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The Use of Molecular Allergy Diagnosis in Anaphylaxis: a Literature Review

  • Anaphylaxis (M Sanchez-Borges, Section Editor)
  • Published:
Current Treatment Options in Allergy Aims and scope Submit manuscript

Abstract

Purpose of the review

Anaphylaxis can be caused mainly by drugs, foods, and hymenoptera or it can be idiopathic, when no cause is identified. The identification of the cause(s) of an anaphylactic reaction can be made by using both top-down (i.e., from patients’ history to MAD) and bottom-up (from MAD screening to the patients’ characterization) strategies.

Recent findings

Independently from the strategy, the patients’ history, skin prick test, second, third, and fourth level in vitro serum or cellular assays, and in vivo challenge tests are mandatory. The diagnosis is based on the results of these tests used at best. Third level specific IgE assays, based on the use of molecular allergens, allow a very accurate description of the specific IgE profile of the patient, resulting in a significant support in the identification of the trigger of the anaphylactic reaction.

Summary

In recent years, this third level has been empowered by the availability of allergen arrays that allow screening a large number of molecular allergens in a single test. In this paper, we analyze the recent scientific literature on this topic, showing that molecular allergy diagnosis does not seem to be yet a standard procedure in the identification of the cause of anaphylaxis.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Personalized Medicine, Asthma and Allergy, Humanitas Research Hospital, Rozzano, Milan, Italy

    Enrico Heffler MD, Giovanni Paoletti MD, Francesca Racca MD, Francesca Puggioni MD, Giovanni Melioli MD & Giorgio Walter Canonica MD

  2. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

    Enrico Heffler MD, Giovanni Melioli MD & Giorgio Walter Canonica MD

  3. Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d’Hebron, Barcelona, Spain

    Victoria Cardona MD & Olga Luengo MD

  4. ARADyAL Research Network, Salamanca, Spain

    Victoria Cardona MD & Olga Luengo MD

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  1. Enrico Heffler MD
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Correspondence to Giovanni Melioli MD.

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Conflict of Interest

Enrico Heffler declares that he has no conflict of interest. Victoria Cardona declares that she has no conflict of interest. Olga Luengo declares that she has no conflict of interest. Giovanni Paoletti declares that he has no conflict of interest. Francesca Racca declares that she has no conflict of interest. Francesca Puggioni declares that she has no conflict of interest. Giovanni Melioli declares that he has no conflict of interest. Giorgio Walter Canonica declares that he has no conflict of interest.

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Key Points

•Molecular allergy diagnosis (MAD) seems to be, at present, the most powerful laboratory method to identify allergen sensitization at single component level.

•Despite MAD was introduced more than 10 years ago in allergy practice, its use in patients with anaphylaxis seems to be at present restricted to research more than to clinics.

•However, in many situations, such as in suspected hymenoptera, food or idiopathic anaphylaxis, MAD is probably the only suitable approach.

This article is part of the Topical Collection on Anaphylaxis

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Heffler, E., Cardona, V., Luengo, O. et al. The Use of Molecular Allergy Diagnosis in Anaphylaxis: a Literature Review. Curr Treat Options Allergy 6, 142–155 (2019). https://doi.org/10.1007/s40521-019-00204-3

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