Editorial

Monitoring Allergic Patients on Omalizumab with Free and Total Serum IgE Measurements

The diagnosis of immediate-type hypersensitivity begins with a thorough clinical history. If objective symptoms of asthma, rhinitis, urticaria, or aeroallergen-, insect-, drug-, or food-induced localized or systemic reactions are detected, sensitization is confirmed by using in vivo tests (intradermal or epicutaneous skin test) and in vitro assays (immunoglobulin E antibody serology, basophil activation, or mediator release). Discordance between the clinical history and confirmatory test results can occur as a result of heterogeneous allergen preparations, assay design and performance variability, differences in data analysis, positive threshold criteria, and interpretation methods. The allergen provocation challenge is considered the gold standard diagnostic test; however, it is rarely used except in food allergy. Molecular allergology advances allow for molecular allergen component and allergenic epitope use and supplementation of complex allergen extracts to enhance diagnostic test sensitivity and specificity. Finally, mast cell tryptase is discussed within the context of patient diagnosis and management.

Asthma is a common disease in paediatrics and adults with a significant morbidity, mortality, and financial burden worldwide. Asthma is now recognized as a heterogeneous disease and emerging clinical and laboratory research has elucidated understanding of asthma’s underlying immunology. The future of asthma is classifying asthma by endotype through connecting discernible characteristics with immunological mechanisms. This comprehensive review of the immunology of asthma details the currently known pathophysiology and clinical practice biomarkers in addition to forefront biologic and targeted therapies for all of the asthma endotypes. By understanding the immunology of asthma, practitioners will be able to diagnose patients by asthma endotype and provide personalized, biomarker-driven treatments to effectively control patients’ asthma.

Since its discovery in 1967, IgE antibody detection in skin and blood has identified a state of allergic sensitization and served as a necessary but not sufficient risk factor that requires objective symptoms to make the definitive diagnosis of human allergic disease. More recently, quantitative IgE antibody levels in serum against allergenic extracts, molecules, and epitopes have pushed its application into more accurately identifying the specificity of the allergic response for targeting immunotherapy, predicting allergic symptom severity after allergen exposure, and attempting to distinguish tolerance from food allergy. This review examines new in vivo and in vitro developments in the design, performance, interference, and application of the methods used to identify allergic sensitization. The increasing accepted applications of molecular allergen and allergen epitope-based IgE antibody measurements, especially as applied to food allergy diagnosis and management, are highlighted as state-of-the-art advances. Despite these major advances in allergic sensitization documentation, their ultimate value requires integration by the clinician with the patient's history and pretest probability of disease.

The diagnosis of immediate-type hypersensitivity begins with a thorough clinical history. If objective symptoms of asthma, rhinitis, urticaria, or aeroallergen-, insect-, drug-, or food-induced localized or systemic reactions are detected, sensitization is confirmed by using in vivo tests (intradermal or epicutaneous skin test) and in vitro assays (immunoglobulin E antibody serology, basophil activation, or mediator release). Discordance between the clinical history and confirmatory test results can occur as a result of heterogeneous allergen preparations, assay design and performance variability, and differences in data analysis, positive threshold criteria, and interpretation methods. The allergen provocation challenge is considered the gold standard diagnostic test, but it is rarely used except in food allergy. Molecular allergology advances allow for component allergen use and supplementation of complex allergen extracts to enhance diagnostic test sensitivity and specificity. Finally, mast cell tryptase is discussed within the context of patient diagnosis and management.

Allergic respiratory diseases are major health problems in paediatric population due their high level of prevalence and chronicity, and to their relevance in the costs and quality of life. One of the most important risk factors for the development of airway diseases in children and adolescents is atopy. The mainstays for the treatment of these diseases are avoiding allergens, controlling symptoms, and preventing them through sustained desensitization by allergen immunotherapy (AIT). AIT is a treatment option that consists in the administration of increasing amounts of allergens to modify the biological response to them, inducing long-term tolerance even after treatment has ended. This treatment approach has shown to decrease symptoms and improve quality of life, becoming cost effective for a large number of patients. In addition, it is considered the only treatment that can influence the natural course of the disease by targeting the cause of the allergic inflammatory response. The aim of this publication is to reflect the advances of AIT in the diagnosis and treatment of allergic respiratory diseases in children and adolescents reviewing articles published since 2000, establishing evidence categories to support the strength of the recommendations based on evidence. The first part of the article covers the prerequisite issues to understand how AIT is effective, such as the correct etiologic and clinical diagnosis of allergic respiratory diseases. Following this, the article outlines the advancements in understanding the mechanisms by which AIT achieve immune tolerance to allergens. Administration routes, treatment regimens, dose and duration, efficacy, safety, and factors associated with adherence are also reviewed. Finally, the article reviews future advances in the research of AIT.