ABSTRACT
Background: Pollen-allergy is common in Austria. The present
study investigated if the use of major pollen-allergens on top of
extract-based diagnosis may improve the diagnostic accuracy and if this
additional knowledge helps to identify patients eligible for
allergen-specific immunotherapy (AIT).
Methods: In this retrospective database analysis patients
sensitized to a grass, birch, ash-tree, mugwort or ragweed were
investigated and results of pollen extracts compared to the respective
major allergens (Phl p 1, Bet v 1, Ole e 1, Art v 1, Amb a 1) were
assessed. Furthermore, extract- and MD- results of patients
double-sensitized to both tree-extracts or both weed-extracts were
compared. In patients with discrepant results, their charts were
reviewed to define if this difference was clinically relevant in regard
to their doctors´ AIT-decision.
Results: 4234 patients (age 1.2-89.7yrs) could be included in
the analyses. There was high agreement between extract-based IgE results
and major allergens concerning single-sensitization to grass/Phl p 1+5
(94.4%), birch/Bet v 1 (94.4%), and ash-tree/Ole e 1 (82.9%), with
lower agreement between mugwort/Art v 1 (64.1%) and ragweed/Amb a 1
(73.8%). Among patients double-sensitized to both tree pollen extracts
only 76% were also sensitized to both major allergens (Bet v 1 and Ole
e 1) and therefore suitable for AIT. In patients double-sensitized to
both weeds, only 25% were also sensitized to both major allergens (Art
v 1 and Amb a 1), 46.2% of mugwort extract positive patients tested
negative for Art v 1. Of these patients, 41.3% were recommended a
ragweed AIT as their Amb a 1 results were positive.
Conclusion: MD can improve diagnostic accuracy in patients with
pollen-allergy and should be implemented in standard clinical care,
especially when double-sensitization to allergens of plants with
overlapping pollen seasons cannot be clearly discerned by patients´
symptoms alone.