title: A Pitfall to Avoid When Using an Allergen Microarray: The Incidental Detection of IgE to Unexpected Allergens.
abstract: The introduction of new laboratory techniques to detect specific IgE antibodies against single allergen molecules rather than whole extracts represents a significant advance in allergy diagnostics. The advantages of such component-resolved diagnosis can be summarized as follows: (1) the ability to identify the truly responsible allergens in polysensitized patients, whether they be genuine (causing specific sensitization to their corresponding allergen source) or primary (the original sensitizing molecule); (2) distinguishing these allergens from simply cross-reactive components; (3) improving the appropriateness of the prescribed specific immunotherapy; and (4) identifying a risk profile for food allergens. Component-resolved diagnosis is performed using either a singleplex (1 assay per sample) platform or a multiplex (multiple assays per sample) platform. Using an immuno solid-phase allergen chip microarray that falls into the latter category--it currently tests sensitivity to 112 allergens--may lead to a pitfall: detecting IgE to unexpected allergens, such as Hymenoptera venom. In fact, testing insect venom sensitivity in individuals with no history of reactions to stings is contrary to current guidelines and presents the physician with the dilemma of how to manage this information; moreover, this may become a legal issue. Based on what is currently known about venom allergy, it remains likely that a positive sensitization test result will have no clinical significance, but the possibility of reacting to a future sting cannot be completely ruled out. Because this problem has not been previously encountered using the more common allergy tests, no indications are currently available on how to effectively manage these cases.
authors.affiliation: Allergy/Pulmonary Rehabilitation, ICP Hospital, Milan, Italy.
authors.forename: Cristoforo
authors.initials: C
authors.lastname: Incorvaia
authors.affiliation: Allergy Service, Sant'Anna Hospital, Como, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Mauro
authors.affiliation: Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
authors.forename: Erminia
authors.initials: E
authors.lastname: Ridolo
authors.affiliation: Allergy/Pulmonary Rehabilitation, ICP Hospital, Milan, Italy.
authors.forename: Eleni
authors.initials: E
authors.lastname: Makrì
authors.affiliation: Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Montagni
authors.affiliation: Medicine Department, Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliera Universitaria San Martino, Genoa, Italy. Electronic address: gio.cip@libero.it.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ciprandi
mesh_terms: D000485:Allergens / Q000276:immunology*; D003429:Cross Reactions; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis*; D007073:Immunoglobulin E / Q000276:immunology*; D033162:Incidental Findings; D046228:Microarray Analysis
chemical_list: D000485:Allergens; D007073:Immunoglobulin E
keywords: component-resolved diagnosis; lipid-transfer proteins; microarray; multiplex; singleplex