Allergologia Molecolare!

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)

…some sort of evolution…

?

first crossroad: in vitro vs in vivo…

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

…do we really need CRD?

vs

…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…

…CRD: a new perspective…

…do we know how to drive the new car?

…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

Webmaster:Felice Rivellese

Thank you!

fil.fassio@tin.it