The effect of component-resolved diagnosis on specific immunotherapy prescription in children with hay fever

Molecular Allergology between Precision Medicine and the Choosing Wisely initiative

“…The same discrepancy can also be explained if the extract assay is analytically less sensitive (higher LoQ) than the molecular one and specific IgE levels are low. In other words, the level of serum IgE antibodies to the implicated molecules could be above the LoQ of the molecular assay but below the LoQ of the extract assay [18]. C Allergen extract positive but its genuine components are negative: In this case, the serum's IgE might recognize only minor, highly cross-reactive components of an allergenic extract, but not its genuine, species-specific (major) components.…”

“…C Allergen extract positive but its genuine components are negative: In this case, the serum's IgE might recognize only minor, highly cross-reactive components of an allergenic extract, but not its genuine, species-specific (major) components. Patients sensitized to panallergens frequently show positive IgE results to many different allergenic extracts containing a member of that highly cross-reactive family and falsely appear to be highly 'polysensitized' [18]. Similarly, patients sensitized to cross-reactive carbohydrate determinants (CCD) only show positive result to extracts but not to corresponding molecules produced as recombinant proteins lacking post-translational modifications like CCDs [19].…”

Looking for Sensitization Profiles In Different Populations by Recombinant Allergens

“…It has also taught us that many of the tests using extracts have positive results that are actually due to the corecognition of widely cross-reacting pan-allergens [2,3] and has explained us that the clinical expression of many food allergies largely depends on the physical and chemical characteristics of the sensitizing allergens [4]. The results of serological tests based on allergen molecules can change our way of prescribing allergen-specific immunotherapy [5]. However, they also show us that the ‘promised land' of tailored immunotherapy is probably infeasible, due to the enormous number of combinations possible in patients sensitized even to one single allergen source [6].…”

Molecular diagnosis and precision medicine in allergy management

“…It remains firm that molecular allergy diagnosis, especially with multiplexed instruments, remains a third-line approach, to be used only in patients with a complex polysensitization profile, and when the standard diagnostics are insufficient to choose the appropriate allergen(s) for AIT [12]. On the other hand, a "tailored" AIT, using only the genuine sensitizers seems difficult to realize, since there are too many different sensitization profiles [39][40][41], and so far, commercial extracts (that are less expensive) perform as well as purified/recombinant molecules for AIT [42,43]. Allergen specific immunotherapy (AIT) is a well-documented effective treatment for respiratory and hymenoptera venom allergy [44][45][46][47][48][49].…”