Molecular allergology place in allergen-specific immunotherapy

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Laboratory methods of allergy diagnosis are an essential tool in the allergist’s daily practice. Molecular allergodiagnostics is an advanced examination method that detects individual allergocomponent sensitization. The risk prediction of severe allergic reactions is the main area of its application, as well as the creation of personalized dietary recommendations for patients with food allergies. Clinical and anamnesis data are fundamental, supplemented by the results of traditional methods of allergy examination (skin prick tests or the specific immunoglobulin E level to whole allergens), in determining the appointment of allergen immunotherapy indications. The widespread use of such resource-intensive examination as molecular allergodiagnostics for all patients is unjustified before prescribing allergen immunotherapy. Additionally, decisions on the allergen immunotherapy continue or the termination cannot be made based on the change data in the level of clinically relevant specific IgE. Concurrently, its use as a third-line diagnostic method can help in solving difficult clinical tasks related to the identification of a causally significant allergen in patients with respiratory allergy symptoms during the seasons of the simultaneous dusting of several plants, as well as differentiate the true from the cross-sensitization in polysensitized patients. The use of molecular allergodiagnostics will be mandatory in prescribing recombinant therapeutic allergens, due to the need for a personalized choice of the drug.

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Daria O. Timoshenko

National Research Center ― Institute of Immunology Federal Medical-Biological Agency of Russia

Author for correspondence.
ORCID iD: 0000-0002-7585-1390
SPIN-code: 2714-0906


Russian Federation, Moscow

Ksenia S. Pavlova

National Research Center ― Institute of Immunology Federal Medical-Biological Agency of Russia

ORCID iD: 0000-0002-4164-4094
SPIN-code: 7593-0838
Scopus Author ID: 7004658159
ResearcherId: P-9255-2017

MD, Cand. Sci. (Med.)

Russian Federation, Moscow

Oksana M. Kurbacheva

National Research Center ― Institute of Immunology Federal Medical-Biological Agency of Russia; Moscow State University of Medicine and Dentistry named after A.I. Evdokimov

ORCID iD: 0000-0003-3250-0694
SPIN-code: 5698-6436

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow; Moscow

Natalia I. Ilina

National Research Center ― Institute of Immunology Federal Medical-Biological Agency of Russia; Moscow State University of Medicine and Dentistry named after A.I. Evdokimov; The Russian National Research Medical University named after N.I. Pirogov

ORCID iD: 0000-0002-3556-969X
SPIN-code: 6715-5650

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow; Moscow; Moscow


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Supplementary files

Supplementary Files
1. Fig. 1. Major and minor allergens (based on materials from open sources).Note: Bet v 1 ― major allergen of birch pollen; Phl p 1 ― major allergen of timothy pollen; Art v 1 ― major allergen of mugwort pollen; Bet v 2 ― minor allergen of birch pollen; Phl p 7 ― minor allergen of timothy pollen; Art v 4 ― minor allergen of mugwort pollen; sIgE ― specific IgE antibodies.

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2. Fig. 2. The risk of developing severe allergic reactions to various plant allergen components (adapted from K. Hoffmann et al. [1]).Note: CCD ― cross-reactive carbohydrate determinants; LTPs ― lipid transfer proteins.

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3. Fig. 3. Allergic diagnosis algorithm in order to select therapeutic allergen.

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4. Fig. 4. The use of molecular allergy diagnosis to identify primary sensitization in a patient with seasonal allergy symptoms.Note: Bet v 1 ― major allergen of birch pollen; Phl p 1 ― major allergen of timothy pollen; Phl p 5 ― major allergen of timothy pollen; sIgE ― specific IgE antibodies.

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