![]() ![]() This cashew allergen (Ana o 3) can be used as a specific marker of pistachio allergy as well, since immunologically, cashew and pistachio appear nearly identical. showed that IgE-mono-sensitization to Ana o 3 is associated with a high risk of severe anaphylaxis. In Greek children, the sensitivity and specificity were 98 and 94%, respectively, using a cutoff of 0.16 kUA/L. Walnut and PecanĪna o 3 is the stable storage protein, 2S albumin of cashew, and is highly predictive of cashew allergy in children at a low IgE-ab cutoff. A systematic review shows that IgE-ab to Cor a 14 has the best precision in diagnosing systemic allergic reactions in response to oral hazelnut challenge, open or blinded, in children with a sensitivity of 78% (95% CI 71–83) and a specificity of 82% (95% CI 77–86) using a cutoff of 0.35 kU/L. However, there have been discrepancies concerning the diagnostic capacity of these molecules across all ages Cor a 9 and Cor a 14 seem to be good predictors of hazelnut allergy in children but are not as convincing in adults. Analysis of the hazelnut allergen molecules, Cor a 9 (11S globulin) and Cor a 14 (2S albumin), has enhanced the diagnostic precision of hazelnut allergy, and most importantly, has revealed that many individuals who thought they had severe allergy toward hazelnuts are in fact healthy. In birch endemic areas, up to 84% of those sensitized to birch are also sensitized to hazelnut, and therefore, analyzing IgE-ab to hazelnut extract, which has a low diagnostic specificity for systemic allergic reaction to hazelnut, can lead to overdiagnosis. Ī similar pattern is observed for hazelnut many patients sensitized to hazelnut do not develop any or only very mild oral symptoms upon exposure to hazelnut, whereas other patients can develop systemic and sometimes life-threatening reactions. The term molecular allergology describes the science that enables quantification of IgE-ab and IgG-ab against individual allergen proteins. The molecular quantification of IgE-ab against individual allergen proteins for diagnostic purposes was termed component-resolved diagnosis (CRD) in 1999. Understanding whether IgE sensitization is a primary (species-specific) event or the result of cross-reactivity to proteins with similar protein structures has been of importance in this work. If a patient has IgE-ab but no symptoms, the patient is classified as being sensitized. The diagnosis of allergy includes having IgE antibodies (IgE-ab) against a specific allergen, in combination with typical allergic symptoms toward the same allergen. More than half a century has passed and efforts are still ongoing to characterize, standardize, and refine allergens for improved clinical diagnosis and allergen-specific immunotherapy. ![]() In 1967, the fifth class of immunoglobulin, immunoglobulin E (IgE), was discovered, which has had immense importance for the understanding, diagnosis, and treatment of allergic disease. The aim of this review is to highlight the importance of clinical observations among allergic patients, focusing on systemic, or unusual and unexpected allergic reactions, where component-testing has further refined the diagnosis of IgE-mediated allergy. ![]() We now have an improved understanding of why patients may react in a serious or unexpected way, as illustrated by these examples, yet many other clinical observations remain unexplained. The examples taken concern allergic reactions toward peanuts, tree nuts, lemon kernels, health drinks, meat, insects, dog dander, cannabis, and semen. In the current article, we focus on recent clinical observations that can now be explained by CRD. Allergists continuously encounter new allergies and are often asked by their patients how to prevent new reactions. Observant physicians and health-care personnel have reported their findings in the medical literature, which in turn has inspired researchers to become involved in clinical research. The progress and developments made in allergy diagnosis often originate from clinical observations and case studies. Another important breakthrough was made in 1999 with the introduction of component-resolved diagnostics (CRD), making it possible to quantify IgE antibodies against individual allergen proteins for diagnostic purposes at a molecular level. More than 50 years have passed and efforts to characterize, standardize, and refine allergens with the aim to improve clinical diagnosis and allergen-specific immunotherapy are still ongoing. The fifth class of immunoglobulin, immunoglobulin E (IgE) was discovered in 1967 and has had immense importance for the understanding, diagnosis, and treatment of allergic disease. ![]()
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