Allergy diagnosis from symptoms to molecules, or from molecules to symptoms: a comparative clinical study

Abstract

BackgroundClassical allergy diagnostic workup “from symptoms to molecules” comprises 1) clinical investigation, 2) skin prick- and IgE- testing, and recently, 3) molecular allergy testing. We aimed to examine the diagnostic fidelity of the alternative approach “from molecules to symptoms”, which was recently suggested in the EAACI Molecular Allergology User’s Guide, in a retrospective clinical study.MethodsRecords from 202 patients with clinically suspected allergic sensitizations were extracted from files at two sites applying either the “ISAC-first” workup with IgE-testing by immuno-solid phase allergen chip ISAC112 followed by selected skin prick tests (SPT) or the “SPT-first” starting with SPT followed by the microarray test.ResultsIn the ISAC-first procedure significantly less SPTs were performed during allergy diagnosis (median 4 vs. 14). By SPT in 19% of patients in the ISAC-first group and in 34% in the SPT-first group additional respiratory allergens (p = 0.014) were detected not positive in ISAC microarray. By ISAC microarray test 18% additional sensitizations were found in the ISAC-first, and 32% in SPT-first cohort (p = 0.016). For food allergens 13 and 12% additional sensitizations were detected by the microarray not detected by SPT in the two groups (p = 0.800). No additional food allergen was found by SPT in the ISAC-first group, while in 6% of the cases in the SPT-first group detected sensitizations were negative in the microarray.DiscussionThe ISAC-first approach followed by (fewer) SPTs meets the demands for a patient’s tailored diagnostic work-up and therefore can be considered equivalent to the conventional way using the skin prick test as first screening tool, followed by IgE diagnosis.ConclusionsFor the diagnostic verification of clinically suspected allergy, the novel concept “from molecules to clinic” offers a reliable diagnostic workup in shorter time. Due to lower skin test numbers it is especially applicable for young children and seniors, in atopic patients, and whenever skin tests get difficult or unreliable.Electronic supplementary materialThe online version of this article (10.1186/s40413-018-0199-y) contains supplementary material, which is available to authorized users.

Linking cross-reactivity clusters of food and respiratory allergens in PAMD@ to asthma and duration of allergy

“…Based on clinical history and results of the ISAC112, alder, birch, hazel, ash, grasses, mugwort, ragweed (ambrosia), buckhorn plantain, house dust mites, cat, dog, and Alternaria among airborne allergens and hazelnut, peanut, wheat flour, egg, cow milk, soy, and cod fish from nutritional allergens were tested in skin prick test as reported previously. 9 …”

A WAO — ARIA — GA2LEN consensus document on molecular-based allergy diagnosis (PAMD@): Update 2020

“…5,74 It is accepted as a first-line diagnostic tool and helps to reduce the time to diagnosis, while having the same precision as the conservative SPT-first approach. 332 Overall, debate in the allergy community reveals that the initial skepticism regarding PAMD@ 121 has moved towards the possibility that it could replace SPT in the future. 122 The path forward for PAMD@ must include education regarding its clinical utility, how to interpret results to improve the identification of clinically relevant primary and cross-reactivity rather than cross-sensitization, and its costeffectiveness.…”

Molecular diagnosis for allergen immunotherapy

“…80 A recent comparative clinical study has shown that the multiplex analysis of IgE to allergenic molecules is a reliable diagnostic tool, which also has proved to be time efficient by decreasing the number of performed SPTs. 81 Concerning the Identification of clinically relevant inhalant allergen sources (ie, tree, grass, or weed pollen) is required before allergenspecific immunotherapy.…”