Molecular diagnosis and immunotherapy.

PURPOSE OF REVIEW: To describe the recent insights of how molecular diagnosis can be useful to improve indication and selection of suitable allergens for specific immunotherapy and to increase its safety.

RECENT FINDINGS: As specific allergen immunotherapy is allergen-specific, the identification of the disease-eliciting allergen is a prerequisite for accurate prescription of anti-allergic treatment. In areas of complex sensitization to aeroallergens or in hymenoptera venom allergy, the use of molecular diagnosis has demonstrated that it may change indication and selection of allergens for immunotherapy in a large proportion of patients when compared with the use of skin prick testing and/or specific IgE determination with commercial extracts. These changes in the prescription of immunotherapy after using molecular diagnosis have been demonstrated to be cost-effective in some scenarios. Some patterns of sensitization to grass or olive pollen allergens may identify patients with higher risk of adverse reaction during immunotherapy.

SUMMARY: Molecular diagnosis, together with other tools and patients' clinical history, can help clinicians better select the most appropriate patients and allergens for specific immunotherapy and, in some cases, predict the risk of adverse reactions.