A WAO - ARIA - GA²LEN consensus document on molecular-based allergy diagnostics
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
World Allergy Organization Journal 2013, 6:17 doi:10.1186/1939-4551-6-17Published: 3 October 2013
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.