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Open Access Highly Accessed Consensus Document

A WAO - ARIA - GA²LEN consensus document on molecular-based allergy diagnostics

Giorgio Walter Canonica1*, Ignacio J Ansotegui2, Ruby Pawankar3, Peter Schmid-Grendelmeier4, Marianne van Hage5, Carlos E Baena-Cagnani6, Giovanni Melioli7, Carlos Nunes8, Giovanni Passalacqua9, Lanny Rosenwasser10, Hugh Sampson11, Joaquin Sastre12, Jean Bousquet13, Torsten Zuberbier14 and WAO-ARIA-GA2LEN Task Force: Katrina Allen, Riccardo Asero, Barbara Bohle, Linda Cox, Frederic de Blay, Motohiro Ebisawa, Rene Maximiliano-Gomez, Sandra Gonzalez-Diaz, Tari Haahtela, Stephen Holgate, Thilo Jakob, Mark Larche, Paolo Maria Matricardi, John Oppenheimer, Lars K Poulsen, Harald E Renz, Nelson Rosario, Marc Rothenberg, Mario Sanchez-Borges, Enrico Scala, Rudolf Valenta

Author Affiliations

1 Allergy & Respiratory, DIMI, Department of Internal Medicine, University of Genoa, Largo Rosanna Benzi, Genoa, Italy

2 Department of Allergy and Immunology, Hospital Quirón Bizkaia, Carretera Leioa-Inbe, Erandio (Bilbao), Spain

3 Department of Pediatrics, Division of Allergy, Nippon Medical School, Tokyo, Japan

4 Department of Dermatology, Allergy Unit, University Hospital of Zurich, Zurich, Switzerland

5 Clinical Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet and University Hospital, Stockholm, Sweden

6 Research Centre for Respiratory Medicine, Catholic University, Cordoba, Argentina

7 Dipartimento di Medicina Sperimentale, Istituto Giannina Gaslini, Genova, Italy

8 Centre of Allergy of Algarve, Algarve, Portugal

9 University of Genoa, Genoa, Italy

10 University of Missouri – Kansas City School of Medicine, Children’s Mercy Hospital and Clinics, Kansas, KS, USA

11 Department of Pediatrics, Division of Allergy/Immunology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

12 Department of Medicine, Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, Avenida Reyes Catolicos, Madrid, Spain

13 Service Maladies Respiratoires, Hopital Arnaud de Villeneuve, Av. Doyen Gaston Giraud, Montepellier, France

14 Clinic for Dermatology and Allergy Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany

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World Allergy Organization Journal 2013, 6:17  doi:10.1186/1939-4551-6-17

Published: 3 October 2013

Abstract

Molecular-based allergy (MA) diagnostics is an approach used to map the allergen sensitization of a patient at a molecular level, using purified natural or recombinant allergenic molecules (allergen components) instead of allergen extracts. Since its introduction, MA diagnostics has increasingly entered routine care, with currently more than 130 allergenic molecules commercially available for in vitro specific IgE (sIgE) testing.

MA diagnostics allows for an increased accuracy in allergy diagnosis and prognosis and plays an important role in three key aspects of allergy diagnosis: (1) resolving genuine versus cross-reactive sensitization in poly-sensitized patients, thereby improving the understanding of triggering allergens; (2) assessing, in selected cases, the risk of severe, systemic versus mild, local reactions in food allergy, thereby reducing unnecessary anxiety for the patient and the need for food challenge testing; and (3) identifying patients and triggering allergens for specific immunotherapy (SIT).

Singleplex and multiplex measurement platforms are available for MA diagnostics. The Immuno-Solid phase Allergen Chip (ISAC) is the most comprehensive platform currently available, which involves a biochip technology to measure sIgE antibodies against more than one hundred allergenic molecules in a single assay. As the field of MA diagnostics advances, future work needs to focus on large-scale, population-based studies involving practical applications, elucidation and expansion of additional allergenic molecules, and support for appropriate test interpretation. With the rapidly expanding evidence-base for MA diagnosis, there is a need for allergists to keep abreast of the latest information. The aim of this consensus document is to provide a practical guide for the indications, determination, and interpretation of MA diagnostics for clinicians trained in allergology.