Precision medicine in the allergy clinic: the application of component resolved diagnosis

Future of allergy and immunology: Is artificial intelligence the key in the digital era?

Artificial intelligence (AI) is reshaping allergy and immunology by integrating cutting-edge technology to enhance patient outcomes and redefine clinical practices and research. This review evaluates AI's evolving role, emphasizing its impact on diagnostic accuracy, personalized treatments, and innovative research methodologies. AI has advanced diagnostic tools, such as models predicting allergen sensitivity, and enhanced immunotherapy strategies. Its ability to process extensive data sets has enabled deeper understanding of allergic diseases and immune system responses, leading to more accurate, effective, and tailored treatments. Furthermore, AI is facilitating personalized care through AI-driven allergen mapping, automated patient monitoring, and targeted immunotherapy. The integration of AI into clinical practice promises a future in which allergy and immunology are characterized by precisely customized health care solutions. This review adheres to Preferred Reporting Items for Systematic reviews and Meta-Analyses flowchart, with a comprehensive analysis of databases, including Scopus, Web of Science, PubMed, and preprint platforms using keywords related to AI and allergy and immunology. From an initial pool of 192 studies, 20 documents were selected based on inclusion criteria. Our findings highlight how AI is transforming allergy and immunology by enhancing patient care, research methodologies, and clinical innovation, offering a glimpse into the near future of technology-driven health care in these fields.

ChatGPT Performance on 120 Interdisciplinary Allergology Questions-Systematic Evaluation With Clinical Error Impact Assessment for Critical Erroneous AI-Guided Chatbot Advice

BACKGROUND

ChatGPT (Chatbot with Generative Pretrained Transformer), despite not being a medical device, may be used by patients for medical inquiries. Its accessibility and convenience, particularly amidst long waiting times for allergology appointments, make it an attractive but potentially erroneous source of advice.

OBJECTIVES

This study evaluates ChatGPT's performance on allergological questions from clinical practice, offering a systematic approach to rating its errors. An Allergological Error Impact Assessment is proposed to analyze the potential consequences of these errors on patients.

METHODS

A total of 120 multidisciplinary allergology questions from dermatology, pediatrics, and pulmonology were prompted to ChatGPT (3.5). Errors were assessed in terms of content, accuracy (ACC), completeness (CO), perceived humanness (PHU), and readability (Flesch Reading Ease). Erroneous responses were categorized on a 3-step severity scale (minor, major, and critical). Critical errors underwent allergological error impact analysis. Statistical evaluation included descriptive analyses and Kruskal-Wallis and Mann-Whitney U tests.

RESULTS

ChatGPT demonstrated good accuracy (mean ACC 4.1/5, standard deviation: 0.78, range: 1-5). CO and PHU were sufficient but lowest for pediatric queries. Readability was at an academic level for most responses. Six critical errors were identified: 1 in dermatology, 2 in pediatrics, and 3 in pulmonology. Notably, a critical pediatric food allergen error carried a potentially life-threatening risk.

CONCLUSION

ChatGPT's imperfect reliability in allergology highlights the need for expert counseling in specialized fields. Tailoring these tools to allergy use cases could improve utility of models like ChatGPT for clinical applications, such as answering questions from allergological routine care.

Exploring the Role of Allergenic Components in Children with House Dust Mite-Induced Allergic Diseases

Purpose

To investigate the main characteristics of HDM-induced allergic diseases in children and to explore allergen component-specific sensitization patterns, features, and correlations with clinical symptoms.

Methods

Serum samples were collected from children with HDM-induced allergic diseases. Information on age, sex, and clinical symptoms was recorded. A protein chip method was used to detect specific IgE (sIgE) against HDM components, including Der p 1, Der f 1, Der p 2, Der f 2, Der p 5, Der p 7, Der p 10, Der p 21, and Der p 23.

Results

116/120 (96.67%) exhibited positive reactions to HDM components. The highest positive rates were for Der p 1 (95.83%) and Der f 1 (95.83%), followed by Der p 2 (86.67%), Der f 2 (85.83%), and Der p 23 (62.50%). Der p 5, 7, and 23 positivity increased with age. Notably, Der p 23 positivity was higher in the allergic asthma (AA) group than in the non-AA, atopic dermatitis (AD), and allergic rhinitis (AR) groups and higher in AR with AA than AR-only. Der p 2 and Der f 2 had higher positive rates in respiratory allergies than in AD alone. The impact of other HDM components on different allergic diseases was minimal. Pearson correlation analysis demonstrated strong positive correlations between sIgE concentrations for various HDM components, especially between Der p 2 and Der f 2 (r = 0.96, p < 0.01).

