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2015 ; 24
(ä): 185-197
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Molecular allergy diagnostics using IgE singleplex determinations: methodological
and practical considerations for use in clinical routine: Part 18 of the Series
Molecular Allergology
#MMPMID27069839
Kleine-Tebbe J
; Jakob T
Allergo J Int
2015[]; 24
(ä): 185-197
PMID27069839
show ga
Allergen molecules (synonyms: single allergens, allergen components) open up new
horizons for the targeted allergen-specific diagnostics of immunoglobulin E (IgE)
in singleplex determination. The following rationales support the targeted use of
allergen molecules and, more importantly, improve test properties: (1) increased
test sensitivity ("analytical sensitivity"), particularly when important
allergens are under-represented or lacking in the extract; (2) improved test
selectivity (analytical specificity), particularly when the selected IgE
repertoire against an allergen yields additional information on: (a) potential
risk, (b) possible cross-reactivity, or (c) primary (species-specific)
sensitization. However, the appropriate indication for the use of single
allergens can only be established on a case-by-case basis (depending on the
clinical context and previous history) and in an allergen-specific manner
(depending on the allergen source and the single allergens available), rather
than in a standardized way. Numerous investigations on suspected food allergy,
insect venom allergy, or sensitization to respiratory allergens have meanwhile
demonstrated the successful use of defined molecules for allergen-specific
singleplex IgE diagnosis. Specific IgE to single allergens is limited in its
suitability to predict the clinical relevance of sensitivity on an individual
basis. In food allergies, one can at best identify the relative risk of a
clinical reaction on the basis of an IgE profile, but no absolutely reliable
prediction on (future) tolerance can be made. Ultimately, the clinical relevance
of all IgE findings depends on the presence of corresponding symptoms and can
only be assessed on an individual basis (previous history, symptom log, and
provocation testing with the relevant allergen source where appropriate). Thus,
also in molecular allergology, the treating physician and not the test result
should determine the clinical relevance of diagnostic findings. ELECTRONIC
SUPPLEMENTARY MATERIAL: Supplementary material is available for this article at
10.1007/s40629-015-0067-z and is accessible for authorized users.