Peculiarities of Allergy Diagnosis in Children

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Allergic disease is a serious problem in practical healthcare. Over the last 40 years there has been exponential growth in the prevalence. According to the world health organization information, allergic diseases are at the 2nd place in prevalence the children, behind the viral infections. Their frequency and severity are increasing. In this regard, the relevance of timely and skilled diagnostic allergopathology is most important. In this study the current state of the question of allergy diagnostics is considered, the international experience is summarized and the approach to the allergy diagnosis based on use of step-by-step identification of a causal and significant factor of allergic reactions is offered. On the basis of the analysis of relevance and the importance for patients of one or the other allergens (taking into account a source of allergens and age of patients) use of a step-by-step allergy diagnostics algorithm is offered. The first step is definition of clinical implications of an allergy. It means direct contact of the phisition with the patient, clarification of its complaints, clinical symptoms, medical history disease. The second step is the confirmation of IgE-dependent mechanism. It involves the using of screening tests that are selected depending on the clinical symptoms and seasonality manifestations (the screening module). The third step is to identify the source of the allergens that are most meaningful for the patient with using test panels (modules). The panels include the most common and clinically relevant triggers of allergic reactions. The fourth step is the search for an individual significant allergens, which were not included in the diagnostic modules. On the fifth step, we plan to conduct component-divided diagnostics and detect the antibodies to unique components of significant allergens. The developed diagnostics algorithm, corresponds to needs of both the adult, and children’s population and provides the personalized approach to the patients.

About the authors

L. S. Namazova-Baranova

National Scientific and Practical Center of Children’s Health;
Pirogov Russian National Research Medical University

ORCID iD: 0000-0002-2209-7531

Академик РАН, доктор медицинских наук, профессор, директор НИИ педиатрии ФГАУ ННПЦЗД Минздрава России, заведующая кафедрой факультетской педиатрии педиатрического факультета РНИМУ им. Н.И. Пирогова.

Адрес: 119991, Москва, Ломоносовский пр-т, д.2, стр. 1

SPIN-код: 1312-2147

M. A. Snovskaya

National Scientific and Practical Center of Children’s Health

Author for correspondence.
ORCID iD: 0000-0002-5263-6743

Кандидат медицинских наук, врач клинической лабораторной диагностики отдела инструментальной диагностики.

Адрес: 119991, Москва, Ломоносовский пр-т, д.2, стр. 1

SPIN-код: 9899-1095

Russian Federation

I. L. Mitushin

National Scientific and Practical Center of Children’s Health

ORCID iD: 0000-0002-0606-7201

Врач-педиатр отдела диагностики и восстановительного лечения.

Адрес: 119991, Москва, Ломоносовский пр-т, д.2, стр. 1

SPIN-код: 4497-2733

O. V. Kozhevnikova

National Scientific and Practical Center of Children’s Health

ORCID iD: 0000-0001-8562-6851

Кандидат медицинских наук, заведующая отделом инструментальной диагностики НИИ педиатрии.

Адрес: 119991, Москва, Ломоносовский пр-т, д.2, стр. 1

SPIN-код: 2215-2910

A. S. Batyrova

National Scientific and Practical Center of Children’s Health

ORCID iD: 0000-0002-9809-6922

Врач клинической лабораторной диагностики отдела инструментальной диагностики.