Conclusion

Der p 1, Der f 1, Der p 2, Der f 2, and Der f 23 are the major allergens, with Der p 5, 7, and 23 showing age-specific sensitization patterns. Der p 2 and Der f 2 are closely associated with respiratory allergies, whereas Der p 23 is particularly linked to the development of asthma. There is a general positive correlation among the sIgE concentrations of various HDM components.

Insect Cell-Expressed Major Ragweed Allergen Amb a 1.01 Exhibits Similar Allergenic Properties to Its Natural Counterpart from Common Ragweed Pollen

Common ragweed pollen allergy has become a health burden worldwide. One of the major allergens in ragweed allergy is Amb a 1, which is responsible for over 90% of the IgE response in ragweed-allergic patients. The major allergen isoform Amb a 1.01 is the most allergenic isoform in ragweed pollen. So far, no recombinant Amb a 1.01 with similar allergenic properties to its natural counterpart (nAmb a 1.01) has been produced. Hence, this study aimed to produce a recombinant Amb a 1.01 with similar properties to the natural isoform for improved ragweed allergy management. Amb a 1.01 was expressed in insect cells using a codon-optimized DNA construct with a removable N-terminal His-Tag (rAmb a 1.01). The recombinant protein was purified by affinity chromatography and physicochemically characterized. The rAmb a 1.01 was compared to nAmb a 1.01 in terms of the IgE binding (enzyme-linked immunosorbent assay (ELISA), immunoblot) and allergenic activity (mediator release assay) in well-characterized ragweed-allergic patients. The rAmb a 1.01 exhibited similar IgE reactivity to nAmb a 1.01 in different IgE-binding assays (i.e., IgE immunoblot, ELISA, quantitative ImmunoCAP inhibition measurements). Furthermore, the rAmb a 1.01 showed comparable dose-dependent allergenic activity to nAmb a 1.01 regarding basophil activation. Overall, the results showed the successful expression of an rAmb a 1.01 with comparable characteristics to the corresponding natural isoform. Our findings provide the basis for an improvement in ragweed allergy research, diagnosis, and immunotherapy.

Ockham's Razor: The Application of Parsimonious Medicine in Allergy/Immunology

The spectacular advances of modern medicine have distracted clinicians from applying the age-old principles of thorough history and examination followed by only ordering tests relevant to the patient's presentation. The most obvious diagnosis is the most likely and should be addressed first. Ockham's razor, or parsimonious medicine, should be applied because plurality of diagnoses is less likely than a single explanation. Component-resolved diagnostics and biological therapies for allergy/immune-mediated diseases have been highly effective when used by specialist allergy services. However, they are accessed too easily and frequently, either before diagnostically appropriate allergy skin testing and challenge have been employed or before the reasons for poor disease control have been investigated. The current fashion to test for vitamin D insufficiency in patients with poorly controlled allergic diseases has rarely achieved benefit but significantly increased costs. There are considerable health/economic benefits from following the proven value of a thorough clinical history, examination, focused allergy/immunology testing, and the judicious use of Ockham's razor.

Molecular sensitization pattern to house dust mites is formed from the first years of life and includes group 1, 2, Der p 23, Der p 5, Der p 7 and Der p 21 allergens

BACKGROUND

As the process and nature of developing sensitivity to house dust mites (HDMs) remain not fully studied, our goal was to establish the pattern, nature and timeframe of house dust mite (HDM) sensitization development in patients in Ukraine as well as the period when treatment of such patients would be most effective.

METHODS

The data of the multiplex allergy test Alex² was collected from 20,033 patients. To determine age specifics of sensitization, descriptive statistics were used. Bayesian Network analysis was used to build probabilistic patterns of individual sensitization.

RESULTS

Patients from Ukraine were most often sensitized to HDM allergens of group 1 (Der p 1, Der f 1) and group 2 (Der p 2, Der f 2) as well as to Der p 23 (55%). A considerable sensitivity to Der p 5, Der p 7 and Der p 21 allergens was also observed. The overall nature of sensitization to HDM allergens among the population of Ukraine is formed within the first year of life. By this time, there is a pronounced sensitization to HDM allergens of groups 1 and 2 as well as to Der p 23. Significance of sensitization to Der p 5, Der p 7 and Der p 21 allergens grows starting from the age of 3-6. Bayesian Network data analysis indicated the leading role of sensitization to Der p 1 and Der f 2. While developing the sensitivity to group 5 allergens, the leading role may belong to Der p 21 allergen.

CONCLUSION

The results obtained indicate the importance of determining the sensitization profile using the multi-component approach. A more detailed study of the optimal age for AIT prescription is required as the pattern of sensitization to HDMs is formed during the first year of life.