Component-resolved diagnostics in the clinical and laboratory investigation of allergy

Abstract

The diagnosis and management of allergy is complex; the clinical symptoms associated with allergic reactions span a broad spectrum of severity, from mild hay fever-type symptoms through to life-threatening anaphylaxis. Obtaining an allergy-focused clinical history is therefore vital for identifying possible allergic triggers and directing testing. However, this focus could be changing as scientific and technological advances have paved the way for developments within in vitro testing for allergy. With knowledge of allergens at the molecular level expanding, there are now the facilities to characterize the sensitization profiles of allergy sufferers and determine the specific molecules (or components) against which the allergen-inducing immunoglobulin type E proteins have been produced. This technology is termed component-resolved diagnostics. We know that accurate identification of immunoglobulin type E specificity, the source of the causative allergen, and knowledge of potential allergic cross-reactivities are required for optimal clinical management of allergy patients. These factors can make allergy a diagnostic challenge outside of a specialist centre, and contribute to the difficulties associated with requesting and interpreting allergy tests. The incorporation of component-resolved diagnostics into current practice has provided a platform for patient-tailored risk stratification and improved the application of allergen-specific immunotherapy, revolutionizing specialist management of these patients. This review discusses the roles of each type of testing in allergy management and predictions for future pathways.

Genuine and cross-reactive allergenic molecules of birch and hazel

“…weeds and birch, i.e. cosensitization (38,39). It is now possible to detect hypersensitivity to genuine or cross-reactive allergenic components, which is not possible either with SPT or with the determination of sIgEs against allergenic extracts.…”

Diagnostic value of the basophil activation test for sensitization to weed allergens

“…Клинические наблюдения у пациентов с поллинозом свидетельствуют о недостаточной информативности кожных проб при определении программы АСИТ, что может быть связано с их положительными результатами при сенсибилизации к минорным аллергенам и кросс-реактивности [5,7,8].…”

“…Золотым стандартом при диагностике аллергического ринита принято считать назальный и конъюнктивальный провокационные тесты; вместе с тем они имеют ряд серьезных недостатков [4,6]. Метод компонент-разделенной аллергодиагностики характеризуется специфичностью, точностью, позволяет определить истинную и кросс-реактивную сенсибилизацию, однако имеет высокую стоимость, сложную схему интерпретации результатов и недоступен в большинстве региональных лабораторий [7,8]. В исследованиях последних лет показано, что тест активации базофилов является надежным аналогом провокационных проб и может эффективно использоваться при диагностике IgE-опосредованных заболеваний и выборе АСИТ [4,9].…”

Protocol for a systematic review of the diagnostic test accuracy of tests for IgE‐mediated food allergy

“…Reported thresholds vary in the literature, likely due to differences in study design and patient characteristics. Component-resolved diagnosis (CRD) refers to the determination of specific IgE levels to specific proteins in food 10 . Additional tests include the basophil activation test (BAT) and the mast cell activation test (MAT); however these are currently not used in routine clinical settings.…”

“…Component-resolved diagnosis (CRD) refers to the determination of specific IgE levels to specific proteins in food. 11 Cellular tests include the basophil activation test (BAT) and the mast cell activation test (MAT); however, these are currently not used in routine clinical practice. CRD is becoming more routine practice and have high specificity for some foods.…”