原標題：過敏原免疫治療的分子診斷
　　在出生隊列中有系統(tǒng)地應用變應原分子的研究表明，特應性致敏是IgE對來自同一變應原來源(即分子傳播)的不同非交叉反應分子（從引發(fā)分子開始）的連續(xù)反應。根據(jù)個體的特應性傾向和過敏原暴露情況，這種連續(xù)現(xiàn)象的程度不同 (單分子、低分子和多分子)，從而使患者群體中的IgE致敏譜的差異極大。在變應性鼻炎患者中，IgE分子致敏譜越寬，哮喘等變應性合并病的風險越大，如口腔變態(tài)反應綜合征。因此，在疾病開始時(早期過敏原免疫治療)，甚至在臨床前致敏階段(過敏原免疫預防)，就建議進行免疫干預?；趩沃鼗蚨嘀胤肿覫gE檢測的診斷方法，可以從交叉反應致敏中鑒別真?zhèn)?，并為過敏原免疫治療選擇合適的提取物。極多分子致敏和有更大哮喘或其他ige介導的合并病風險的患者，可以通過過敏原微陣列或宏陣列程序很容易地識別，并可能受益于抗ige治療。IgE分子檢測開啟了精確過敏學的新紀元，根據(jù)優(yōu)選的原則，常規(guī)使用應以成本效益為目標。
延伸閱讀
JACI                                                    
Molecular diagnosis for allergen immunotherapy
DOI: https://doi.org/10.1016/j.jaci.2018.12.1021
Abstract:
The extensive use of allergen molecules in birth cohort studies revealed that atopic sensitization is a sequential IgE response to distinct non–cross-reacting molecules from the same allergenic source (ie, molecular spreading), starting with an initiator molecule. This phenomenon reaches different degrees of progression (monomolecular, oligomolecular, and polymolecular) according to the individual atopic propensity and allergen exposure, thus producing an extreme heterogeneity of IgE sensitization profiles in patient populations. In patients with allergic rhinitis, the broader the IgE molecular sensitization profile, the greater is the risk of asthma and other allergic comorbidities, such as oral allergy syndrome. Hence it has been proposed to anticipate immunologic intervention at disease onset (early allergen immunotherapy) or even earlier during the preclinical sensitization stage (allergen immunoprophylaxis). Diagnostic algorithms based on singleplex or multiplex molecular IgE tests allow the discrimination of genuine from cross-reacting sensitization and the selection of the right extracts for allergen immunotherapy composition. Patients with extreme molecular poly-sensitization and greater risk of asthma or other IgE-mediated comorbidities, can be easily identified by means of allergen microarray or macroarray procedures and might benefit from anti-IgE treatment. IgE molecular tests have opened the era of precision allergology, and their routine use should aim at cost-effectiveness,  according to the principles of the Choosing Wisely initiative.
All Authors:
Paolo Maria Matricardi, MDa,?,'Correspondence information about the author MD Paolo Maria MatricardEmail the author MD Paolo Maria Matricardi, Stephanie Dramburg, MDa, Ekaterina Potapov, MSa, Chrysanthi Skevaki, MD, PhDb, Harald Renz, MDb
　　創(chuàng)建過敏性疾病的科研、科普知識交流平臺，為過敏患者提供專業(yè)診斷、治療、預防的共享平臺。