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Filippo FassioDept. of Biomedicine – Immunoallergology Unit (Director Prof. E Maggi)
University of Florence
Allergy Tests: history…
Allergy Tests: a very long road…
1880: ProvocationTesting
1967: Characterization of IgE
’70s: RAST
…some sort of evolution…
No allergies(no allergy testing)
Allergy!(allergy testing)
Prick test…
• High sensibility and specificity• Immediate response• Low cost (?)
• Influenced by therapies and skin conditions• Need of allergist or experienced physician• Contra-indications• Time-consuming
In vitro IgE tests…
• High sensibility and specificity• Not influenced by therapies and
skin conditions• No contra-indications of in vivo tests
• Need of a lab and equipment• Expensive• Not immediate response
Allergy Tests: a very long road…
1880: ProvocationTesting
1967: Characterization of IgE
’70s: RAST
1995: Recombinant Allergens
2001: Allergen Microarray
…not just a single crossroad…
…from extracts to molecules…
…from extracts to molecules…
…from extracts to molecules…
=
…a bit of complexity!
…a bit of complexity!
…can we do better?Let’s put all these “lights” in an ordinated array…
Allergen microarray: 103 “lights” and growing…
…allergy microarray
…is he a candidate for vaccine therapy?
47-yo man whit rhinitis…
Grass +++Birch ++Olive tree ++
Case 1: pollens…
…cross-reaction or co-sensitization?
Case 1: pollens…
Co-sensitization!(Grass, Birch, Olive tree))
Case 1: pollens…
Cross-reaction!(Just grass + Phl p 12: Profilin)
Case 1: pollens…
Case 2: latex…
Case 2: latex…
Case 2: latex…
Case 3: foods…
A young patient with hazelnut allergy…
…she tolerates other kind of nuts even if discouraged to eat them…
This is her prick test for food allergens:
• Hazelnut +++• Walnut(+/-)
Case 3: foods…
Case 3: foods…
Total IgE (RIST): 37 kU/l
Specific IgE for respiratory allergens: < 0.10 kUI/l
Specific IgE for food allergens:
• Hazelnut 3,07 kUI/l• Walnut 0,12 kUI/l
Case 3: foods…
Cor a 1: Bet v 1-homologue (PR-10)
Cor a 2: profilin (homologue to Bet v 2)
Cor a 8: LTP
Cor a 9: 11S globulin (homologue to Ara h 3)
Case 3: foods…Hazelnut allergy in Europe:- Cor a 1: 75% (100% north europe, 17% south europe)- Cor a 2: 42% (profilin)- Cor a 8: 28% (5-15% north europe, 71% south europe)
Cor a 1 + Cor a 8 = 96%
Case 3: foods…
What’s the patient allergic to?
Cor a 1
Cor a 8
Cor a 2
Cor a 9
None!
Case 3: foods…
…because 103 molecular allergens are a lot…
…but nature has many more…
=we still need “traditional” testing with allergen
extracts too…
…what kind of research is needed?
…what’s the role for young allergists?
Molecular allergology and CRD are highly active “Works in Progress” fields
No need to change perspective: learn CRD at the same time of “traditional
diagnostics” to get the most out of them
1880: ProvocationTesting
1967: Characterization of IgE
’70s: RAST
1995: Recombinant Allergens
2001: Allergen Microarray
Allergy Tests: a very long road…
…ahead!
Piemonte – Val d’Aosta:
Stefano Pizzimenti
Campania: Francesca
Rossi
Puglia:Laura Losappio
Lazio - Abruzzo: Maria Costanza
Turi
Sicilia:Selene ImbesiCalabria:
Mariella Patafi
Sardegna: Gianni Pala
Emilia Romagna: Silvia Peveri
Liguria: Valentina
Garelli
Lombardia: Marco
Caminati
Silvia Peveri, 2010
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