A Pitfall to Avoid When Using an Allergen Microarray: The Incidental Detection of IgE to Unexpected Allergens

Incorvaia, Cristoforo; Melato, Mauro; Ridolo, Erminia; Makrì, Eleni; Montagni, Marcello; Ciprandi, Giorgio

doi:10.1016/j.jaip.2014.09.020

Cited by 21 publications

(14 citation statements)

References 34 publications

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“…milk and egg, were similar to those in the United States and EU . A new study in the EU demonstrated that self‐reported allergy and specific IgE binding using an allergen‐protein microarray overestimated clinical reactivity .…”

Section: Origin Of Allergenonline Database and Selection Of Candidatesupporting

confidence: 56%

AllergenOnline: A peer‐reviewed, curated allergen database to assess novel food proteins for potential cross‐reactivity

Goodman

Ebisawa

Ferreira

et al. 2016

Molecular Nutrition Food Res

165

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Section: Origin Of Allergenonline Database and Selection Of Candidatesupporting

confidence: 56%

AllergenOnline: A peer‐reviewed, curated allergen database to assess novel food proteins for potential cross‐reactivity

Goodman

Ebisawa

Ferreira

et al. 2016

Molecular Nutrition Food Res

165

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“…A recent paper cautioned against overreliance on the ISAC alone for diagnostic purposes. The array unexpectedly detected IgE to hymenoptera venom allergens in patients with no clinical history of reactions to insect stings [19•]. Using in vitro IgE test results without documenting the patient’s clinical history is contrary to current diagnostic guidelines for venom allergy and poses a dilemma for management of patients.…”

Section: Next-generation Innovationsmentioning

confidence: 99%

Technological Innovations for High-Throughput Approaches to In Vitro Allergy Diagnosis

Chapman

Wuenschmann

King

et al. 2015

Curr Allergy Asthma Rep

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Allergy diagnostics is being transformed by the advent of in vitro IgE testing using purified allergen molecules, combined with multiplex technology and biosensors, to deliver discriminating, sensitive, and high-throughput molecular diagnostics at the point of care. Essential elements of IgE molecular diagnostics are purified natural or recombinant allergens with defined purity and IgE reactivity, planar or bead-based multiplex systems to enable IgE to multiple allergens to be measured simultaneously, and, most recently, nanotechnology-based biosensors that facilitate rapid reaction rates and delivery of test results via mobile devices. Molecular diagnostics relies on measurement of IgE to purified allergens, the “active ingredients” of allergenic extracts. Typically, this involves measuring IgE to multiple allergens which is facilitated by multiplex technology and biosensors. The technology differentiates between clinically significant cross-reactive allergens (which could not be deduced by conventional IgE assays using allergenic extracts) and provides better diagnostic outcomes. Purified allergens are manufactured under good laboratory practice and validated using protein chemistry, mass spectrometry, and IgE antibody binding. Recently, multiple allergens (from dog) were expressed as a single molecule with high diagnostic efficacy. Challenges faced by molecular allergy diagnostic companies include generation of large panels of purified allergens with known diagnostic efficacy, access to flexible and robust array or sensor technology, and, importantly, access to well-defined serum panels form allergic patients for product development and validation. Innovations in IgE molecular diagnostics are rapidly being brought to market and will strengthen allergy testing at the point of care.

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“…Based on the experience that detection of allergen‐specific IgE does not equal clinical relevance, current guidelines on allergy diagnostics recommend that the diagnostic workup should be primarily guided by the clinical symptoms. Random screening for IgE sensitization is discouraged as the number of positive IgE results to a certain allergen source usually exceeds by far the number of clinical relevant allergies . This ‘top‐down’ approach – from the symptoms to the allergen source – also applies to molecular allergy diagnostics and can be defined as follows:…”

Section: From Symptoms To Molecules: the ‘Top‐down Approach’mentioning

confidence: 99%

EAACI Molecular Allergology User's Guide

Matricardi

Kleine-Tebbe²,

Hoffmann

et al. 2016

Pediatric Allergy Immunology

740

870

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The availability of allergen molecules ('components') from several protein families has advanced our understanding of immunoglobulin E (IgE)-mediated responses and enabled 'component-resolved diagnosis' (CRD). The European Academy of Allergy and Clinical Immunology (EAACI) Molecular Allergology User's Guide (MAUG) provides comprehensive information on important allergens and describes the diagnostic options using CRD. Part A of the EAACI MAUG introduces allergen molecules, families, composition of extracts, databases, and diagnostic IgE, skin, and basophil tests. Singleplex and multiplex IgE assays with components improve both sensitivity for low-abundance allergens and analytical specificity; IgE to individual allergens can yield information on clinical risks and distinguish cross-reactivity from true primary sensitization. Part B discusses the clinical and molecular aspects of IgE-mediated allergies to foods (including nuts, seeds, legumes, fruits, vegetables, cereal grains, milk, egg, meat, fish, and shellfish), inhalants (pollen, mold spores, mites, and animal dander), and Hymenoptera venom. Diagnostic algorithms and short case histories provide useful information for the clinical workup of allergic individuals targeted for CRD. Part C covers protein families containing ubiquitous, highly cross-reactive panallergens from plant (lipid transfer proteins, polcalcins, PR-10, profilins) and animal sources (lipocalins, parvalbumins, serum albumins, tropomyosins) and explains their diagnostic and clinical utility. Part D lists 100 important allergen molecules. In conclusion, IgE-mediated reactions and allergic diseases, including allergic rhinoconjunctivitis, asthma, food reactions, and insect sting reactions, are discussed from a novel molecular perspective. The EAACI MAUG documents the rapid progression of molecular allergology from basic research to its integration into clinical practice, a quantum leap in the management of allergic patients.

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A Pitfall to Avoid When Using an Allergen Microarray: The Incidental Detection of IgE to Unexpected Allergens

Cited by 21 publications

References 34 publications

AllergenOnline: A peer‐reviewed, curated allergen database to assess novel food proteins for potential cross‐reactivity

AllergenOnline: A peer‐reviewed, curated allergen database to assess novel food proteins for potential cross‐reactivity

Technological Innovations for High-Throughput Approaches to In Vitro Allergy Diagnosis

EAACI Molecular Allergology User's Guide

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