Setting the standard in allergy diagnostics 2019 edition with the latest news in molecular allergology Go molecular! A clinical reference guide to molecular allergy Part 2: The allergen components Second edition | By Neal Bradshaw For more information on this topic allergyai.com Go molecular! Preface In the previous 2013 edition of Go the content in this new version of Go Molecular, I produced a straight forward Molecular has been aimed to provide clinical reference guide book to describe improved diagnostic explanations in common allergens and their constituent the form of tables, with concise clinical components. This guide is an update interpretation comments. Also new is a to the original but keeps the focus on section on aero-allergen components, understanding component test results, an introduction to micro-array, as well as well as what tests are actually as new information on diagnostic gaps commercial available (since this is an regarding certain food components. important practical aspect of molecular allergy!). If you need further supporting information relating to molecular allergy then I can Since 2013 the science of molecular recommend visiting our webpage: allergy has exploded with many new allergyai.com. studies both using single and multiplex allergen testing formats. There is a lot Neal Bradshaw of new clinical evidence to consider, Portfolio Manager - Allergy emerging allergens like alpha-gal and the Thermo Fisher Scientific availability of new ImmunoCAPTM Allergen Components. Beyond the new science, Disclaimer: The content of this book is intended as an aid to the physician to interpret allergen specific IgE antibody test results. It is not intended as medical advice on an individual level. A definitive clinical diagnosis of IgE mediated allergic disorders should only be made by the physician based on the clinical history for the individual patient after all clinical and laboratory findings have been evaluated. It should not be based on the results of any single diagnostic method. Further information about molecular allergy and our testing portfolio can be found at: allergyai.com. 75552.AL.GB1.EN.v1.19 2 The allergen components Contents Foreword 4 Pollen – Trees 50 Birch 50-51, Other trees 51, Olive/European Ash Introduction 5 51, London plane tree 52, Cypress 52 What’s in this guidebook? 8 Pollen – Weeds 54 Common Ragweed, Wall Peillitory, Allergen Components from English plantain, Mugwort, Saltwort 54-56 plant sources 10 Molds 56 Food allergens components in Alternaria alternata 56-57, some common foods 12 Aspergillus fumigatus 58-59 Food allergens from plant sources 14 Venoms 60 Peanut 14-15, Soybean 16-17, Hazelnut 18-19, Honey bee, Common Wasp/Yellow Jacket, Walnut 20-21, Cashew 22-23, Brazil nut 24-25, Paper Wasp 60-62 Fruits and Rosaceae family 26-27, Wheat 28-29 Occupational allergens 62 Latex 62-63 Food allergens from animal sources 30 Hen’s egg 30-31, Cow’s milk 32-33, Red meat - Introduction to Allergen Micro Array 64 Galactose-alpha-1, 3-Galactose (alpha-gal) 34-35 ImmunoCAP ISAC Shellfish and crustaceans 36 Facts on ImmunoCAP ISAC 65 Shrimp 36-37 Advantages of ImmunoCAP ISAC Fish allergens 38 Recommended further educational 68 Cod, Carp 38-39 resources Inhalant allergen components 39 ImmunoCAP Allergen Components 70 list Furry Animals 40 Cat 41-42, Dog 42-43, Horse 44-45 ImmunoCAP ISACE112i Chip 74 House dust mites 46 ImmunoCAP Allergen Components - 77 Complete product names Pollen – Grasses 48 Bermuda grass, Timothy grass 48-49 3 Go molecular! Foreword With the advent of allergen components, area with, for example, the whole peanut allergy has got much more complicated. allergen suddenly been replaced by more However whole allergen diagnostics, than 10 individual components with with skin prick testing or serum specific different clinical impacts. The second IgE, commonly don’t allow us to edition of this book is very welcome unravel the complexity that some of our with its updated information about each allergy patients exhibit. Using allergen of the various allergen components. components to understand the molecular Importantly, their clinical implications are allergology of these complex patients explained allowing us to use information has a real potential to improve our clinical about allergic sensitisation to each decision-making. The use of component individual component to improve the resolved diagnostics may optimise our management of our patients. investigation plans and improve our diagnoses, management plans and the Professor Graham Roberts advice we give to our allergy patients. Professor of Paediatric Allergy and All this though relies on clinicians Respiratory Medicine acquiring an understanding of molecular University of Southampton diagnostics. This is a rapidly