Allergies: the molecular revolution is underway

29 janvier 2026

By Ana Espino | Published on January 29, 2026 | 3 min readAllergic diseases affect approximately 30 to 40% of the global population, with an increasing prevalence. They are caused by an inappropriate IgE-mediated immune response to normally harmless allergens, leading to clinical manifestations ranging from rhinitis to anaphylaxis. Management currently relies on allergen avoidance, symptomatic tre

By Ana Espino | Published on January 29, 2026 | 3 min read

Allergic diseases affect approximately 30 to 40% of the global population, with an increasing prevalence. They are caused by an inappropriate IgE-mediated immune response to normally harmless allergens, leading to clinical manifestations ranging from rhinitis to anaphylaxis.

Management currently relies on allergen avoidance, symptomatic treatments (antihistamines, corticosteroids), and, in some cases, allergen-specific immunotherapy (AIT). However, conventional diagnosis, based on skin prick tests and the measurement of specific IgE to allergen extracts, lacks precision. These tests fail to differentiate between cross-reactivity and clinically relevant sensitizations, which limits the ability to personalize treatment.

The main current challenge is to move from extract-based diagnostics to a more precise, standardized, and mechanistic approach capable of guiding targeted therapeutic decisions. Molecular allergy diagnosis (MAD), through the analysis of IgE directed against purified or recombinant allergenic components, proposes a new strategy based on the molecular structure of allergens.

This review aims to assess the advancements in molecular diagnosis in allergic diseases, its clinical relevance, and its added value in a personalized medicine framework.

Could the key be hidden in proteins?

The following MAD technologies were reviewed: ImmunoCAP, ISAC (microarrays), and ALEX. Their clinical performance was analyzed across several conditions: allergic rhinitis, asthma, food allergies, drug allergies, and for patient stratification in immunotherapy.

Molecular diagnosis allows for the differentiation of primary sensitizations from cross-reactive responses, by precisely identifying IgE directed against major or minor allergenic molecules, or panallergens such as PR-10 proteins, profilins, and LTPs.

In food allergies, MAD helps predict clinical severity. For instance, sensitization to storage proteins or LTPs is associated with more severe reactions, whereas reactivity to PR-10 proteins is typically mild and heat-labile. In allergic rhinitis and asthma, it enables finer patient stratification, especially in complex polysensitized profiles, allowing for more accurate targeting of AIT and reducing therapeutic failures.

MAD also improves the selection of allergen extracts for immunotherapy by identifying those that contain the clinically relevant components for each patient. Additionally, it helps identify high-risk profiles for anaphylaxis, particularly in venom and drug allergies.

Ultimately, this approach promotes the rise of precision medicine in allergology, by combining molecular data with individualized clinical interpretation.

A better diagnosis to Treat Right

Despite their high prevalence, allergic diseases remain poorly characterized immunologically, leading to non-targeted and sometimes ineffective treatments. Molecular allergy diagnosis, by identifying IgE directed at specific allergenic molecules, addresses the need for a more mechanistic and personalized approach.

This study aimed to demonstrate how MAD can enhance diagnostic precision, better predict clinical severity, and guide therapeutic decisions, particularly regarding allergen immunotherapy.

The results confirm that this approach provides greater diagnostic resolution than conventional testing and paves the way for precision allergology.

However, limitations remain, warranting further investigation. Future research will include the integration of MAD into standardized diagnostic algorithms, evaluation of its long-term clinical impact, and the development of more accessible technological platforms, to support its wider adoption in everyday clinical practice.

Read next: Adrenaline and anaphylaxis: could we inject it better?

About the author – Ana Espino

PhD in Immunology, specialized in Virology

As a scientific writer, Ana is passionate about bridging the gap between research and real-world impact. With expertise in immunology, virology, oncology, and clinical studies, she makes complex science clear and accessible. Her mission: to accelerate knowledge sharing and empower evidence-based decisions through impactful communication.

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Scientific reference

Matricardi PM, et al. Molecular allergy diagnosis enabling personalized medicine. J Allergy Clin Immunol. 2025 Sep;156(3):485-502

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