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Oral immunotherapy (OIT) can successfully desensitize many peanut allergic subjects, but clinical tolerance diminishes over time upon discontinuation, or low dose maintenance, of peanut. Therefore, in order to improve the efficacy and sustainability of such therapy, we sought to identify biomarkers and clinical tools that can predict therapeutic outcomes and monitor treatment responses.

The extensive use of allergen molecules in birth cohort studies revealed that atopic sensitization is a sequential IgE response to distinct non–cross-reacting molecules from the same allergenic source (ie, molecular spreading), starting with an initiator molecule. This phenomenon reaches different degrees of progression (monomolecular, oligomolecular, and polymolecular) according to the individual atopic propensity and allergen exposure, thus producing an extreme heterogeneity of IgE sensitization profiles in patient populations. In patients with allergic rhinitis, the broader the IgE molecular sensitization profile, the greater is the risk of asthma and other allergic comorbidities, such as oral allergy syndrome.

More than 400 occupational sensitizers are identified, but only a limited number of them are characterized on the molecular level.Natural rubber latex (NRL) allergy is an excellent model for improving sIgE measurement with recombinant major allergen.IgE-sensitization profile in patients with baker’s asthma showed great inter-individual variation.For diagnosis of baker’s asthma extract-based diagnostic is still recommended.Increasing the knowledge of occupational allergens and implement and evaluate standardized tools in clinical practice is necessary.

Corren et al. (Sept. 22 issue)1 report that treatment with lebrikizumab was associated with improved lung function in patients with asthma, and that improvement wasgreater in patients with high pretreatment levels of serum periostin or of the fraction of exhaled nitric oxide (FENO). The authors justifiably emphasize periostin because of its lower intra-patient variability, but in doing so, they raise an important question: what is the relationship between periostin and FENO at baseline in individual patients?