Filippo Fassio
Dept. of Biomedicine – Immunoallergology Unit (Director Prof. E Maggi)
University of Florence
Allergy Tests: history…
Allergy Tests: a very long road…
1880: ProvocationTesting
1967: Characterization of IgE
’70s: RAST
…some sort of evolution…
No allergies
(no allergy testing)
Allergy!
(allergy testing)
…some sort of evolution…
first crossroad: in vitro vs in
vivo…
Prick test…
• High sensibility and specificity
• Immediate response
• Low cost (?)
• Influenced by therapies and skin cond...
In vitro IgE tests…
• High sensibility and specificity
• Not influenced by therapies and
skin conditions
• No contra-indic...
Allergy Tests: a very long road…
1880: ProvocationTesting
1967: Characterization of IgE
’70s: RAST
1995: Recombinant Aller...
…not just a single crossroad…
…from extracts to molecules…
…from extracts to molecules…
…from extracts to molecules…
…a bit of complexity!
…a bit of complexity!
…can we do better?
Let’s put all these “lights” in an ordinated array…
Allergen microarray: 103 “lights” and growing…
…allergy microarray
…do we really need CRD?
…is he a candidate for vaccine therapy?
47-yo man whit rhinitis…
Grass +++
Birch ++
Olive tree ++
Case 1: pollens…
…cross-reaction or co-sensitization?
Case 1: pollens…
Co-sensitization!
(Grass, Birch, Olive tree))
Case 1: pollens…
Cross-reaction!
(Just grass + Phl p 12: Profilin)
Case 1: pollens…
Case 2: latex…
Case 2: latex…
Case 2: latex…
Case 3: foods…
A young patient with hazelnut allergy…
…she tolerates other kind of nuts even if
discouraged to eat them…
This is her prick test for food allergens:
• Hazelnut +++
• Walnut(+/-)
Case 3: foods…
Case 3: foods…
Total IgE (RIST): 37 kU/l
Specific IgE for respiratory allergens: < 0.10 kUI/l
Specific IgE for food allerg...
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 globu...
Case 3: foods…
Hazelnut allergy in Europe:
- Cor a 1: 75% (100% north europe, 17% south europe)
- Cor a 2: 42% (profilin)
...
Case 3: foods…
What’s the patient allergic to?
Cor a 1
Cor a 8
Cor a 2
Cor a 9
None!
Case 3: foods…
…because 103 molecular allergens are a lot…
…but nature has many more…
=
we still need “traditional” testin...
…CRD: a new perspective…
…do we know how to drive the new
car?
…what kind of research is
needed?
…what’s the role for young
allergists?
Molecular allergology and CRD are highly
active “Works in Progress” fields
No need ...
1880: ProvocationTesting
1967: Characterization of IgE
’70s: RAST
1995: Recombinant Allergens
2001: Allergen Microarray
Al...
Piemonte – Val d’Aosta:
Stefano Pizzimenti
Campania:
Francesca Rossi
Puglia:
Laura Losappio
Lazio - Abruzzo:
Maria Costanz...
Thank you!
fil.fassio@tin.it
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Allergologia Molecolare!

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Allergologia Molecolare!

  1. 1. Filippo Fassio Dept. of Biomedicine – Immunoallergology Unit (Director Prof. E Maggi) University of Florence
  2. 2. Allergy Tests: history…
  3. 3. Allergy Tests: a very long road… 1880: ProvocationTesting 1967: Characterization of IgE ’70s: RAST
  4. 4. …some sort of evolution… No allergies (no allergy testing) Allergy! (allergy testing)
  5. 5. …some sort of evolution…
  6. 6. first crossroad: in vitro vs in vivo…
  7. 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. 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. 9. Allergy Tests: a very long road… 1880: ProvocationTesting 1967: Characterization of IgE ’70s: RAST 1995: Recombinant Allergens 2001: Allergen Microarray
  10. 10. …not just a single crossroad…
  11. 11. …from extracts to molecules…
  12. 12. …from extracts to molecules…
  13. 13. …from extracts to molecules…
  14. 14. …a bit of complexity!
  15. 15. …a bit of complexity!
  16. 16. …can we do better? Let’s put all these “lights” in an ordinated array… Allergen microarray: 103 “lights” and growing…
  17. 17. …allergy microarray
  18. 18. …do we really need CRD?
  19. 19. …is he a candidate for vaccine therapy? 47-yo man whit rhinitis… Grass +++ Birch ++ Olive tree ++ Case 1: pollens…
  20. 20. …cross-reaction or co-sensitization? Case 1: pollens…
  21. 21. Co-sensitization! (Grass, Birch, Olive tree)) Case 1: pollens…
  22. 22. Cross-reaction! (Just grass + Phl p 12: Profilin) Case 1: pollens…
  23. 23. Case 2: latex…
  24. 24. Case 2: latex…
  25. 25. Case 2: latex…
  26. 26. Case 3: foods… A young patient with hazelnut allergy… …she tolerates other kind of nuts even if discouraged to eat them…
  27. 27. This is her prick test for food allergens: • Hazelnut +++ • Walnut(+/-) Case 3: foods…
  28. 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. 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. 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. 31. Case 3: foods… What’s the patient allergic to? Cor a 1 Cor a 8 Cor a 2 Cor a 9 None!
  32. 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. 33. …CRD: a new perspective…
  34. 34. …do we know how to drive the new car?
  35. 35. …what kind of research is needed?
  36. 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. 37. 1880: ProvocationTesting 1967: Characterization of IgE ’70s: RAST 1995: Recombinant Allergens 2001: Allergen Microarray Allergy Tests: a very long road… …ahead!
  38. 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. 39. Thank you! fil.fassio@tin.it

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