Адрес: 119991, Москва, Ломоносовский пр-т, д.2, стр. 1

SPIN-код: 8567-3506


  1. Anto JM, Pinart M, Akdis M, et al. Understanding the complexity of IgE-related phenotypes from childhood to young adulthood: a Mechanisms of the Development of Allergy (MeDALL) seminar. J Allergy Clin Immunol. 2012;129(4):943-954 e944. doi: 10.1016/j.jaci.2012.01.047.
  2. Bousquet J, Gern JE, Martinez FD, et al. Birth cohorts in asthma and allergic diseases: report of a NIAID/NHLBI/MeDALL joint workshop. J Allergy Clin Immunol. 2014;133(6):1535-1546. doi: 10.1016/j.jaci.2014.01.018.
  3. Аллергология и иммунология для педиатров / Под ред. Баранова А.А., Хаитова Р.М. ― М.: Союз педиатров России; 2008. [Baranov AA, Haitova RM, editors. Allergologija i immunologija dlja pediatrov. Moscow: Sojuz pediatrov Rossii; 2008. (In Russ)].
  4. Ковальчук Л.В., Ганковская Л.В., Мешкова Р.Я. Клиническая иммунология и аллергология с основами общей иммунологии. ― М.: ГЭОТАР-Медиа; 2011. [Kovalchuk LV, Gankovskaja LV, Meshkova RJ. Klinicheskaja immunologija i allergologija s osnovami obshhej immunologii. Moscow: GEOTAR-Media; 2011. (In Russ)].
  5. Osterballe M, Hansen TK, Mortz CG, et al. The prevalence of food hypersensitivity in an unselected population of children and adults. Pediatr Allergy Immunol. 2005;16(7):567-573. doi: 10.1111/j.1399-3038.2005.00251.x.
  6. Казмирчук В.Е., Ковальчук Л.В., Мальцев Д.В. Клиническая иммунология и аллергология с возрастными особенностями. 2-е изд. переработ. и доп. ― Киев: ВСИ Медицина; 2012. [Kazmirchuk VE, Kovalchuk LV, Malcev DV. Klinicheskaja immunologija i allergologija s vozrastnymi osobennostjami. 2nd ed. Kiev: VSI Medicina; 2012. (In Russ)].
  7. Аллергия у детей: от теории ― к практике. Сер. Современная педиатрия: от теории ― к практике / Под ред. Намазовой-Барановой Л.С. ― Москва; 2011. [Namazova-Baranova LS, editor. Allergiya u detey: ot teorii ― k praktike. Series: Sovremennaja pediatrija: ot teorii ― k praktike. Moscow; 2011. (in Russ.)].
  8. Schroeder HW, Jr., Cavacini L. Structure and function of immunoglobulins. J Allergy Clin Immunol. 2010;125(2 Suppl 2):S41-52. doi: 10.1016/j.jaci.2009.09.046.
  9. Johansson SG, Hourihane JO, Bousquet J, et al. A revised nomenclature for allergy. An EAACI position statement from the EAACI nomenclature task force. Allergy. 2001;56(9):813-824.
  10. Tschopp JM, Sistek D, Schindler C, et al. Current allergic asthma and rhinitis: diagnostic efficiency of three commonly used atopic markers (IgE, skin prick tests, and Phadiatop). Results from 8329 randomized adults from the SAPALDIA Study. Swiss Study on Air Pollution and Lung Diseases in Adults. Allergy. 1998;53(6):608-613. doi: 10.1111/j.1398-9995.1998.tb03937.x
  11. Gergen PJ, Arbes SJ, Jr., Calatroni A, et al. Total IgE levels and asthma prevalence in the US population: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol. 2009;124(3):447-453. doi: 10.1016/j.jaci.2009.06.011.
  12. Manise M, Bakayoko B, Schleich F, et al. IgE mediated sensitisation to aeroallergens in an asthmatic cohort: relationship with inflammatory phenotypes and disease severity. Int J Clin Pract. 2016;70(7):596-605. doi: 10.1111/ijcp.12837.
  13. Kiiski V, Karlsson O, Remitz A, Reitamo S. High serum total IgE predicts poor long-term outcome in atopic dermatitis. Acta Derm Venereol. 2015;95(8):943-947. doi: 10.2340/00015555-2126.
