Molecular diagnosis usefulness for idiopathic anaphylaxis

Abstract

Purpose of review Molecular diagnosis has become an indispensable tool in allergy. In suspected idiopathic anaphylaxis, it is mandatory to extend the diagnostic search to its limits. The current review evaluates how molecular diagnosis allows to identify a number of difficult to prove potential culprits. Recent findings Depending on different geographical areas, it has been shown that the number of anaphylaxis labelled as idiopathic may decrease by the use of molecular diagnosis. The most relevant allergens identified are alpha-gal, omega-5-gliadin, Anisakis, lipid transfer proteins and oleosins. The role of cofactors has been shown to be relevant in a high proportion of cases. Mast cell disorders should always be ruled out. Summary There is a need to provide further molecular diagnostic tests for use in clinical practice to identify sensitization to allergens not well represented in current commercial assays.

Molecular Allergy Diagnosis in Clinical Practice: Frequently Asked Questions

“…MD has been useful to identify causes of anaphylaxis previously labelled as idiopathic. In the case of singleplex assays, the clinician may choose the single components to be tested as for example is the case of delayed meat anaphylaxis, which can be diagnosed by detecting sIgE to -gal (galactose--1,3-galactose) or sIgE to -5-gliadin (Tri a 19) in cases of suspected wheat dependent exerciseinduced anaphylaxis or other known allergens [61].…”

“…Another approach is the use of multiplexed assays, in which a high number of individual allergen molecules are tested simultaneously. Molecular diagnosis arrays allow their use as a form of 'screening' tool in anaphylaxis to assess sensitization of the patient identifying the potential triggers [61].…”

Capítulo 7. Anafilaxia

“…Algunos de los alergenos identificados en pacientes son alfa-gal, nsLTP, oleosinas y omega-5-gliadina. 1,2 ANAFILAXIA Y DIAGNÓSTICO MOLECULAR Todavía existe una necesidad importante de desarrollar biomarcadores para diagnosticar y predecir el riesgo que tiene un individuo de presentar anafilaxia. El diagnóstico por componentes ha permitido mejorar nuestra capacidad para identificar fenotipos clínicos específicos y ha evolucionado la comprensión de los perfiles de sensibilización, por lo que…”

The use of microarray and other multiplex technologies in the diagnosis of allergy

“…In thinking about the use of IgE microarrays, there are certain clinical scenarios in which the ability to test a large panel of allergens in a single test could have real advantages (Table 4). These include the work-up of idiopathic anaphylaxis, 45 pollen-food allergy syndrome, 46 local allergy, [47][48][49][50] and food allergy. 51,52 Heaps et al 25 investigated 110 cases labeled as idiopathic anaphylaxis based on standard evaluation and found that ISAC testing identified likely culprits in an additional 20% of these cases.…”