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　　原标题：过敏原免疫治疗的分子诊断
　　在出生队列中有系统地应用变应原分子的研究表明，特应性致敏是IgE对来自同一变应原来源(即分子传播)的不同非交叉反应分子（从引发分子开始）的连续反应。根据个体的特应性倾向和过敏原暴露情况，这种连续现象的程度不同 (单分子、低分子和多分子)，从而使患者群体中的IgE致敏谱的差异极大。在变应性鼻炎患者中，IgE分子致敏谱越宽，哮喘等变应性合并病的风险越大，如口腔变态反应综合征。因此，在疾病开始时(早期过敏原免疫治疗)，甚至在临床前致敏阶段(过敏原免疫预防)，就建议进行免疫干预。基于单重或多重分子IgE检测的诊断方法，可以从交叉反应致敏中鉴别真伪，并为过敏原免疫治疗选择合适的提取物。极多分子致敏和有更大哮喘或其他ige介导的合并病风险的患者，可以通过过敏原微阵列或宏阵列程序很容易地识别，并可能受益于抗ige治疗。IgE分子检测开启了精确过敏学的新纪元，根据优选的原则，常规使用应以成本效益为目标。
延伸阅读
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
　　创建过敏性疾病的科研、科普知识交流平台，为过敏患者提供专业诊断、治疗、预防的共享平台。