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Allergologia Molecolare!

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  • 1. Filippo Fassio Dept. of Biomedicine – Immunoallergology Unit (Director Prof. E Maggi) University of Florence
  • 2. Allergy Tests: history…
  • 3. Allergy Tests: a very long road… 1880: ProvocationTesting 1967: Characterization of IgE ’70s: RAST
  • 4. …some sort of evolution… No allergies (no allergy testing) Allergy! (allergy testing)
  • 5. …some sort of evolution…
  • 6. first crossroad: in vitro vs in vivo…
  • 7. Prick test… • High sensibility and specificity • Immediate response • Low cost (?) • Influenced by therapies and skin conditions • Need of allergist or experienced physician • Contra-indications • Time-consuming
  • 8. In vitro IgE tests… • High sensibility and specificity • Not influenced by therapies and skin conditions • No contra-indications of in vivo tests • Need of a lab and equipment • Expensive • Not immediate response
  • 9. Allergy Tests: a very long road… 1880: ProvocationTesting 1967: Characterization of IgE ’70s: RAST 1995: Recombinant Allergens 2001: Allergen Microarray
  • 10. …not just a single crossroad…
  • 11. …from extracts to molecules…
  • 12. …from extracts to molecules…
  • 13. …from extracts to molecules…
  • 14. …a bit of complexity!
  • 15. …a bit of complexity!
  • 16. …can we do better? Let’s put all these “lights” in an ordinated array… Allergen microarray: 103 “lights” and growing…
  • 17. …allergy microarray
  • 18. …do we really need CRD?
  • 19. …is he a candidate for vaccine therapy? 47-yo man whit rhinitis… Grass +++ Birch ++ Olive tree ++ Case 1: pollens…
  • 20. …cross-reaction or co-sensitization? Case 1: pollens…
  • 21. Co-sensitization! (Grass, Birch, Olive tree)) Case 1: pollens…
  • 22. Cross-reaction! (Just grass + Phl p 12: Profilin) Case 1: pollens…
  • 23. Case 2: latex…
  • 24. Case 2: latex…
  • 25. Case 2: latex…
  • 26. Case 3: foods… A young patient with hazelnut allergy… …she tolerates other kind of nuts even if discouraged to eat them…
  • 27. This is her prick test for food allergens: • Hazelnut +++ • Walnut(+/-) Case 3: foods…
  • 28. Case 3: foods… Total IgE (RIST): 37 kU/l Specific IgE for respiratory allergens: < 0.10 kUI/l Specific IgE for food allergens: • Hazelnut 3,07 kUI/l • Walnut 0,12 kUI/l
  • 29. Case 3: foods… Cor a 1: Bet v 1-homologue (PR-10) Cor a 2: profilin (homologue to Bet v 2) Cor a 8: LTP Cor a 9: 11S globulin (homologue to Ara h 3)
  • 30. Case 3: foods… Hazelnut allergy in Europe: - Cor a 1: 75% (100% north europe, 17% south europe) - Cor a 2: 42% (profilin) - Cor a 8: 28% (5-15% north europe, 71% south europe) Cor a 1 + Cor a 8 = 96%
  • 31. Case 3: foods… What’s the patient allergic to? Cor a 1 Cor a 8 Cor a 2 Cor a 9 None!
  • 32. Case 3: foods… …because 103 molecular allergens are a lot… …but nature has many more… = we still need “traditional” testing with allergen extracts too…
  • 33. …CRD: a new perspective…
  • 34. …do we know how to drive the new car?
  • 35. …what kind of research is needed?
  • 36. …what’s the role for young allergists? Molecular allergology and CRD are highly active “Works in Progress” fields No need to change perspective: learn CRD at the same time of “traditional diagnostics” to get the most out of them
  • 37. 1880: ProvocationTesting 1967: Characterization of IgE ’70s: RAST 1995: Recombinant Allergens 2001: Allergen Microarray Allergy Tests: a very long road… …ahead!
  • 38. Piemonte – Val d’Aosta: Stefano Pizzimenti Campania: Francesca Rossi Puglia: Laura Losappio Lazio - Abruzzo: Maria Costanza Turi Sicilia: Selene ImbesiCalabria: Mariella Patafi Sardegna: Gianni Pala Emilia Romagna: Silvia Peveri Liguria: Valentina Garelli Lombardia: Marco Caminati
  • 39. Thank you! fil.fassio@tin.it

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