原標(biāo)題：過(guò)敏原免疫治療的分子診斷
　　過(guò)敏原分子在出生隊(duì)列研究中的廣泛應(yīng)用顯示，特應(yīng)性致敏是從觸發(fā)分子開(kāi)始，對(duì)來(lái)自同一過(guò)敏原源的不同非交叉反應(yīng)分子的連續(xù)性IgE應(yīng)答。根據(jù)個(gè)體的特應(yīng)性?xún)A向和過(guò)敏原暴露情況，這一現(xiàn)象的演化程度不同(單分子、低分子和多分子)，從而在患者人群中產(chǎn)生了IgE致敏譜的極度異質(zhì)性。在過(guò)敏性鼻炎患者中，IgE分子致敏譜越寬，哮喘和其他過(guò)敏性并發(fā)癥(如口腔變態(tài)反應(yīng)綜合征)的風(fēng)險(xiǎn)越大。因此，在疾病開(kāi)始時(shí)(早期過(guò)敏原免疫治療)，甚至在臨床前致敏階段(過(guò)敏原免疫預(yù)防)，進(jìn)行免疫干預(yù)是可能的。基于單重或多重分子IgE檢測(cè)的診斷方法，可區(qū)分真正致敏和交叉致敏，并可選擇合適的過(guò)敏原免疫治療提取物?？梢酝ㄟ^(guò)過(guò)敏原微陣列或宏陣列方法輕易識(shí)別極度的多重分子致敏患者和具有較大的患哮喘或其它IgE介導(dǎo)的并發(fā)癥風(fēng)險(xiǎn)的患者，并可受益于抗IgE治療。IgE分子檢測(cè)開(kāi)啟了精確變態(tài)反應(yīng)學(xué)的時(shí)代，根據(jù)明智選擇的原則，常規(guī)使用應(yīng)以成本效益為目標(biāo)。
延伸閱讀
JACI：                                        
Molecular diagnosis for allergen immunotherapy
 https://doi.org/10.1016/j.jaci.2018.12.1021
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 Author:
Paolo Maria Matricardi Stephanie Dramburg Ekaterina Potapova Chrysanthi Skevaki, Harald Renz
　　創(chuàng)建過(guò)敏性疾病的科研、科普知識(shí)交流平臺(tái)，為過(guò)敏患者提供專(zhuān)業(yè)診斷、治療、預(yù)防的共享平臺(tái)。