evolving 4 The allergen components Introduction Since the last version of this book rather they are an enhancement over testing with allergen components has conventional extract tests, giving more become a more standard diagnostic tool, factual information. The results have to providing an essential part of an allergy be interpreted like any other specific IgE diagnosis work-up. Molecular allergology test and cannot be solely relied upon to has refined the way that clinicians tailor determine a diagnosis; results should their approach to patient management always be used in conjunction with by redefining the patient diagnostic an allergy-focused clinical history and journey. Allergen components have made physical examination and the diagnosis is understanding allergy more scientific, then made by the physician. moving towards precision medicine. This helps improve the understanding of a Testing with allergen components patient’s true clinical reactivity, as well as helps in: making decisions to improve their quality of life. 1. Understanding patient risk – adding confidence to your assessment1-5 Tests incorporating allergen components 2. Aiding in the selection of the proper are defined entities, in that you know treatment extract of Allergen Specific exactly what allergen protein you have in Immunotherapy (AIT) – useful for the test. Sometimes allergen component example in venom and aero-allergy protein is present in a higher amount patient selection1-5 in an allergen component test when 3. Understanding cross-reactions compared to a corresponding extract between species – helping to based test. This can make allergen understand multiple sensitizations e.g. component tests analytically even more in pollen food syndrome1-5 sensitive and specific at measuring important IgEs of interest. Many ImmunoCAP Allergen Components are available in our product range and By using tests with allergen components familiarity with them is essential to you add another tool to the diagnostic understand their clinical implications. To armoury, which may make it possible to help you implement testing with allergen understand more about the underlying components more supporting information allergies. Tests with allergen components on molecular allergy is available at: are not diagnostic magic bullets; allergyai.com. 5 Go molecular! Tests with allergen components Absence of detectable allergen specific themselves are not technically different IgE antibodies does not necessarily to other specific IgE tests that are exclude the potential for an allergy-like routinely ordered from your lab such reaction1-2. For example in food allergy, as milk, egg, cat or peanut allergens. circulating IgE antibodies may remain Extracts like these are made up of lots of undetectable despite a convincing clinical different allergen components. Tests with history. The antibodies may be directed allergen components differ as each test towards allergens that are revealed or involves measuring specific IgE to pure altered during industrial processing, single recombinant or native allergen cooking or digestion and therefore do proteins from a source. For example not exist in the original food for which the Pru p 3 is an nsLTP (non-specific lipid patient is tested1-2. transfer protein) from peach. Antibodies produced by patients in response Limitations of ImmunoCAP products test to specific allergen proteins can be results: measured using ImmunoCAP single (ImmunoCAP Allergen Component) or Samples with results below limit of multiplex (ImmunoCAP ISAC) component quantitation obtained with ImmunoCAP tests. Both platforms therefore can be Allergen Components are recommended used to give an overview of the patients to be tested with the corresponding immunological response in their current extract based ImmunoCAP Allergen allergy status. and/or additional relevant ImmunoCAP Allergen Components, if not already Presence of allergen specific IgE performed and a clinical indication is implies a risk of allergic disease and its present. The extract based testing can significance must be evaluated within cover additional allergen components the clinical context. Generally the higher present in the allergen source material the level of IgE antibodies the higher the to which the patient may be sensitized, probability of a clinically manifest allergic but which are not presently available as reaction1-5. ImmunoCAP Allergen Components or on ImmunoCAP ISAC. However for different patients identical results for the same allergens may not be associated with clinically equivalent manifestations, due to differences in individual patient sensitivities. This may also be true for one individual patient at different occasions due to presence or absence of reaction promoting cofactors1-5.