Addressing Molecular Diagnosis of Occupational Allergies

Abstract

Purpose of ReviewNumerous clinically relevant allergenic molecules enhance the performance of specific (s) IgE tests and improve the specificity of allergy diagnosis. This review aimed to summarize our current knowledge of the high-molecular-weight allergens involved in the development of occupational asthma and rhinitis and to critically analyze the contribution of component-resolved diagnosis in the management of these conditions.Recent FindingsThere is a lack of standardization and validation for most available extracts of occupational agents, and assessment of sIgE reactivity to occupational allergen components has been poorly investigated, with the notable exception of natural rubber latex (NRL) and wheat flour. In the case of NRL, the application of recombinant single allergens and amplification of natural extracts with stable recombinant allergens improved the test sensitivity. IgE-sensitization profile in patients with baker’s asthma showed great interindividual variation, and extract-based diagnostic is still recommended. For other occupational allergens, it remains necessary to evaluate the relevance of single allergen molecules for the sensitization induced by occupational exposure.SummaryProgress has been made to characterize occupational allergens especially NRL and wheat, although there is still an unmet need to increase the knowledge of occupational allergens, to include standardized tools into routine diagnostic, and to evaluate their usefulness in clinical practice.

Identification and molecular characterization of allergenic non‐specific lipid‐transfer protein from durum wheat (Triticum turgidum)

“…The ImmunoCAP analysis justifies the implementation of Tri tu 14 for component‐resolved diagnosis (CRD) in addition to wheat extract to increase the diagnostic sensitivity at least for 2/25 patients. So far, Raulf and co‐workers reported whole wheat flour extract rather than single allergens to have superior diagnostic sensitivity in BA. The authors hypothesized that, upon inclusion of further allergens, CRD might help to differentiate eg, between BA and wheat‐induced FA.…”

“…In general, common wheat is a source of numerous allergens which can be classified into two groups: the first group comprising the salt insoluble fraction, including gliadin and gluten which constitutes approximately 80% of wheat protein content . Wheat proteins of this group have been described as allergens involved in coeliac disease and in WDEIA . The second group is represented by the albumin/globulin soluble fraction and comprises 15%‐20% of total wheat proteins, including allergenic α‐amylase/trypsin inhibitor subunit as well as the non‐specific lipid‐transfer proteins (nsLTPs) .…”

“…2,3 Wheat proteins of this group have been described as allergens involved in coeliac disease and in WDEIA. 4 The second group is represented by the albumin/globulin soluble fraction and comprises 15%-20% of total wheat proteins, including allergenic α-amylase/trypsin inhibitor subunit as well as the non-specific lipid-transfer proteins (nsLTPs). 5 Both allergens are implicated in BA, 4,6 and in some cases of WDEIA.…”

“…4 The second group is represented by the albumin/globulin soluble fraction and comprises 15%-20% of total wheat proteins, including allergenic α-amylase/trypsin inhibitor subunit as well as the non-specific lipid-transfer proteins (nsLTPs). 5 Both allergens are implicated in BA, 4,6 and in some cases of WDEIA. 7 In line with this, nsLTPs which belong to the family of pathogenesis-related proteins (PR14) have been identified as major allergens in plant-derived foods, with a highest prevalence of sensitization in the Mediterranean area.…”

Pathogenesis of Celiac Disease and Other Gluten Related Disorders in Wheat and Strategies for Mitigating Them

“…It is considered one of the most common types of occupational, cereal-induced allergic asthma and is mediated by IgE antibodies specific to cereal flour antigens: mainly proteins from wheat, rye, barley and rice (264)(265)(266). The primary cereal used in bread baking is wheat and it acts as a major allergen in 60-70% of symptomatic bakers (267). Bakers develop asthma as well as rhinitis with increased levels of specific IgE antibodies against flour dust from different sources (268).…”