Abstract
The type of allergic sensitization is of central importance in the diagnosis and treatment of respiratory allergic diseases. At least 10% of the general population (and more than 50% of patients consulting for respiratory allergies) are polysensitized. Here, we review the recent literature on (i) the concepts of polysensitization, paucisensitization, co-sensitization, co-recognition, cross-reactivity, cross-sensitization, and polyallergy, (ii) the prevalence of polysensitization and (iii) the relationships between sensitization status, disease severity and treatment strategies. In molecular terms, clinical polysensitization can be divided into cross-sensitization (also known as cross-reactivity, in which the same IgE molecule binds to several allergens with common structural features) and co-sensitization (the simultaneous presence of different IgEs binding to allergens that may not necessarily have common structural features). There is a strong overall association between sensitization in skin prick tests and total IgE values but there is debate as to whether IgE thresholds are useful guides to the presence or absence of clinical symptoms in individual cases. Molecular information from component-resolved techniques appears to be of value for diagnosis and treatment decisions. Polysensitization develops over time and is a risk factor for respiratory allergy (being associated with disease severity) and therefore has clinical relevance for treatment decisions. The subterm polysensitization has been defined as polysensitization to between two and four allergens. Polyallergy is defined as clinically confirmed allergy to two or more allergens. Single-allergen grass pollen allergen immunotherapy (AIT) is safe and effective in polysensitized patients, whereas multi-allergen AIT requires more supporting evidence. Given that AIT may be more efficacious in moderate-to-severe disease than in mild disease, polysensitization could be an indication for this type of treatment. There is a need for flowcharts or decision trees for choosing the allergens for AIT in polysensitized patients and polyallergic patients.
Highlights
Allergic respiratory diseases (including allergic rhinitis (AR) and allergic asthma (AA)) are major public health issues, with high prevalence and significant burden [1,2,3,4,5]
We reviewed the recent literature in order to (i) identify definitions of polysensitization, paucisensitization, co-sensitization, co-recognition, cross-reactivity and polyallergy, (ii) assess the prevalence of monosensitization and polysensitization in the general population and in patients consulting physicians for respiratory allergy, (iii) evaluate the relationship between sensitization status and the severity of allergic disease, and (iv) describe the key factors for diagnosis and treatment
In a glossary issued by the European Academy of Allergy and Clinical Immunology’s Immunotherapy Task Force, Alvarez-Cuesta et al defined an allergen as “a protein or glycoprotein capable of binding immunoglobulin E (IgE)” [13]
Summary
Allergic respiratory diseases (including allergic rhinitis (AR) and allergic asthma (AA)) are major public health issues, with high prevalence and significant burden [1,2,3,4,5]. Polysensitized patients in Europe are typically treated with one or a few allergens deemed to be most clinically relevant [10,11,12]. We reviewed the recent literature in order to (i) identify definitions of polysensitization, paucisensitization, co-sensitization, co-recognition, cross-reactivity ( known as cross-sensitization) and polyallergy, (ii) assess the prevalence of monosensitization and polysensitization in the general population and in patients consulting physicians for respiratory allergy, (iii) evaluate the relationship between sensitization status and the severity of allergic disease, and (iv) describe the key factors for diagnosis and treatment
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
