A WAO - ARIA - GA2LEN consensus document on molecular-based allergy diagnosis (PAMD@): Update 2020

Abstract

Precision allergy molecular diagnostic applications (PAMD@) is increasingly entering routine care. Currently, more than 130 allergenic molecules from more than 50 allergy sources are commercially available for in vitro specific immunoglobulin E (sIgE) testing. Since the last publication of this consensus document, a great deal of new information has become available regarding this topic, with over 100 publications in the last year alone. It thus seems quite reasonable to publish an update. It is imperative that clinicians and immunologists specifically trained in allergology keep abreast of the new and rapidly evolving evidence available for PAMD@. PAMD@ may initially appear complex to interpret; however, with increasing experience, the information gained provides relevant information for the allergist. This is especially true for food allergy, Hymenoptera allergy, and for the selection of allergen immunotherapy. Nevertheless, all sIgE tests, including PAMD@, should be evaluated within the framework of a patient's clinical history, because allergen sensitization does not necessarily imply clinical relevant allergies.

Keywords: Cross reactivity; Diagnosis; Molecular allergy; Panallergen; Specific IgE, PAMD@.

Fig. 1

Relevant molecules involved in the identification of cat, dog and horse sensitization

Fig. 2

A practical algorithm emplying allergen molecules for the identification of sensitization to hymenoptera. HBV: Honey bee venom; VYJV = Yallow Jacket venoms; PDV: polisted dominulus venom; CCD: Cross-reactive Carbohydrate Determinants