  14. Stone KD, Prussin C, Metcalfe DD. IgE, mast cells, basophils, and eosinophils. J Allergy Clin Immunol. 2010;125(2 Suppl 2):S73-80. doi: 10.1016/j.jaci.2009.11.017.
  15. Chen X, Li Y, Zeng M. Diagnostic values of combination of free running asthma screening test and total serum allergen IgE level in children with asthma. Chin Med J (Engl). 2014;127(5):873-877.
  16. Brauer M, Hoek G, Smit HA, et al. Air pollution and development of asthma, allergy and infections in a birth cohort. Eur Respir J. 2007;29(5):879-888. doi: 10.1183/09031936.00083406.
  17. Sherrill DL, Stein R, Halonen M, et al. Total serum IgE and its association with asthma symptoms and allergic sensitization among children. J Allergy Clin Immunol. 1999;104(1):28-36. doi: 10.1016/S0091-6749(99)70110-7
  18. Ahmad Al Obaidi AH, Mohamed Al Samarai AG, Yahya Al Samarai AK, Al Janabi JM. The predictive value of IgE as biomarker in asthma. J Asthma. 2008;45(8):654-663. doi: 10.1080/02770900802126958.
  19. Eigenmann PA, Sicherer SH, Borkowski TA, et al. Prevalence of IgE-Mediated Food Allergy Among Children With Atopic Dermatitis. Pediatrics. 1998;101(3):e8-e8.
  20. Wallace DV, Dykewicz MS, Bernstein DI, et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008;122(2 Suppl):S1-84. doi: 10.1016/j.jaci.2008.06.003.
  21. Niggemann B, Nilsson M, Friedrichs F. Paediatric allergy diagnosis in primary care is improved by in vitro allergen-specific IgE testing. Pediatr Allergy Immunol. 2008;19(4):325-331. doi: 10.1111/j.1399-3038.2007.00651.x.
  22. Settipane RJ, Hagy GW, Settipane GA. Long-term risk factors for developing asthma and allergic rhinitis: a 23-year follow-up study of college students. Allergy Proc. 1994;15(1):21-25. doi: 10.2500/108854194778816634
  23. Leung DY, Nicklas RA, Li JT, et al. Disease management of atopic dermatitis: an updated practice parameter. Joint Task Force on Practice Parameters. Ann Allergy Asthma Immunol. 2004;93(3 Suppl 2):S1-21. doi: 10.1016/S1081-1206(10)61385-3
  24. Zheng T, Yu J, Oh MH, Zhu Z. The atopic march: progression from atopic dermatitis to allergic rhinitis and asthma. Allergy Asthma Immunol Res. 2011;3(2):67-73. doi: 10.4168/aair.2011.3.2.67.
  25. Schafer T. The impact of allergy on atopic eczema from data from epidemiological studies. Curr Opin Allergy Clin Immunol. 2008;8(5):418-422. doi: 10.1097/ACI.0b013e32830e71a7.
  26. Eller E, Kjaer HF, Host A, et al. Food allergy and food sensitization in early childhood: results from the DARC cohort. Allergy. 2009;64(7):1023-1029. doi: 10.1111/j.1398-9995.2009.01952.x.
  27. Kamemura N, Tada H, Shimojo N, et al. Intrauterine sensitization of allergen-specific IgE analyzed by a highly sensitive new allergen microarray. J Allergy Clin Immunol. 2012;130(1):113-121 e112. doi: 10.1016/j.jaci.2012.02.023.
  28. Powe DG, Jagger C, Kleinjan A, et al. ‘Entopy’: localized mucosal allergic disease in the absence of systemic responses for atopy. Clin Exp Allergy. 2003;33(10):1374-1379. doi: 10.1046/j.1365-2222.2003.01737.x
  29. Bernstein IL, Li JT, Bernstein DI, et al. Allergy diagnostic testing: An updated practice parameter. Ann Allergy Asthma Immunol. 2008;100(3 SUPPL. 3):S1-S148.
  30. Hamilton RG, Franklin Adkinson N, Jr. In vitro assays for the diagnosis of IgE-mediated disorders. J Allergy Clin Immunol. 2004;114(2):213-225; quiz 226.
