Allergy Department, Fundación Jiménez Díaz, Madrid, Spain.
Clin Exp Allergy. 2010 Oct;40(10):1442-60. doi: 10.1111/j.1365-2222.2010.03585.x. Epub 2010 Aug 2.
Development and progress made in the field of recombinant allergens have allowed for the development of a new concept in allergy diagnosis, molecular diagnosis (MD), which makes it possible to identify potential disease-eliciting molecules. Microarray-based testing performed with a small amount of serum sample enables clinicians to determine specific-IgE antibodies against multiple recombinants or purified natural allergen components. Performance characteristics of allergens so far tested are comparable with current diagnostic tests, but have to be confirmed in larger studies. The use of allergen components and the successful interpretation of test results in the clinic require some degree of knowledge about the basis of allergen components and their clinical implications. Allergen components can be classified by protein families based on their function and structure. This review provides a brief overview of basic information on allergen components, recombinants or purified, currently available or soon to become commercially available in ImmunoCAP or ISAC systems, including names, protein family and function. Special consideration is given to primary or species-specific sensitization and possible cross-reactivity, because one of the most important clinical utility of MD is its ability to reveal whether the sensitization is genuine in nature (primary, species-specific) or if it is due to cross-reactivity to proteins with similar protein structures, which may help to evaluate the risk of reaction on exposure to different allergen sources. MD can be a support tool for choosing the right treatment for the right patient with the right timing. Such information will eventually give clinicians the possibility to individualize the actions taken, including an advice on targeted allergen exposure reduction, selection of suitable allergens for specific immunotherapy, or the need to perform food challenges. Nevertheless, all in vitro tests should be evaluated together with the clinical history, because allergen sensitization does not necessarily imply clinical responsiveness.
重组变应原领域的发展和进步催生了过敏诊断的新概念——分子诊断（MD），MD 使得识别潜在致病分子成为可能。采用少量血清样本进行基于微阵列的检测，可以让临床医生确定针对多种重组体或纯化天然变应原成分的特异性 IgE 抗体。到目前为止，已检测到的变应原的性能特征与当前的诊断测试相当，但需要在更大规模的研究中加以证实。变应原成分的应用以及临床检测结果的成功解读需要对变应原成分的基础及其临床意义有一定程度的了解。根据功能和结构，变应原成分可以按蛋白家族进行分类。本文简要概述了当前 ImmunoCAP 或 ISAC 系统中可获得或即将上市的重组或纯化变应原成分的基本信息，包括名称、蛋白家族和功能，同时特别关注主要或种属特异性致敏和可能的交叉反应性，因为 MD 的最重要的临床应用之一就是能够揭示致敏是天然的（主要的、种属特异性的）还是由于与具有相似蛋白结构的蛋白发生交叉反应所致，这有助于评估暴露于不同变应原来源时发生反应的风险。MD 可以成为一个支持工具，帮助临床医生为合适的患者在合适的时间选择合适的治疗方法。此类信息最终将使临床医生能够个体化地采取行动，包括建议减少针对变应原的暴露、选择适合特定免疫治疗的变应原，或是否需要进行食物挑战。然而，所有的体外检测都应与临床病史一起评估，因为变应原致敏并不一定意味着临床反应性。
