from 826 patients sensitized to at least one pollen-derived molecule were subjected to analysis. The highest observed sensitization rate was 81.0% to grass-specific molecules (the most frequent being Phl p 1; 69.6%). The second most frequent sensitization was 54.8% to Betulaceae-specific molecules (Bet v 1; 54.2%). Together, grasses and Betulaceae components (and their cosensitizations with other components) comprised the vast majority of pollen sensitizations. Unexpectedly frequently observed sensitizations were those to Cupressaceae-specific molecules (14.1%), Oleaceae-specific molecules (10.8%), and the plane tree-derived molecule Pla a 2 (15.5%). The sensitization rates for all other molecules were within the expected range (Art v 1, 13.6%; Pla l 1, 9.6%; Che a 1, 8.4%; Par j 2, 0.9%; Amb a 1, 0.8%, and Sal k 1, 0.5%). Cross-reacting molecule sensitization rates were found to be 12.4% for profilins, 5.0% for polcalcins, and 6.4% for lipid transfer proteins. Molecular diagnosis of allergy gives a more precise and comprehensive insight into pollen sensitization patterns than extract-based testing, allowing a better understanding of the sensitization process and regional differences. The data presented here may help to improve the diagnostic and allergen-specific treatment procedures in the respective region.

Inflammation of the lower airway in patients with allergic rhinitis with and without asthma has been confirmed by means of both sputum eosinophil count and sputum ECP level. Persistent inflammation of lower airway in periods without allergen exposure was proven in seasonal asthma. This may have implications for the therapy of seasonal allergic rhinitis with and without asthma in terms of promoting long-term anti-inflammatory treatment.

In our population, IgE-mediated sensitization was found in up to 49% of all patients with AD, most common in men and in head and neck type.

BackgroundThe major sources of allergens in the indoor air include house dust mites, dander derived from domestic animals and rodents, cockroach, and several fungi. Mites are the main cause of allergies in some countries with a warmer climate, but the epidemiological significance of mite and cockroach allergens in Central Europe has not been established yet.MethodsWe assessed sensitization profiles of allergy patients in a Central European region in regard to sensitization to mites and cockroach. We used molecular diagnosis by means of the microarray ISAC, and we investigated 1766 patients with clinical suspicion to an allergic disorder. 1255 of them were positive to at least one allergen component, and this group was subjected to statistical analysis.ResultsThe sensitization to at least one mite-specific molecule (Der p 1, 2, Der f 1, 2) was observed relatively frequently in 32.7% of patients. Specific IgE to mite group 2 molecules is almost fully cross-reactive. Group 1 allergens are also cross-reactive, but in some patients, a species-specific response was observed. Relatively high rate of sensitization both to group 1 and 2 allergens in our patients indicates the greater role of co-sensitizations. Isolated sensitizations to molecules derived from glyciphagid mites Lep d 2 and/or Blo t 5 without sensitization to other mite-derived molecules were observed only exceptionally (in 0.6% of cases). True sensitization to at least one cockroach-specific molecule (Bla g 1, 2, 5) was very rare (in 0.6% of cases), and nearly all of them were co-sensitizations with other noncockroach-derived molecules. Sensitization to an inhaled tropomyosin was observed rarely in 2.2% of patients (Der p 10 in 1.9% and Bla g 7 in 1.5%). Co-sensitization of inhaled tropomyosins with the respective mite- or cockroach-specific molecules was observed only in the minority of patients suggesting the different route of sensitization being more frequent.ConclusionsThe majority of patients are co-sensitized to several molecules of the respective allergen source. The knowledge of this molecular spectrum of sensitization is important for optimal diagnosis and treatment in respect to allergen content in mite extracts used for diagnostic and therapeutic purposes. In regard to the sensitization patterns of Central European patients, it is necessary to point out the importance of quantifying at least three major mite components Der f 1, Der p 1 and Der f 2 (or Der p 2).

We report 2 patients with cold urticaria with different response to treatment with omalizumab (Xolair®). Cold contact urticaria (CCU) is a common subtype of physical urticaria. It is characterized by the development of wheal and/or angioedema within minutes after cold contact. Clinical manifestation of CCU can range from mild, localized whealing to life-threatening anaphylactic shock reactions. Omalizumab has been described to be useful in cases of chronic urticaria and may be an interesting option for treatment of CCU. We describe one patient with significant and long-lasting improvement of symptoms and one without any improvement after anti-immunoglobulin E therapy. In our case reports, we want to highlight that there is still a small group of patients without benefit from omalizumab treatment. It is necessary to identify this minor subgroup of patients where omalizumab does not represent an effective treatment possibility.