Zusammenfassung
Die Verwendung rekombinanter Allergenkomponenten eröffnet mehrere diagnostische Möglichkeiten. So können krankheitsspezifische Sensibilisierungsmuster wie etwa bei der allergisch bronchopulmonalen Aspergillose ABPA identifiziert werden. Durch Bestimmung der Majorallergene wichtiger Pollen (Bet v 1, Ole 1, Phl p 1/Phl p 5) kann eine präzisere Indikationsstellung im Hinblick auf eine allergenspezifische Immuntherapie ermöglicht werden, da Extrakte v. a. Majorallergene enthalten. Sensibilisierungen auf Nebenallergene wie Profiline und Polcalcine beeinflussen aufgrund der großen Kreuzreaktivität herkömmliche IgE-Tests, sind aber oft von untergeordneter klinischer Bedeutung. Bei Nahrungsmitteln können häufige Kreuzreaktionen etwa mit Birkenpollen über Bet v 1/PR-10-Proteine nachgewiesen werden. Zudem lassen Sensibilisierungen auf Speicherproteine etwa von Erdnuss (Ara h 2) oder Lipidtransferproteine von Pfirsich (Pru p 3) oder Haselnuss (Cor a 8) Rückschlüsse auf ein höheres Anaphylaxierisiko zu. Anstrengungsinduzierte Beschwerden (Tri a 19), unklare Latexsensibilisierungen oder Doppelpositivität bei Insektengiftallergien sind weitere aktuell sinnvolle Einsatzgebiete. Microarray-basierte Allergenchips erlauben bereits heute die Bestimmung von IgE gegen über 100 Allergenen aus kleinsten Serummengen, bedürfen aber noch der Evaluation und Optimierung bezüglich Allergenauswahl und Sensitivität.
Abstract
Component-resolved diagnosis of allergies allows disease-specific patterns of sensitization in some conditions such as allergic bronchopulmonary aspergillosis ABPA). By determination of IgE against important pollen allergens such as Bet v 1, Ole e 1 or Phl p1/Phl p 5, more precise guidance for allergen-specific immunotherapy may be achieved, as pollen extracts contain mostly these major allergens. Sensitizations against minor allergens such as profilins or polcalcins influence the outcome of IgE measurements against full allergen sources, but are often of limited clinical relevance. In food allergy, frequent cross reactivity between pollens such as birch pollen via Bet v 1/PR10 proteins can be identified. Sensitization against some storage proteins such as peanut (Ara h 2) or lipid transfer proteins of peach (Pru p 3) or hazelnut (Cor a 8) may indicate an increased risk of severe anaphylactic reactions. Exercise-induced anaphylaxis, unclear sensitizations against latex or double-positivity in insect allergy are other useful indications for component-resolved diagnosis. Microarray-based allergen chip diagnosis makes possible today the detection of IgE against more than 100 allergens in tiny amounts of serum and is very promising, but still needs evaluation and optimization in regard to allergen selection and sensitivity.
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Interessenkonflikt
Der korrespondierende Autor weist auf folgende Beziehungen hin: Der Autor PD Dr. Peter Schmid-Grendelmeier wirkt als Berater für die Firmen Bühlmann AG, Siemens Diagnostics AG und Phadia AG und erhielt von diesen Firmen Honorare für Vorträge.
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Schmid-Grendelmeier, P. Rekombinante Allergene. Hautarzt 61, 946–953 (2010). https://doi.org/10.1007/s00105-010-1967-y
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DOI: https://doi.org/10.1007/s00105-010-1967-y