Utilization of Component-Resolved Diagnosis in Precision Allergology

Abstract

It is very important to identify the causal allergen of each patient in the diagnosis and treatment of allergic diseases. An experimental method of specific IgE testing for single clinically meaningful antigens is called component resolved diagnosis (CRD). Since the introduction of CRD, many single antigens with clinical significance from animal and plant allergenic source have become known. Bet v 1, the major allergen of white birch pollen, can be an indication marker for allergen-specific immunotherapy if the patient is sensitized. Phl p 1, the group I allergen of timothy grass pollen, is an important marker that suggests that patients are truly sensitized to grass pollen. The major allergen of ragweed pollen, Amb a 1 and Art v 1, which is the major allergen of mugwort pollen, are clinically important to distinguish true sensitization. House dust mites have several clinically useful component allergens. Der p 1 and Der p 2 are the initiation molecules in the molecular spreading of allergic diseases caused by house dust mites. Among food allergens, Ara h 2 from peanut, which is closely related to anaphylaxis among several clinical manifestation of peanut allergy. Tri a 19, well known to omega-5 gliadin is important in patients with wheat-dependent exercise-induced anaphylaxis. It is conceivable that the molecular biological concept of CRD methods should lead to ‘patient-customized treatment’ beyond ‘diagnosis’ in the future. Primary prevention of the allergic diseases will apply, which will conceptually be called ‘allergen immunprophylaxis’. This is the right direction of future precision allergology.