  31. Павлова К.С., Курбачева О.М. Клинико-экономический анализ терапии больных аллергическим ринитом и атопической бронхиальной астмой с наличием бытовой сенсибилизации. // Российский аллергологический журнал. — 2006. ― №3. ― С. 22–27. [Pavlova KS, Kurbacheva OM. Kliniko-ekonomicheskiy analiz terapii bol’nykh allergicheskim rinitom i atopicheskoy bronkhial’noy astmoy s nalichiem bytovoy sensibilizatsii. Rossiyskiy allergologicheskiy zhurnal. 2006;(3):22-27. (in Russ.)]
  32. Sanz ML, Blazquez AB, Garcia BE. Microarray of allergenic component-based diagnosis in food allergy. Curr Opin Allergy Clin Immunol. 2011;11(3):204-209. doi: 10.1097/ACI.0b013e3283466fe4.
  33. van Ree R. Clinical importance of non-specific lipid transfer proteins as food allergens. Biochem Soc Trans. 2002;30(6):910-913. doi: 10.1042/bst0300910.
  34. Garcia BE, Lizaso MT. Cross-reactivity syndromes in food allergy. J Investig Allergol Clin Immunol. 2011;21(3):162-170.
  35. Masthoff LJ, Mattsson L, Zuidmeer-Jongejan L, et al. Sensitization to Cor a 9 and Cor a 14 is highly specific for a hazelnut allergy with objective symptoms in Dutch children and adults. J Allergy Clin Immunol. 2013;132(2):393-399. doi: 10.1016/j.jaci.2013.02.024.
  36. Nicolaou N, Poorafshar M, Murray C, et al. Allergy or tolerance in children sensitized to peanut: prevalence and differentiation using component-resolved diagnostics. J Allergy Clin Immunol. 2010;125(1):191-197 e191-113. doi: 10.1016/j.jaci.2009.10.008.
  37. Constantin C, Quirce S, Poorafshar M, et al. Micro-arrayed wheat seed and grass pollen allergens for component-resolved diagnosis. Allergy. 2009;64(7):1030-1037. doi: 10.1111/j.1398-9995.2009.01955.x.
  38. Bartra J, Sastre J, del Cuvillo A, et al. From pollinosis to digestive allergy. J Investig Allergol Clin Immunol. 2009;19 Suppl 1:3-10.
  39. Kwon J, Kim J, Cho S, et al. Characterization of food allergies in patients with atopic dermatitis. Nutr Res Pract. 2013;7(2):115-121. doi: 10.4162/nrp.2013.7.2.115.
  40. Kumar R, Singh BP, Srivastava P, et al. Relevance of serum IgE estimation in allergic bronchial asthma with special reference to food allergy. Asian Pac J Allergy Immunol. 2006;24(4):191-199.
  41. Asarnoj A, Hamsten C, Waden K, et al. Sensitization to cat and dog allergen molecules in childhood and prediction of symptoms of cat and dog allergy in adolescence: A BAMSE/MeDALL study. J Allergy Clin Immunol. 2016;137(3):813-821 e817. doi: 10.1016/j.jaci.2015.09.052.
  42. Сновская М.А., Намазова-Баранова Л.С., Семикина Е.Л., и др. Возрастная эпидемиология распространенности антительного ответа у детей с пищевой аллергией. // Вестник РАМН. — 2016. ― Т. 71. ― №1. ― С. 68−76. [Snovskaya MA, Namazova-Baranova LS, Semikina EL, et al. Age-specific Epidemiology of the Antibody Response Prevalence in Children with Food Allergy. Annals of the Russian academy of medical sciences. 2016;71(1):68-76. (in Russ)]. doi: 10.15690/vramn637.
  43. Намазова-Баранова Л.С., Турти Т.В., Сновская М.А., и др. Оценка переносимости и безопасности монокомпонентных продуктов прикорма в питании детей раннего возраста с риском развития аллергических болезней. // Вопросы современной педиатрии. — 2016. ― Т. 15. — №2. ― С. 42−48 [Namazova-Baranova LS, Turti TV, Snovskaya MA, et al. Assessment of Tolerability and Safety of Monocomponent Complementary Food Products in the Diet of Infants With Risk for Allergic Diseases. Current pediatrics. 2016;15(2):154-160. (in Russ)]. doi: 10.15690/vsp.v15i2.1533.
