Potential, Pitfalls and current Status of molecular Diagnostics using the example of Insect Venom Allergy

Molecular approaches in allergy diagnosis in the last years evolved from a merely academic exercise to an essential tool in modern diagnostics. Thereby, the classical diagnostics based on crude extracts, mostly a complex cocktail of a variety of different molecules, could be broadened by a plethora of single components rendering an analysis much more reliable, but also much more complex. In few areas the advancement is as evident as in hymenoptera venom allergy. Hymenoptera venom allergy is one of the most severe hypersensitivities with regard to the high risk of anaphylactic conditions with potential fatal outcome. In Western Europe this relates primarily to allergies to venoms of the honeybee and the common yellow jacket. Although the composition of allergenic extracts has been resolved for a plethora of allergen sources in detail, only major allergens of hymenoptera venoms had been characterized. Today an increasing number of allergens is identified, characterized regarding function and nature and assessed for allergenic potential. Moreover, advanced expression strategies for recombinant production of venom allergens allow for modification of the molecules and provide insight into different types of IgE reactivities and sensitization pattern. The obtained knowledge about the allergens in hymenoptera venom cocktails and their molecular use can help to improve current diagnostics for hymenoptera venom allergy and serve as tools for reevaluation and improvement of current therapeutic strategies.