Component Resolved Diagnostics in Severe Allergy Problems

Case history: Current allergy tests define allergen-containing sources, not specific allergenic molecules. Molecular allergology improves clinical practice helping to differenciate true allergy from sensitisation, to predict the severity of the reaction and how long the allergy persist, to rationalise oral food challanges and make immunotherapy more effective.

Component resolved diagnostics was used for estimating sensitisation against foods and inhalant allergens in a child with severe allergy against several foods and inhalant allergens. Atopic dermatitis was diagnosed at 3 mo of age and due to very severe milk allergy only amino-acid based formula was possible to use. At 6 mo of age the level of IgE antibodies against casein, wheat, potato, cat was increased. At 2 yrs of age the child was sensitised against egg, rye, soy, mix of meets, nuts, tree pollens and at 3 yrs the level of total IgE was over 5000kU/l. Using strict elimination diet and medication the symptoms of atopic dermatitis and asthma were almost under control.

According component resolved diagnostics (Thermo Scientific, Immunocap ISAC) the child was multi-sensitised with IgE to species-specific and cross-reactive components. IgE to milk Bos d8 (casein)–7.2 ISU is associated with persistent milk allergy. IgE to egg Gal d1 (ovomucoid)–31 ISU is associated with persistent egg allergy. IgE to the storage proteins peanut Ara h1–1.7 ISU, hazelnut Cor a9–0.9 ISU, soybean Gly m6–0.6 ISU is associated with risk of severe allergic reactions. IgE to birch Bet v1–44 ISU may cross-react with pollen of related trees and plant food containing PR-10 proteins. IgE to cow Bos d6–3.2 ISU, cat Fel d2–1.9 ISU, dog Can f3–1.4 ISU explain cross-sensitisation between furry animals and may cause allergic reactions after meat consumption or airway exposure to animal hair or dander.

In the presentation will be given overview of the course of the disease, diet, results of immunotherapy with milk.