Michel Migueres has received consulting fees, honoraria for lectures and/or research funding from Stallergenes, Novartis, Astra Zeneca, Chiesi, Pierre Fabre Santé Ignacio Dávila has received consulting fees, honoraria for lectures and/or research funding from Stallergenes. Franco Frati is an employee of Stallergenes Italia SRL. Angel Azpeitia is an employee of Stallergenes Iberica SA. Yasmine Jeanpetit and Michèle Lhéritier-Barrand are employees of Stallergenes SA. Cristoforo Incorvaia has received consulting fees from Stallergenes Italia. Giorgio Ciprandi has received consulting fees from Stallergenes Italia. This work was supported by an educational grant from Stallergenes.
MM, IDG, FF, AA, YJ, MLB, CI and GC all made substantial contributions to the identification and review of relevant literature, drafting the manuscript and/or revising it critically for important intellectual content. All the authors have given final approval of the version to be published.
The type of allergic sensitization is of central importance in the diagnosis and treatment of respiratory allergic diseases. At least 10% of the general population (and more than 50% of patients consulting for respiratory allergies) are polysensitized. Here, we review the recent literature on (i) the concepts of polysensitization, paucisensitization, co-sensitization, co-recognition, cross-reactivity, cross-sensitization, and polyallergy, (ii) the prevalence of polysensitization and (iii) the relationships between sensitization status, disease severity and treatment strategies. In molecular terms, clinical polysensitization can be divided into cross-sensitization (also known as cross-reactivity, in which the same IgE molecule binds to several allergens with common structural features) and co-sensitization (the simultaneous presence of different IgEs binding to allergens that may not necessarily have common structural features). There is a strong overall association between sensitization in skin prick tests and total IgE values but there is debate as to whether IgE thresholds are useful guides to the presence or absence of clinical symptoms in individual cases. Molecular information from component-resolved techniques appears to be of value for diagnosis and treatment decisions. Polysensitization develops over time and is a risk factor for respiratory allergy (being associated with disease severity) and therefore has clinical relevance for treatment decisions. The subterm polysensitization has been defined as polysensitization to between two and four allergens. Polyallergy is defined as clinically confirmed allergy to two or more allergens. Single-allergen grass pollen allergen immunotherapy (AIT) is safe and effective in polysensitized patients, whereas multi-allergen AIT requires more supporting evidence. Given that AIT may be more efficacious in moderate-to-severe disease than in mild disease, polysensitization could be an indication for this type of treatment. There is a need for flowcharts or decision trees for choosing the allergens for AIT in polysensitized patients and polyallergic patients.
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