Molecular diagnosis of food allergy: cracking the code
3 June 2016
UAntwerp - Campus Drie Eiken - Building Q - Promotiezaal - Universiteitsplein 1 - 2610 WILRIJK
Organization / co-organization:
Faculty of Medicine and Health Sciences
Prof D. Ebo & Prof L. De Clerck
PhD defence Margaretha Faber - Faculty of Medicine and Health Sciences
IgE-mediated food allergy constitutes an important and increasing health issue with significant morbidity and mortality. Although double blind placebo controlled food challenges remain the gold standard for correct diagnosis, the technique has not entered mainstream use for obvious ethical, practical and economic reasons. Therefore, in clinical practice most physicians rely upon quantification of specific immunoglobulin E (sIgE) antibodies and skin tests to confirm their clinical suspicion. However, diagnosis of food allergy is not always straightforward, as these in vivo and in vitro tests are not absolutely predictive for the clinical outcome. In other words, these tests frequently hamper correct diagnosis of food allergy as they fail to discriminate between patients with genuine overt food allergy and individuals who are merely sensitized, viz. have a positive test result but have no food-related symptoms. Moreover, difficulties are compounded as sensitization profiles might display significant age-related and geographical differences. Therefore, diagnosis of food allergy might benefit from in vitro diagnostics such as allergen component-based specific IgE (sIgE) assays (component resolved diagnosis) and flow cytometric quantification of in vitro activated basophils (basophil activation test).
This doctoral thesis focusing on hazelnut and peanut allergy, shows that the diagnostic management of both hazelnut and peanut allergic patients can benefit from component resolved diagnostics. As a matter of fact, component resolved diagnosis proved mainly useful in the individual risk assessment of hazelnut - and peanut allergic patients. Alternatively, our data confirm that sensitisation profiles and their phenotypic expression might display significant differences that cannot simply be predicted by sIgE binding studies but require more functional assessments like basophil activation tests that mirror the in vivo situation.