Component‐resolved diagnosis of pollen allergy based on skin testing with profilin, polcalcin and lipid transfer protein pan‐allergens

Abstract

SummaryBackground Allergy diagnosis needs to be improved in patients suffering from pollen polysensitization due to the existence of possible confounding factors in this type of patients. Objective To evaluate new diagnostic strategies by comparing skin responses to pan-allergens and conventional allergenic extracts with specific IgE (slgE) to purified allergen molecules. Methods One thousand three hundred and twenty-nine pollen-allergic patients were diagnosed by a combination of an in vitro method with a panel of 13 purified allergens, including major allergens and pan-allergens, using a high-capacity screening technology (ADVIA-Centaur s ) and skin prick test (SPT) to pan-allergens and conventional extracts. Results There was a high concordance (k index) between in vitro (slgE to major allergens) and in vivo (SPT to conventional extracts) methods in patients who were not sensitized to panallergens, but SPT with conventional extracts failed to diagnose patients with sensitization to pan-allergens. In patients who were simultaneously sensitized to polcalcins and profilins, there was a duplication both in the number of sensitizations to major allergens and in the years of disease evolution. There was a statistical association between sensitization to profilins and/or lipid transfer proteins and food allergy (PoO.0001). Conclusion The novel diagnostic strategy has proven to be a valuable tool in daily clinical practice. Introduction of routine SPT to pan-allergens is a simple and feasible way of improving diagnostic efficacy. Patients sensitized to pan-allergens should be tested by an adequate panel of allergenic molecules in order to identify the allergens that are responsible for the allergic disease.

Challenges for Allergy Diagnosis in Regions with Complex Pollen Exposures

“…However, regulatory burdens make a massive molecule-based skin prick test (SPT) commercialization almost impossible, at least in the near future. However, it would be feasible to introduce a limited number of new approaches that might allow the identification of pan-allergen reactors [2,26,27]. By doing this, the subset of patients that cannot be diagnosed by SPT might be quickly identified, allowing a better diagnosis in the remaining patients.…”

“…It is a diagnostic confounding factor and, when found as a sensitizer together with profilin, is linked to more complex sensitization profiles and many years of disease evolution [2]. As a consequence, it should be incorporated into diagnostic panels for CRD.…”

“…There is a specific marker, Pla l 1 [63], an Ole e 1-like member, that is available for specific diagnosis. Epidemiological studies suggest that plantain allergy is relevant in some areas [2,3].…”

“…In addition to grasses, other pollens, such as Oleaceae, Amaranthaceae, Cupressaceae, Asteraceae, and Urticaceae, play a significant clinical role [2,3]. In North America, there are pollen regions coincident with European ones with the added complexity of greater tree diversity and a high incidence of ragweed pollinosis [4,5].…”

“…While frequent sensitizers, such as grasses or birch, can be easily standardized, pollens with low prevalence in the allergic population are difficult to standardize and can be biased, at least partly, to pan-allergensensitized populations [2]. It can be estimated that at least 20 % of pollen-allergic patients are sensitized to pan-allergens and will yield positive skin responses to almost any pollen extract.…”