We have new diagnostic and therapeutic advances for allergic diseases

Prevalence

More than 150 million Europeans suffer from allergic diseases, and by the year 2050 they will affect 50% of the population of the western world.

In Catalonia there are almost 2.5 million allergy sufferers and in Spain, 16 million. One of the pathologies that has increased the most in the last decade is food allergy. In Catalonia it has almost tripled and, as in Europe, one in ten children has one or more food allergies. Unfortunately, every year there are fatal anaphylactic reactions caused by food and the number of hospitalizations for severe reactions has increased sevenfold.

Respiratory pathology is the most frequent, and bronchial asthma the most significant allergic disease. The most frequently implicated allergens are house dust mites, together with pollens (parietaria, grasses, banana tree, cypress, olive tree, etc.).

It is estimated that the concentration of pollen will oscillate this spring around 1500 grains per cubic meter of air in Barcelona. After pollens, environmental fungi (alternaria, cladosporium, etc.) and animal epithelia (cat, dog, horse, etc.) are prevalent. Other relevant allergens are hymenoptera venoms (bee, wasp, polistes), drugs (NSAIDs, antibiotics, anesthetics, etc.), occupational substances (cereals, solvents, etc.) and contact substances (metals, hair dyes, cosmetics, etc.).

Diagnostic advances

New developments for the in vitro diagnosis of allergic diseases are related to molecular diagnostics. It is based on component diagnosis, that is, on the determination of IgE immunoglobulin in panels of purified, natural or recombinant allergens. The objective is to determine primary or specific sensitization and with similar proteins. For example, cross-reactions between plants and between foods and some pollens are frequent due to the sharing of common proteins, such as lipid transporter proteins (LTP).

Therapeutic advances

1. New allergy vaccines or specific immunotherapy are developed with new allergens that are more purified and with higher allergenic concentration, thus contributing to better tolerance and better clinical response. They are the only treatment that can modify the natural evolution of the allergic pathology and also reduce health care costs, both indirect costs related to loss of work productivity and quality of life of the patient, as well as direct costs, reducing medical services costs by 40% and symptomatic drugs by 30%.
2. Anti-IgE drugs. For the last ten years we have been using molecules such as omalizumab, indicated for the treatment of four very relevant pathologies: severe bronchial asthma, chronic spontaneous urticaria, severe atopic dermatitis and food allergy requiring desensitization, with great success.
   New anti-IgE molecules are already in the development phase that will presumably further improve the therapeutic arsenal, such as mepolizumab (IL-5), librikizumab (IL-13), dupilumab (IL-4 and IL-13) and lilelizumab (anti-IgE).
3. Oral immunotherapy with food: adverse reactions caused by food proteins, due to immunological mechanisms and involving intolerance of the food, have been treated for a decade with oral immunotherapy, especially in children with cow’s milk and egg protein allergy.