The Use of Molecular Allergy Diagnosis in Anaphylaxis: a Literature Review

Purpose of the review Anaphylaxis can be caused mainly by drugs, foods, and hymenoptera or it can be idiopathic, when no cause is identified. The identification of the cause(s) of an anaphylactic reaction can be made by using both top-down (i.e., from patients’ history to MAD) and bottom-up (from MAD screening to the patients’ characterization) strategies. Recent findings Independently from the strategy, the patients’ history, skin prick test, second, third, and fourth level in vitro serum or cellular assays, and in vivo challenge tests are mandatory. The diagnosis is based on the results of these tests used at best. Third level specific IgE assays, based on the use of molecular allergens, allow a very accurate description of the specific IgE profile of the patient, resulting in a significant support in the identification of the trigger of the anaphylactic reaction. Summary In recent years, this third level has been empowered by the availability of allergen arrays that allow screening a large number of molecular allergens in a single test. In this paper, we analyze the recent scientific literature on this topic, showing that molecular allergy diagnosis does not seem to be yet a standard procedure in the identification of the cause of anaphylaxis.