Component-resolved diagnostics in pediatric allergy. Diagnostic and therapeutic implications

Background. Extracts obtained from complete allergenic sources are usually poorly defined mixtures of major allergens, cross-reactive allergens, and non-allergenic material. The analysis of those extracts seldom allows for a precise diagnosis of the allergen responsible for the symptoms (in vivo or in vitro), especially in patients sensitized to more than one allergenic source. Advances in the characterization of allergens (molecular biology and recombinant DNA techniques) have allowed for the development of new diagnostic tools based on purified and recombinant allergens. Objective. To review the effect that advances in the characterization of purified and recombinant allergens have had in the diagnostics of pediatric allergy. Method. Literature review of manuscripts published until December 2014. Articles evaluating the usefulness of molecular diagnosis in pediatric allergy were reviewed. Results. Advances in the characterization of allergens have facilitated the development of new diagnostic tools based on purified and recombinant allergens that can improve the efficiency of conventional allergy diagnosis methods. The use of recombinant and purified allergens for the study of the allergic sensitization of polysensitized patients and of patients with complex allergic disease may help discern genuine sensitization of the patient from cross-reactivity with greater accuracy. Conclusions. The identification of the specific allergen that is sensitizing the patient is an essential requirement for optimal diagnosis and treatment; multiplexed molecular diagnosis can provide very useful information to aid in the management of these children.