  44. Сновская М.А., Батырова А.С., Намазова-Баранова Л.С. О минимизации затрат на высокоэффективную диагностику аллергии у детей: анализ согласованности результатов аллергологического in vitro- и in vivo-обследования. // Вестник РАМН. ― 2015. ― Т. 70. — №6. ― С.748−755. [Snovskaya MA, Batyrova AS, Namazova-Baranova LS, et al. About Minimization of Expenses on Allergy Diagnosis in Children: Analysis of Consistency of in Vitro- and in Vivo-Allergic Examinations Results. Annals of the Russian academy of medical sciences. 2015;70(6):748-755. (in Russ)]. doi: 10.15690/vramn583.
  45. Федеральные клинические рекомендации по оказанию медицинской помощи детям с аллергическим ринитом. — М.; 2015. [Federal clinical guidelines for the medical care providing for children with allergic rhinitis. Moscow; 2015. (in Russ.)] Доступно по ссылке URL:
  46. Pomes A, Chapman MD, Wunschmann S. Indoor Allergens and Allergic Respiratory Disease. Curr Allergy Asthma Rep. 2016;16(6):43. doi: 10.1007/s11882-016-0622-9.
  47. In: Pope AM, Patterson R, Burge H, editors. Indoor Allergens: Assessing and Controlling Adverse Health Effects. Washington (DC); 1993.
  48. Asam C, Hofer H, Wolf M, et al. Tree pollen allergens-an update from a molecular perspective. Allergy. 2015;70(10):1201-1211. doi: 10.1111/all.12696.
  49. D’Amato G, Spieksma FT, Liccardi G, et al. Pollen-related allergy in Europe. Allergy. 1998;53(6):567-578. doi: 10.1111/j.1398-9995.1998.tb03932.x
  50. Bousquet PJ, Chinn S, Janson C, et al. Geographical variation in the prevalence of positive skin tests to environmental aeroallergens in the European Community Respiratory Health Survey I. Allergy. 2007;62(3):301-309. doi: 10.1111/j.1398-9995.2006.01293.x.
  51. Gadermaier G, Hauser M, Ferreira F. Allergens of weed pollen: an overview on recombinant and natural molecules. Methods. 2014;66(1):55-66. doi: 10.1016/j.ymeth.2013.06.014.
  52. Zock JP, Heinrich J, Jarvis D, et al. Distribution and determinants of house dust mite allergens in Europe: the European Community Respiratory Health Survey II. J Allergy Clin Immunol. 2006;118(3):682-690. doi: 10.1016/j.jaci.2006.04.060.
  53. Kuljanac I. The role of Dermatophagoides pteronyssinus in atopic dermatitis. Acta Dermatovenerol Croat. 2006;14(2):86-89.
  54. Gabriel MF, Postigo I, Tomaz CT, Martinez J. Alternaria alternata allergens: Markers of exposure, phylogeny and risk of fungi-induced respiratory allergy. Environ Int. 2016;89-90:71-80. doi: 10.1016/j.envint.2016.01.003.
  55. Liccardi G, Triggiani M, Piccolo A, et al. Sensitization to Common and Uncommon Pets or Other Furry Animals: Which May Be Common Mechanisms? Transl Med UniSa. 2016;14:9-14. PMC4912333.
  56. Sanchez A, Cardona R, Sanchez J. In silico analysis of the identity of lipocalin of dog, cat, horse, cow, hamster and hen. Possible role in allergic diseases. Rev Alerg Mex. 2016;63(1):1-10.
  57. Rona RJ, Keil T, Summers C, et al. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol. 2007;120(3):638-646. doi: 10.1016/j.jaci.2007.05.026.
  58. Westman M, Lupinek C, Bousquet J, et al. Early childhood IgE reactivity to pathogenesis-related class 10 proteins predicts allergic rhinitis in adolescence. J Allergy Clin Immunol. 2015;135(5):1199-1206 e1191-1111. doi: 10.1016/j.jaci.2014.10.042.

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