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  • 1. Filippo Fassio
    Dept. of Biomedicine – ImmunoallergologyUnit (Director Prof. E Maggi)
    UniversityofFlorence
  • 2. AllergyTests: history…
  • 3. AllergyTests: a very long road…
    1880: ProvocationTesting
    1967: CharacterizationofIgE
    ’70s: RAST
  • 4. …somesortofevolution…
    Allergy!
    (allergytesting)
    No allergies
    (no allergytesting)
  • 5. …somesortofevolution…
    ?
  • 6. first crossroad: in vitro vs in vivo…
  • 7. Prick test…
    High sensibility and specificity
    Immediate response
    Low cost (?)
    Influencedbytherapies and skinconditions
    Needofallergist or experiencedphysician
    Contra-indications
    Time-consuming
  • 8. In vitro IgEtests…
    High sensibility and specificity
    Notinfluencedbytherapies and skinconditions
    No contra-indicationsofin vivo tests
    Needof a lab and equipment
    Expensive
    Not immediate response
  • 9. AllergyTests: a very long road…
    1880: ProvocationTesting
    1967: CharacterizationofIgE
    ’70s: RAST
    1995: RecombinantAllergens
    2001: AllergenMicroarray
  • 10. …not just a single crossroad…
  • 11. …fromextractstomolecules…
  • 12. …fromextractstomolecules…
  • 13. …fromextractstomolecules…
    =
  • 14. …a bit ofcomplexity!
  • 15. …a bit ofcomplexity!
  • 16. …canwe do better?
    Let’s put allthese “lights” in anordinatedarray…
    Allergenmicroarray: 103“lights” and growing…
  • 17. …allergymicroarray
  • 18. …dowereallyneed CRD?
    vs
  • 19. Case 1: pollens…
    47-yo man whitrhinitis…
    Grass +++
    Birch ++
    Olive tree ++
    …ishe a candidate for vaccine therapy?
  • 20. Case 1: pollens…
    …cross-reaction or co-sensitization?
  • 21. Case 1: pollens…
    Co-sensitization!
    (Grass, Birch, Olive tree))
  • 22. Case 1: pollens…
    Cross-reaction!
    (Just grass + Phl p 12: Profilin)
  • 23. Case 2: latex…
  • 24. Case 2: latex…
  • 25. Case 2: latex…
  • 26. Case 3: foods…
    A youngpatientwithhazelnutallergy…
    …shetoleratesotherkindofnutsevenifdiscouragedtoeatthem…
  • 27. Case 3: foods…
    Thisisherprick test forfoodallergens:
    • Hazelnut+++
    • 28. Walnut(+/-)
  • Case 3: foods…
    Total IgE (RIST): 37 kU/l
    SpecificIgEforrespiratoryallergens: < 0.10 kUI/l
    SpecificIgEforfoodallergens:
    • Hazelnut 3,07 kUI/l
    • 29. Walnut 0,12 kUI/l
  • Case 3: foods…
    Cor a 1: Bet v 1-homologue (PR-10)
    Cor a 2: profilin (homologuetoBet v 2)
    Cor a 8: LTP
    Cor a 9: 11S globulin (homologueto Ara h 3)
  • 30. Case 3: foods…
    Hazelnutallergy in Europe:
    • Cor a 1: 75% (100% northeurope, 17% southeurope)
    • 31. Cor a 2: 42% (profilin)
    • 32. Cor a 8: 28% (5-15% northeurope, 71% southeurope)
    Cor a 1 + Cor a 8 = 96%
  • 33. Case 3: foods…
    None!
    What’s the patientallergicto?
    Cor a 2
    Cor a 1
    Cor a 8
    Cor a 9
  • 34. Case 3: foods…
    …because103molecularallergens are a lot…
    …but nature hasmanymore…
    =
    westillneed “traditional” testingwithallergenextractstoo…
  • 35. …CRD: a newperspective…
  • 36. …doweknowhowto drive the newcar?
  • 37. …whatkindofresearchisneeded?
  • 38. …what’s the roleforyoungallergists?
    Molecularallergology and CRD are highlyactive “Works in Progress” fields
    No needtochangeperspective:
    learn CRD at the sametimeof “traditionaldiagnostics” toget the most out ofthem
  • 39. AllergyTests: a very long road…
    1880: ProvocationTesting
    …ahead!
    1967: CharacterizationofIgE
    ’70s: RAST
    1995: RecombinantAllergens
    2001: AllergenMicroarray
  • 40. Lombardia:
    Marco Caminati
    Piemonte – Val d’Aosta:
    Stefano Pizzimenti
    Emilia Romagna:
    Silvia Peveri
    Liguria:
    Valentina Garelli
    Lazio - Abruzzo:
    Maria Costanza Turi
    Campania:
    Francesca Rossi
    Sardegna:
    Gianni Pala
    Puglia:
    Laura Losappio
    Sicilia:
    SeleneImbesi
    Calabria:
    Mariella Patafi
    Webmaster:
    Felice Rivellese
    Silvia Peveri, 2010
  • 41. Thankyou!
    fil.fassio@tin.it