原标题:过敏原免疫治疗的分子诊断
——浙大迪迅 译
过敏原分子在出生队列研究中的广泛应用显示,特应性致敏是从触发分子开始,对来自同一过敏原源的不同非交叉反应分子的连续性IgE应答。根据个体的特应性倾向和过敏原暴露情况,这一现象的演化程度不同(单分子、低分子和多分子),从而在患者人群中产生了IgE致敏谱的极度异质性。在过敏性鼻炎患者中,IgE分子致敏谱越宽,哮喘和其他过敏性并发症(如口腔变态反应综合征)的风险越大。因此,在疾病开始时(早期过敏原免疫治疗),甚至在临床前致敏阶段(过敏原免疫预防),进行免疫干预是可能的。基于单重或多重分子IgE检测的诊断方法,可区分真正致敏和交叉致敏,并可选择合适的过敏原免疫治疗提取物。可以通过过敏原微阵列或宏阵列方法轻易识别极度的多重分子致敏患者和具有较大的患哮喘或其它IgE介导的并发症风险的患者,并可受益于抗IgE治疗。IgE分子检测开启了精确变态反应学的时代,根据明智选择的原则,常规使用应以成本效益为目标。
延伸阅读
JACI:
[IF:13.1]
Molecular diagnosis for allergen immunotherapy
https://doi.org/10.1016/j.jaci.2018.12.1021
The extensive use of allergen molecules in birth cohort studies revealed that atopic sensitization is a sequential IgE response to distinct non–cross-reacting molecules from the same allergenic source (ie, molecular spreading), starting with an initiator molecule. This phenomenon reaches different degrees of progression (monomolecular, oligomolecular, and polymolecular) according to the individual atopic propensity and allergen exposure, thus producing an extreme heterogeneity of IgE sensitization profiles in patient populations. In patients with allergic rhinitis, the broader the IgE molecular sensitization profile, the greater is the risk of asthma and other allergic comorbidities, such as oral allergy syndrome. Hence it has been proposed to anticipate immunologic intervention at disease onset (early allergen immunotherapy) or even earlier during the preclinical sensitization stage (allergen immunoprophylaxis). Diagnostic algorithms based on singleplex or multiplex molecular IgE tests allow the discrimination of genuine from cross-reacting sensitization and the selection of the right extracts for allergen immunotherapy composition. Patients with extreme molecular poly-sensitization and greater risk of asthma or other IgE-mediated comorbidities, can be easily identified by means of allergen microarray or macroarray procedures and might benefit from anti-IgE treatment. IgE molecular tests have opened the era of precision allergology, and their routine use should aim at cost-effectiveness, according to the principles of the Choosing Wisely initiative.
All Author:
Paolo Maria Matricardi Stephanie Dramburg Ekaterina Potapova Chrysanthi Skevaki, Harald Renz
2018-12-24 Review
创建过敏性疾病的科研、科普知识交流平台,为过敏患者提供专业诊断、治疗、预防的共享平台。