Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transl Med. Aug 12, 2015; 4(2): 44-50
Published online Aug 12, 2015. doi: 10.5528/wjtm.v4.i2.44
Component-resolved allergen testing: The new frontier
Matthew T Tallar, Mitchell H Grayson
Matthew T Tallar, Mitchell H Grayson, Section of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, United States
Author contributions: Tallar MT and Grayson MH contributed to this paper.
Supported by The Children’s Research Institute of the Children’s Hospital of Wisconsin; and the Department of Pediatrics, Medical College of Wisconsin.
Conflict-of-interest statement: Matthew T Tallar has no conflicts of interest to report; Mitchell H Grayson has received research grants from Polyphor, Merck, Children’s Research Institute of the Children’s Hospital of Wisconsin, the Department of Pediatrics of the Medical College of Wisconsin, and the National Institutes of Health.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mitchell H Grayson, MD, Associate Professor, Section of Allergy and Clinical Immunology, Department of Pediatrics, Medical College of Wisconsin, MFRC Room 5068, 8701 Watertown Plank Road, Milwaukee, WI 53226, United States. wheeze@allergist.com
Telephone: +1-414-2666840 Fax: +1-414-2666437
Received: January 28, 2015
Peer-review started: January 28, 2015
First decision: February 7, 2015
Revised: March 3, 2015
Accepted: April 10, 2015
Article in press: April 14, 2015
Published online: August 12, 2015
Processing time: 198 Days and 13 Hours
Abstract

The discovery that allergen specific IgE (sIgE) identified individuals who were allergic to specific allergens, revolutionized allergy and immunology. Recently, component-resolved allergen testing (CRD) has shown promise in improving the field yet again. Prior to development of CRD immunoassays, whole allergen extracts were used to detect IgE mediated allergic disease either by oral, cutaneous, or conjunctival provocation. The most widely used immunoassays detect sIgE to either whole allergen sources or individual allergic components. The use of CRD micro-assay technology (not Food and Drug Administration approved in the United States) has been used to evaluate multiple allergens in parallel. This technique allows for determination of primary vs secondary sensitizations from either close sequence homology or cross-reactive carbohydrate determinants. Published studies have shown beneficial uses in hymenoptera venom immunotherapy, anaphylaxis, and food allergy. The use of component testing for aeroallergen immunotherapy has been studied, however clinical use is hampered by lack of allergen components approved for injection. Therefore, although promising in many respects, the frontier of CRD testing requires more data before it can be widely used in clinical practice.

Keywords: Component resolved diagnosis; Molecular allergy; IgE; Polysensitization; Immunotherapy; Venom allergy; Food allergy

Core tip: Component-resolved allergen diagnostic testing is testing for specific allergenic proteins in a given allergen. This testing modality may revolutionize diagnostics and treatment of immediate hypersensitivity reactions. Several promising studies and allergen components have been described for patients with food allergy, venom allergy, and idiopathic anaphylaxis. Some appear to have clinical utility, such as ω-5 gliadin in evaluating wheat dependent, exercise induced anaphylaxis. Components for many of the relevant aeroallergens have been characterized; however, readily available allergen components for injection are lacking, and further research is needed before these practices can be recommended for widespread clinical use.