Symptom patterns and comparison of diagnostic methods in ragweed pollen allergy

Abstract

The aim of the present study was to determine the pattern of symptoms of ragweed pollen-induced allergic disease in sensitized patients from Romania and to compare the molecular diagnosis of allergy with the skin prick test, in order to better characterize allergic patients and to guide therapy. A total of 97 subjects, including patients with ragweed pollen-induced allergic rhinoconjunctivitis with/without asthma, as well as healthy controls, were recruited prospectively in one ragweed pollen season, submitted to allergy questionnaires, skin prick tests and multiplex specific IgE (immunoglobulin E) measurement by ImmunoCAP ISAC (ImmunoCAP Immuno-Solid phase Allergy Chip) assay. A total of 83 patients were sensitized to ragweed pollen. Most patients (73%) were diagnosed with moderate-severe intermittent allergic rhinoconjunctivitis and 25% of the patients also had allergic asthma. The most common symptoms were watery rhinorrhea (91.57%), nasal obstruction (86.75%), and sneezing (85.54%). Most patients were polysensitized (62.65%), especially to other pollens, house dust mites and animal danders. Only 90% of the patients with positive skin prick test to ragweed pollen extract also had increased specific serum IgE to Amb a 1. Current options for specific molecular diagnosis of ragweed allergy are limited, as they only contain one or few of the sensitizing allergens present in ragweed pollen. An improved component-resolved diagnosis, using several ragweed pollen allergens, is required for better patient characterization and subsequent selection of an appropriate allergen immunotherapy product, thereby enabling a more personalized approach to the management of the ragweed-allergic patient.

Complex IgE sensitization patterns in ragweed allergic patients: Implications for diagnosis and specific immunotherapy

“…Also patients without Amb a 1‐specific IgE were identified (Table S2). The percentage (12.3%) of patients with signal to other ragweed allergens than Amb a 1 (P19) (3 patients) and of those without signal on the blot (13 patients) is similar with the percentage (13.2%) of patients negative to Amb a 1 but positive to ragweed pollen extract skin prick test obtained by Haidar et al 56 . in a population from the same geographic area.…”

Insect Cell-Expressed Major Ragweed Allergen Amb a 1.01 Exhibits Similar Allergenic Properties to Its Natural Counterpart from Common Ragweed Pollen

“…Furthermore, they can serve as benchmark molecules for the development of innovative molecular allergy vaccines [36][37][38]44]. Currently, 11 allergens have been described for ragweed pollen [16] and Amb a 1 is considered the major allergen, with more than 90% of ragweed allergic patients sensitized to it [2,17,45]. Amb a 1 has five known isoforms [27] with different IgE-binding capacities [30], among which Amb a 1.01 reportedly has the highest allergenic activity, indicating that it is the most important component in diagnostic tests and a major benchmark for AIT developments [21].…”

Relationship between IgE Levels Specific for Ragweed Pollen Extract, Amb a 1 and Cross-Reactive Allergen Molecules

“…Antigen E, now termed major ragweed pollen allergen Amb a 1, was considered to be the most important ragweed pollen allergen and to be sufficient for allergen-specific immunotherapy of allergy to ragweed pollen [ 34 ]. However, more recent studies conducted in western Romania [ 35 , 36 ] investigating the sensitization profiles of ragweed-allergic patients showed complex IgE reactivity profiles. These studies suggest that besides Amb a 1, other allergens from ragweed, including pan-allergens, may play a role in ragweed sensitization and, therefore, should be considered for diagnosis and immunotherapy.…”