Abstract
The initial laboratory approach in the diagnosis of allergies is to detect the type of allergic reaction, i.e. whether the patient’s allergy is mediated by immunoglobulin E (IgE) or not. For this purpose, the concentration of total serum IgE (tIgE) and specific IgE (sIgE) are determined. Progress in laboratory diagnostics is the use of component-resolved diagnosis (CRD) which implies determination of sIgE against purified native and recombinant allergenic molecules. Component-resolved diagnosis is used in laboratory practice as singleplex and multiplex assays. The choice of allergen for singleplex assay is based on anamnesis, clinical findings of a patient and on skin prick test results. Multiplex-microarray assays simultaneously determine multiple sIgE’s against numerous allergens. The goal of CRD is to distinguish the true allergens from the cross-reactive allergen molecules. Component-resolved diagnosis allows predicting the risk of severe symptoms, as well as anticipating the development of allergies. Thus, determination of sIgE against allergenic components may significantly improve current diagnostics of allergy. Since this method is applied in laboratory practice just a few years, it is necessary to acquire new knowledge and experience, to establish good co-operation between specialist in medical biochemistry and laboratory medicine and the specialist allergologist, so that the method can be applied in a rational manner. Component-resolved diagnosis will significantly improve the diagnostics of IgE-mediated allergy in the future. The aim of this article is to present potentials of CRD in the laboratory diagnostics of allergy mediated by IgE.
Highlights
The initial laboratory approach in the diagnosis of allergies is to detect the type of allergic reaction, i.e. whether the patient’s allergy is mediated by immunoglobulin E (IgE) or not
Determination of specific IgE (sIgE) concentration over a number of years implied identification of sIgE by allergenic extract materials derived from natural allergen source materials
Progress in laboratory diagnostics of IgE-mediated allergy is the use of component-resolved diagnosis (CRD) or molecular diagnosis of allergies
Summary
The initial laboratory approach in the diagnosis of allergies (such as atopic eczema, food allergy, rhinitis and wheezing disorders) is to detect the type of allergic reaction, i.e. whether the patient’s allergy is mediated by immunoglobulin E (IgE) or not. Genuine allergenic molecules imply major allergens, which in most patients cause a primary, species-specific sensitization (induce synthesis of sIgE) and consequent allergic reaction. Cross-reactive allergenic molecules, due to their similarity to major/ genuine molecule, can only cause allergic reaction after previous contact with the main sensitizer, and. Immunoglobulin E can bind to a cross-reactive molecule within a similar type of allergen sources (e.g. within mites or within grasses) and can bind to stable molecules with similar functions in the various types of allergenic components belonging to the same protein family (e.g. within profilins, tropomyosins, lipocalins, calcium binding proteins, etc.) [6] It enables detection of crossreactive carbohydrate determinants (CCDs), which have no clinical relevance [11]. Clinical symptoms include contact dermatitis, allergic contact dermatitis (hypersensitivity type IV), and urticaria, angioedema, rhinitis, conjunctivitis, bronchospasm, and anaphylaxis (type I hypersensitivity reaction). sIgE to at least 10 allergenic molecules may be identified
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