Challenges for Allergy Diagnosis in Regions with Complex Pollen Exposures

Over the past few decades, significant scientific progress has influenced clinical allergy practice. The biological standardization of extracts was followed by the massive identification and characterization of new allergens and their progressive use as diagnostic tools including allergen micro arrays that facilitate the simultaneous testing of more than 100 allergen components. Specific diagnosis is the basis of allergy practice and is always aiming to select the best therapeutic or avoidance intervention. As a consequence, redundant or irrelevant information might be adding unnecessary cost and complexity to daily clinical practice. A rational use of the different diagnostic alternatives would allow a significant improvement in the diagnosis and treatment of allergic patients, especially for those residing in complex pollen exposure areas

Enhanced diagnosis of pollen allergy using specific immunoglobulin E determination to detect major allergens and panallergens.

Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Validation Studies;BACKGROUND Pollen is one of the main causes of allergic sensitization. It is not easy to make an etiological diagnosis of pollen-allergic patients because of the wide variety of sensitizing pollens, association with food allergy, and increasing incidence of polysensitization, which may result from the presence of allergens that are common to different species, as is the case of panallergens. OBJECTIVE To compare the results of skin prick tests (SPT) using whole pollen extract with specific immunoglobulin (Ig) E determination for several allergens (purified panallergens included) in the diagnosis of polysensitized pollen-allergic patients. METHODS The study sample comprised 179 pollen-sensitized patients who underwent SPT with pollen extract and allergen-specific IgE determination against different allergens. RESULTS The level of concordance between the traditional diagnostic test (SPT) and IgE determination was low, especially in patients sensitized to the panallergens profilin and polcalcin. In the case of SPT, the results demonstrated that patients who are sensitized to either of these panallergens present a significantly higher number of positive results than patients who are not. However, IgE determination revealed that while patients sensitized to polcalcins are sensitized to allergens from a higher number of pollens than the rest of the sample, this is not the case in patients sensitized to profilins. On the other hand, sensitization to profilin or lipid transfer proteins was clearly associated with food allergy. CONCLUSIONS Sensitization to panallergens could be a confounding factor in the diagnosis of polysensitized pollen-allergic patients as well as a marker for food allergy. However, more studies are required to further investigate the role of these molecules.This study was partially supported by ALK-Abelló, S.A.YesRESUMEN:Introducción: el polen es una de las principales causas de sensibilización alérgica. No es fácil a veces hacer un diagnóstico etiológico de los pacientes polínicos debido a la gran variedad de pólenes alergénicos, asociaciones con alergias a alimentos, y al incremento de la polisensibilización. Éste último factor parece deberse fundamentalmente a la existencia de alérgenos comunes en diferentes especies, como es el caso de los panalérgenos. Objetivos: comparar los resultados de los test cutáneos intraepidérmicos usando extractos completos de pólenes con la determinación de IgE específica a diferentes alérgenos (incluido panalérgenos purifi cados) en el diagnóstico de pacientes alérgicos polisensibilizados a pólenes. Métodos: se incluyeron 179 pacientes sensibilizados a pólenes. Se les realizó test cutáneos con extractos de pólenes y se determinó la IgE específi ca frente a diferentes alérgenos. Resultados: el nivel de concordancia entre el test diagnóstico tradicional y el diagnóstico molecular fue bajo, especialmente en pacientes sensibilizados a profilina y polcalcina. En el caso de las pruebas cutáneas, los resultados demostraron que los pacientes que estaban sensibilizados a alguno de esos panalérgenos presentaban un número signifi cativamente mayor de resultados positivos que los pacientes no sensibilizados a panalérgenos. Sin embargo, en la determinación de IgE específi ca a alérgenos, se observó que mientras los pacientes sensibilizados a polcalcina estaban sensibilizados a alérgenos de un mayor número de pólenes que el resto de la muestra, esto no ocurría con los sensibilizados a profilinas. Por otro lado, la sensibilización a profi lina o LTP se asoció claramente con alergia alimentaria. Conclusiones: la sensibilización a panalérgenos podría ser un factor de confusión en el diagnóstico de los pacientes polínicos polisensibilizados, así como un marcador de alergia a alimentos. En cualquier caso, se requieren más estudios para investigar más a fondo el papel de estas molécula

Reduced work/academic performance and quality of life in patients with allergic rhinitis and impact of allergen immunotherapy.

Allergic rhinitis (AR) is characterised by burdensome nasal and/or ocular symptoms. This inflammatory disease can be debilitating and thus result in considerable health-related and economic consequences. In a cross-sectional study, adult subjects with AR (N = 683) completed three allergy-specific questionnaires that assessed the impact of AR on the work/academic performance, daily activities, health-related quality of life (HRQOL), and satisfaction with allergen immunotherapy (AIT). Regression analyses were used to examine the associations between several clinical variables and the patient-reported outcomes. Total loss of productivity was 21.0 and 21.2 % for employed and student patients, respectively, whereas the impairment of daily activities was 22.0 %. The mean overall HRQOL score was 1.94 ± 1.29 (on the scale of 0-6 points). Global score for satisfaction with AIT was 65.5 ± 24.8 (on a 0-100 scale). Simple regression analysis found statistically significant associations between loss of work and academic productivity, impairment of daily activities and the type and severity of AR. AIT was a protective factor. The persistent and more severe types of AR and lack of AIT contributed to the worsening of HRQOL. AR (the persistent and more severe form of the disease) has an impact on functional characteristics of adult patients in Spain. AIT might reduce the effect of this disease on the work/academic performance and HRQOL. Trial registration Retrospectively registered

Veterinary allergy diagnosis: past, present and future perspectives

Fleas, several aeroallergens as well as many food allergens are the most common allergenic sources for animals and frequent cause of allergic reactions with different target organs such as skin, eyes, and respiratory or digestive systems. Allergy diagnosis needs to follow well-established guidelines under clinical and laboratory approaches. Since 1980 with the Hanifin & Rajka’s criteria for the diagnosis of atopic dermatitis (AD) in humans, successive proposals have been developed to identify atopic dermatitis in dogs. A consensual plan was first proposed by Willemse in 1986 undergoing several modifications in 1994. Prélaud and colleagues made important changes to the plan in 1998 and it was further adjusted by Favrot in 2009. In 2010, this plan was approved by the International Task Force on Canine Atopic Dermatitis (CAD). It was subjected in 2015 to minor updates with regard to therapeutic options. To improve diagnostic accuracy by integrating the basic knowledge on sensitization development and allergen nature and diversity, allergen sources and implicated molecular allergens for animals should be clearly identified. As well as in human medicine, this molecular epidemiology concept is essential for the veterinary allergy diagnosis in the near future, standing as the basis of a component-resolved diagnosis (CRD). Besides current pharma- cotherapy, it will be highly relevant to increase the efficiency of the avoidance measures and specific immunotherapy. Clinical guidelines will lead to at least 80 % of positive diagnosis of atopy, but newer laboratory methods in veterinary medicine aiming to a more precise diagnosis and a better integration of the clinical/laboratory diagnostic course are needed. Allergoms identification for animals, from different allergen sources proteoms should become a priority in veterinary allergology, in order to allow the intended CRD, which is essential to understand the cross-reaction phenomena, allowing a more precise and possibly effective component-resolved immunotherapy (CRIT). Further research has been carried out for a better understanding of the interaction between allergic clinical condition and immune pathophysiology. As well as in human medicine, a deeper knowledge of the molecular immunological mechanisms in veterinary allergy — with their specific allergen triggers — will also provide the veterinary allergist with the necessary information to act more efficiently in the future