Molecular allergy diagnosis enabling personalized medicine.

Abstract

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 (MA) diagnosis establishes the patient's IgE reactivity profile at a molecular allergen level and has moved allergology into the "Precision Medicine" era. 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, epidemiological studies and prediction of symptoms, phenotypes, and development 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 MA diagnosis into daily clinical practice requires continuous medical education, training of doctors in MA diagnosis and may be facilitated by clinical decision support systems such as diagnostic algorithms which may take advantage of artificial intelligence (AI).