Recombinant Marker Allergens: Diagnostic Gatekeepers for the Treatment of Allergy

Abstract

During the past decade an increasing number of recombinant allergens have become available, representing a significant proportion of the epitope complexity of natural allergen extracts. Component-resolved diagnosis with recombinant allergens reveals the antibody reactivity profile of allergic patients and identifies the disease-eliciting allergen molecules. This article exemplifies how recombinant allergen molecules with high cross-reactive potential can be used as marker allergens to identify allergic patients who are cross-sensitized to a variety of allergen sources. It further demonstrates how the use of allergens with a restricted distribution in a certain group of allergen sources may allow the identification of patients who have been genuinely sensitized by a particular allergen molecule. Drawing from those examples, it is suggested how diagnostic tests based on such recombinant marker allergens may be used to improve the choice and monitoring of currently available forms of specific immunotherapy.

Developments in allergen‐specific immunotherapy: from allergen extracts to allergy vaccines bypassing allergen‐specific immunoglobulin E and T cell reactivity

“…With the increasing availability of new component-resolved forms of allergy diagnosis, correct diagnosis of the disease-causing allergens becomes easier and should facilitate the accurate prescription of immunotherapy [60][61][62][63]. Diagnostic tests based on the major allergens of the most common allergen sources are now available, but treatment is still based on allergen extracts.…”

Immunoglobulin E Reactivity of Recombinant Allergen Tyr p 13 from Tyrophagus putrescentiae Homologous to Fatty Acid Binding Protein

“…However, VOL. 12,2005 IgE REACTIVITY OF Tyr p 13 583 the frequencies of IgE binding to these allergens are low, suggesting that they are minor allergens, e.g., 11% (5 of 45) to Blo t 13 from Blomia tropicalis (5), 23% (3 of 13) to Aca s 13 from Acarus siro (8), and 13% (6 of 45) to Lep d 13 from Lepidoglyphus destructor (7). However, recombinant Blo t 13 inhibited 62% of IgE binding to crude extract according to the radioallergosorbent inhibition test using one patient's serum, which suggests that it may be clinically significant for some patients.…”

“…In addition, skin prick testing using T. putrescentiae commercial allergen extract is not believed to be reliable for the detection of measurable levels of IgE antibodies (11). Thus, the cloning and genetic engineering of the allergens offers many advantages, and they are expected to replace crude extracts for diagnosis and treatment in the near future (12). In a study using a panel of seven purified natural or recombinant allergens, mite-allergic patients who were polysensitized to various minor allergens, which included highly cross-reactive allergens and storage mite allergens, could be discriminated from those who were mainly sensitized to major allergens (e.g., Der p 1 and Der p 2) (19).…”

Component-resolved diagnostics: laboratory results are not enough

“…Assays based on recombinant and/or highly purified allergens allow a deeper examination of crossreactions, risk molecules and prognostic significant sensitizations, thus paving the way to the socalled "molecular or componentresolved diag nostics (CRD)" [6]. CRD more suitably allows the genuine sensitization of patients toward a given allergenic source to be identified, along with crossreactive molecules that suggest crosssensitization to several allergen sources [7].…”