原標(biāo)題：過敏原免疫治療的分子診斷
　　在出生隊(duì)列中有系統(tǒng)地應(yīng)用變應(yīng)原分子的研究表明，特應(yīng)性致敏是IgE對(duì)來自同一變應(yīng)原來源(即分子傳播)的不同非交叉反應(yīng)分子（從引發(fā)分子開始）的連續(xù)反應(yīng)。根據(jù)個(gè)體的特應(yīng)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(yīng)性鼻炎患者中，IgE分子致敏譜越寬，哮喘等變應(yīng)性合并病的風(fēng)險(xiǎn)越大，如口腔變態(tài)反應(yīng)綜合征。因此，在疾病開始時(shí)(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(yù)防)，就建議進(jìn)行免疫干預(yù)?；趩沃鼗蚨嘀胤肿覫gE檢測(cè)的診斷方法，可以從交叉反應(yīng)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(dǎo)的合并病風(fēng)險(xiǎn)的患者，可以通過過敏原微陣列或宏陣列程序很容易地識(shí)別，并可能受益于抗ige治療。IgE分子檢測(cè)開啟了精確過敏學(xué)的新紀(jì)元，根據(jù)優(yōu)選的原則，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
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(shí)交流平臺(tái)，為過敏患者提供專業(yè)診斷、治療、預(yù)防的共享平臺(tái)。