Biomarkers and Molecular Testing Advance Precision Allergy Care

Allergic diseases often present with similar symptoms but can be driven by distinct biological mechanisms, making standardized care inefficient for many patients. Historically, individuals with pollen or other allergies often received similar regimens despite differences in the underlying causes of their disease. Advances in molecular diagnostics can now distinguish true sensitization from cross-reactivity and help guide therapy selection. Building on these advances, new guidance positions allergen immunotherapy as part of a precision-medicine approach.

Wroclaw Medical University (Wroclaw, Poland) has highlighted recommendations published in Allergy by the European Academy of Allergy and Clinical Immunology (EAACI) that reposition allergen immunotherapy (AIT) as a targeted intervention. The guidance focuses on allergy “endotypes,” or distinct disease mechanisms that can produce similar clinical symptoms, as a basis for treatment decisions. Under this framework, AIT is presented as a causal therapy tailored to an individual’s disease course rather than a uniform approach to symptom relief.

Image: Modern diagnostic tools can pinpoint the specific allergenic proteins driving a patient’s sensitization, helping distinguish true allergy from cross-reactivity (image credit: Adobe Stock)

A central enabler is component-resolved diagnostics (CRD), which identifies the specific allergenic proteins provoking an immune response. By characterizing sensitization at the molecular level, CRD can distinguish genuine allergy from cross-reactivity and help predict whether AIT is likely to be effective. The approach directs selection of allergen components to match each patient’s detailed allergy profile.

Biomarkers are also gaining importance within this model. Classical markers, such as allergen-specific immunoglobulin E (IgE) and immunoglobulin G4 (IgG4), as well as more advanced indicators of immune regulation, including regulatory T cell (Treg) activity, may support patient qualification for therapy, inform safety assessments, and monitor treatment effects. However, many tools remain at the validation stage. A key objective is to reliably identify which patients will benefit from AIT.

Implementation challenges include incomplete biomarker standardization, limited access to advanced diagnostics, and the high costs associated with such testing. Interpreting molecular results also requires specialist expertise, while unified clinical protocols are still being developed. Despite these barriers, the guidance frames AIT as one of the most advanced examples of personalized care in allergology when guided by endotype classification, component-resolved diagnostics (CRD), and biomarker-informed decision-making.

“The role of allergen immunotherapy (AIT) is shifting from a standard approach toward targeted therapy. Thanks to precision medicine, AIT is increasingly selected based on the patient's detailed allergy profile, including the identification of specific allergen components,” said Prof. Marek Jutel at the Department and Clinic of Clinical Immunology at Wroclaw Medical University.

“Despite its great potential, precision medicine in allergology is still in an early stage of development, and its full implementation requires further research and systemic changes,” stated Prof. Jutel.

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Wroclaw Medical University
EAACI