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Clinical anamnesis, in vivo provocation testing, and in vitro determination of allergen-specific IgE comprise the traditional three pillars of diagnosis of IgE-associated allergy. Specific IgE levels to the clinically relevant grass pollen allergens Phl p 1, Phl p 2, Phl p 5, and Phl p 6 were significantly higher in the group with moderate rhinitis compared to children having mild rhinitis (Figure A). B, The sum of major grass pollen allergen-specific IgE levels (sIgE [ISU] Phl p 1 + 2+5 + 6; y-axis) and C, the number of grass pollen allergens recognized by IgE (y-axis) of children with mild vs moderate rhinitis (x-axis) are displayed. [Extracted from the article]

Background: Skin testing represents a commonly used first diagnostic method in clinical practice, but allergen extracts may vary in composition and often contain cross‐reactive allergens and therefore do not always allow the precise identification of the sensitizing allergen source. Our aim was to investigate the suitability of a single recombinant hybrid molecule, consisting of the four major timothy grass pollen allergens (Phl p 1, Phl p 2, Phl p 5, and Phl p 6) for in vivo diagnosis of genuine grass pollen allergy in children suffering from pollinosis. Methods: Sixty‐four children aged from 6 to 17 years with a positive skin reaction and/or specific IgE to grass pollen extract and respiratory symptoms of pollinosis as well as 9 control children with allergy to other allergen sources were studied. SPT was performed with the recombinant hybrid, the four recombinant timothy grass pollen allergens, and grass pollen extract. Specific IgE reactivity to 176 micro‐arrayed allergen molecules was determined using ImmunoCAP ISAC technology. IgE reactivity to the hybrid was detected by non‐denaturing RAST‐based dot blot assay. Results: Genuine grass pollen sensitization was confirmed in 94% of the children with positive SPT to grass pollen extract by SPT and IgE reactivity to the hybrid. The four hybrid‐negative children showed IgE reactivity to cross‐reactive allergens such as Phl p 4, Phl p 11, and Phl p 12 and had also sensitizations to pollen allergens from unrelated plants. Conclusions: The recombinant hybrid molecule represents a useful tool for in vivo diagnosis of genuine grass pollen sensitization. [ABSTRACT FROM AUTHOR]

Correct identification of the culprit allergen is an essential part of diagnosis and treatment in immunoglobulin E (IgE)-mediated allergic diseases. In recent years, molecular biology has made important advances facilitating such identification and overcoming some of the drawbacks of natural allergen extracts, which consist of mixtures of various proteins that may be allergenic or not, specific for the allergen source or widely distributed (panallergens). New technologies offer the opportunity for a more accurate component-resolved diagnosis, of benefit especially to polysensitized allergic patients. The basic elements of molecular diagnostics with potential relevance to immunotherapy prescription are reviewed here, with a focus on Southern European sensitization patterns to pollen allergens. We propose a basic algorithm regarding component-resolved diagnostic work-up for pollen allergen-specific immunotherapy candidates in Southern Europe; this and similar algorithms can form the basis of improved patient management, conceptually a 'Component-Resolved Allergy Management'. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]