Component-resolved diagnosis of pollen allergy based on skin testing with profilin, polcalcin and lipid transfer protein pan-allergens.
BACKGROUND
Allergy diagnosis needs to be improved in patients suffering from pollen polysensitization due to the existence of possible confounding factors in this type of patients.


OBJECTIVE
To evaluate new diagnostic strategies by comparing skin responses to pan-allergens and conventional allergenic extracts with specific IgE (sIgE) to purified allergen molecules.


METHODS
One thousand three hundred and twenty-nine pollen-allergic patients were diagnosed by a combination of an in vitro method with a panel of 13 purified allergens, including major allergens and pan-allergens, using a high-capacity screening technology (ADVIA-Centaur) and skin prick test (SPT) to pan-allergens and conventional extracts.


RESULTS
There was a high concordance (kappa index) between in vitro (sIgE to major allergens) and in vivo (SPT to conventional extracts) methods in patients who were not sensitized to pan-allergens, but SPT with conventional extracts failed to diagnose patients with sensitization to pan-allergens. In patients who were simultaneously sensitized to polcalcins and profilins, there was a duplication both in the number of sensitizations to major allergens and in the years of disease evolution. There was a statistical association between sensitization to profilins and/or lipid transfer proteins and food allergy (P<0.0001).


CONCLUSIONS
The novel diagnostic strategy has proven to be a valuable tool in daily clinical practice. Introduction of routine SPT to pan-allergens is a simple and feasible way of improving diagnostic efficacy. Patients sensitized to pan-allergens should be tested by an adequate panel of allergenic molecules in order to identify the allergens that are responsible for the allergic disease.
Barber
D
D
Departamento de I+D, ALK-Abelló, Madrid, Spain. domingo.barber@alk-abello.com
de la Torre
F
F
Lombardero
M
M
Antépara
I
I
Colas
C
C
Dávila
I
I
Tabar
A I
AI
Vidal
C
C
Villalba
M
M
Salcedo
G
G
Rodríguez
R
R
D000293:Adolescent; D000328:Adult; D052179:Antigens, Plant / Q000276:immunology / Q000494:pharmacology*; D002352:Carrier Proteins; D002648:Child; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D008297:Male; D010940:Plant Proteins; D051304:Profilins / Q000276:immunology / Q000494:pharmacology*; D006255:Rhinitis, Allergic, Seasonal / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology; D012882:Skin Tests; D013030:Spain / Q000453:epidemiology
D052179:Antigens, Plant; D002352:Carrier Proteins; D010940:Plant Proteins; D051304:Profilins; C511920:lipid transfer proteins, plant; D007073:Immunoglobulin E