Matricardi Paolo Maria, van Hage Marianne, Custovic Adnan, Korosec Peter, Santos Alexandra F, Valenta Rudolf
Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Institute of Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
Department of Medicine Solna, Division of Immunology and Respiratory Medicine, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden.
J Allergy Clin Immunol. 2025 Jan 22. doi: 10.1016/j.jaci.2025.01.014.
Allergic patients are characterized by complex and patient-specific IgE sensitization profiles to various allergens, which are accompanied by different phenotypes of allergic disease. Molecular allergy diagnosis establishes the patient's IgE reactivity profile at a molecular allergen level and has moved allergology into the era of precision medicine. Molecular allergology started in the late 1980s with the isolation of the first allergen-encoding DNA sequences. Already in 2002, the first allergen microarrays were developed for the assessment of complex IgE sensitization patterns. Recombinant allergens are used for a precise definition of personal IgE reactivity profiles, identification of genuine IgE sensitization to allergen sources for refined prescription of allergen-specific immunotherapy and allergen avoidance diagnosis of co- versus cross-sensitization, epidemiologic studies, and prediction of symptoms, phenotypes, and development of allergic disease. For example, molecular IgE sensitization patterns associated with more severe respiratory allergies, severe food allergy, and allergy to honeybee or vespids are already established. The implementation of molecular allergy diagnosis into daily clinical practice requires continuous medical education and training doctors in molecular allergy diagnosis, and may be facilitated by clinical decision support systems such as diagnostic algorithms that may take advantage of artificial intelligence.
过敏患者的特征是对各种过敏原具有复杂且因人而异的IgE致敏谱，同时伴有不同表型的过敏性疾病。分子过敏诊断在分子过敏原水平上确定患者的IgE反应谱，使过敏学进入了精准医学时代。分子过敏学始于20世纪80年代末，当时首次分离出编码过敏原的DNA序列。早在2002年，就开发出了第一种用于评估复杂IgE致敏模式的过敏原微阵列。重组过敏原用于精确界定个人IgE反应谱、识别对过敏原来源的真正IgE致敏，以优化过敏原特异性免疫疗法的处方和避免过敏原诊断交叉致敏与共同致敏、进行流行病学研究以及预测症状、表型和过敏性疾病的发展。例如，与更严重的呼吸道过敏、严重食物过敏以及对蜜蜂或黄蜂过敏相关的分子IgE致敏模式已经确定。将分子过敏诊断应用于日常临床实践需要持续的医学教育并培训医生进行分子过敏诊断，借助诊断算法等临床决策支持系统（可能利用人工智能）或许会有所帮助。
