A Molecular Diagnostic Algorithm to Guide Pollen Immunotherapy in Southern Europe: Towards Component-Resolved Management of Allergic Diseases

Abstract

Correct identification of the culprit allergen is an essential part of diagnosis and treatment in immunoglobulin E (IgE)-mediated allergic diseases. In recent years, molecular biology has made important advances facilitating such identification and overcoming some of the drawbacks of natural allergen extracts, which consist of mixtures of various proteins that may be allergenic or not, specific for the allergen source or widely distributed (panallergens). New technologies offer the opportunity for a more accurate component-resolved diagnosis, of benefit especially to polysensitized allergic patients. The basic elements of molecular diagnostics with potential relevance to immunotherapy prescription are reviewed here, with a focus on Southern European sensitization patterns to pollen allergens. We propose a basic algorithm regarding component-resolved diagnostic work-up for pollen allergen-specific immunotherapy candidates in Southern Europe; this and similar algorithms can form the basis of improved patient management, conceptually a ‘Component-Resolved Allergy Management'.

Seasonal variations of allergenic pollen in a Mediterranean region – Alexandroupolis, north-east Greece

“…Evidence on seasonal aeroallergen levels can help generate an alarm system for sensitized individuals and clinicians. Protection from exposure and prophylactic medication can reduce referral to medical centres by as much as 50%, thus reducing the cost of treatment [25,26]. …”

Advances in allergen-microarray technology for diagnosis and monitoring of allergy: The MeDALL allergen-chip

“…Furthermore, several cockroach allergens were included [51,52]. The panel of pollen allergens contained allergens useful for the identification of the genuine sensitizing pollen species as well as cross-reactive allergens [53,54]. Furthermore, attempts were made to include relevant food allergens from, e.g., nuts, peanuts, milk and several other allergen sources [55][56][57][58][59].…”

Molecular Approach to Optimal Choice of Specific Immunotherapy for Patients with Sensitization to Weed Pollen Allergens

“…The "allergic season" for weed pollen usually occurs later than for trees and grasses: as a rule, from midsummer to late autumn (5) . Currently, 35 weed allergens have been identified which may play an important role in the development of allergic rhinitis, pollen allergy, asthma and food allergy (www.allergen.org) (6) . It is interesting to note, that main pollen allergens are confined to four main families of proteins: pectate lyases, defensin-like proteins, Ole e 1-like proteins, and a group of nonspecific lipid transfer proteins (nsLTP).…”