ALEX – Allergy Explorer

New Allergy Test @ SRL Kabul

 WHAT IS ALLERGY?
∗ Allergy is a term to describe a misguided reaction of the
immune system. The term allergy itself is a combination of
the Greek words for unknown and reaction.
∗ Immune system is triggered by harmless substances (e.g.
pollen, mite particles, etc.), which leads to symptoms like
itchy eyes, rhinitis or in rare cases life-threatening
reactions (Anaphylactic shock).
∗ Antibodies of the IgE* class play a pivotal role in the
development of immediate type allergies. Without IgE,
allergy (Type I) is not possible.
 WHAT IS ALLERGY?
∗ Allergies affect around 25 % of the general population.
Many allergic patients do not take their allergy seriously
and are suffering from subsequent complications, e.g.
allergic asthma or are subject to unnecessary dietary
restrictions.
∗ Mostly allergy starts in childhood. Parents have to manage
the safety and unimpeded development of their child. To
help parents in this endeavor a proper diagnosis and early
therapeutic interventions are essential.
 Allergic reaction

∗ Manifestation of symptoms after repeated

exposure to an allergen after (latent) period
of sensitization
∗ IgE-mediated release of mediators and
zytokines from effector cells like mast cells,
eosinophils and T-lymphocytes
∗ Symptoms may occur in single organ but also
systemically
 What is IgE ?
∗ Immuno-Globulin Class E (IgE) is part of a molecule
class known as Immuno-Globulins or Antibodies.
∗ In healthy individuals function of IgE is to fight
parasitic infections.
∗ In allergic person IgE is misdirected to fight harmless
substances like Pollen or Dust Mite etc.
∗ Without the elevated levels of IgE, Type I allergies
(immediate type) do not occur.
 Manifestations of Allergy
∗ Eyes - allergic conjunctivitis
∗ Nose - allergic rhinitis
∗ larynx- angioedema
∗ Lung - allergic bronchial asthma
∗ Skin – urticaria, rash
∗ Gastrointestinal - diarrhea, abdominal cramps
∗ Systemic - Anaphylaxis
What is Dust Mite ? ∗ Signs of a dust mite
Allergy include:
• Coughing
• Facial pressure
• Dark skin under
eyes
• Congestion
• Sneezing
• Itchy & watery eyes
• Difficult breathing
• Skin irritations
 Skin Irritations and Watery Eyes?
Allergy with Dust Mites ?

∗ 4 out of 5 homes have dust mite infestations.

∗ A large number of people have asthma attacks &
catch other sicknesses. 50 % of asthma is attributed
to dust mites.
∗ There are 3 Major types of dust mites: “American”,
“European” and Euroglyphus maynei Dust mites and
other 30 thousand varieties.
∗ Approximately 100 thousand mites can live in a
square yard of carpet.
 Anaphylaxis
• Anaphylactic shock is a serious Allergy Reaction

• Symptoms are directly related to the massive release of

vasoactive substances leading to fall in blood pressure, shock,
difficulty in breathing and even death.

• It can be due to the following:

– Horse gamma globulin given to patients who are sensitized to
horse protein.
– Injection of a drug that is capable of acting as a hapten into a
patient who is sensitive, eg penicillin.
– Following a wasp or bee sting in highly sensitive individuals.
– Foods – peanuts, shellfish, etc.
 What testing is Required ?
∗ True food allergies are an immunological response to
specific food proteins
∗ Test methods can target proteins or the genetic material
that produces the proteins (DNA)
∗ The test method needs to be as specific as possible for
the food material of concern
∗ The test method need to be able to detect the material of
concern in as wide as possible a range of circumstances
(e.g. processed informs of the food including heat treated)
 What Techniques are Available?
∗ Protein-based methods that determine
proteins characteristic of the allergenic
source material (but not necessarily the allergenic
proteins)
∗ DNA-based methods targeted to a sequence
of DNA bp (may not be related to allergenic proteins)
∗ Most Test use protein-based methods (ELISA)
detecting a specific amino acids (epitope)
 Diagnostics in allergy

In vivo
∗ Skin-Prick testing, Intradermal testing

In vitro
∗ Specific IgE & Total IgE
Skin Prick Testing (SPT)
8 Year Old Child : Rhino Conjunctivitis since 2
years, end of May to middle of June
 Intra-dermal Allergy test (Prick test)

∗ Small amount of allergen injected into skin

Look for wheal
o test ∗- Intradermal formation
Allergy testof 3mmtest)
(Prick or greater in diameter
∗ Simple, inexpensive, can screen for multiple allergens.
∗ Stop anti-histamines 24-72 hours before test.
∗ Danger of systemic reaction
∗ Not for children under 3 Years
 Diagnostic test: Patch test – Epicutan test
Allergen containig adhesive tape is fixed to the back.
Evaluation after 48 & 96 hrs and later (6-8 days).

Steroids, antihistamins may influence the test result

 In vitro test
• Measure total IgE or antigen-specific IgE in serum
• Less sensitive than skin tests.
• RIST, RAST, Allergen specific and Microarray has
better sensitivity.

RAST RadioAllergoSorbent Test Protein array

 First in Afghanistan:
ALLEX Allergy Explorer
∗ Allergy Explorer is the first in vitro multiplex
allergy test allowing simultaneous measurement
of total IgE (tIgE) and specific IgE (sIgE) against a
wide range of allergen extracts and molecular
allergens.
∗ ALEX is based on a proprietary nano-bead
technology.
 Alex Allergy : Advantage

∗ Measurement of total and specific IgE

∗ Near-complete allergen panel, individually
optimized
∗ Multiplex test : Single Test for Complete Info
∗ Integrated CCD inhibition
 CCD Inhibitor ?
∗ The ALEX assay integrates a powerful Cross-reactive
Carbohydrate Determinants (CCDs) inhibitor.
∗ This clears up specific IgE results, helps in interpretation of
CCD positive patients and increase specificity of test results.
∗ Most allergen preparations originating from plants or insects
contain cross-reactive carbohydrate determinants (CCDs).
∗ IgE Antibodies directed against CCDs cross-react with all
proteins containing these CCD epitopes.
∗ Approximately 25 % of patients have anti-CCD IgEs, resulting in
a significant number of positive sIgE results, especially when
testing allergen extracts
 SIMULTANEOUS DETECTION OF tIgE, sIgE
EXTRACTS & sIgE MOLECULAR ALLERGENS
∗ Conventional single plex test is laborious in obtaining
completer allergy profiles.
∗ Many testing cycles required give clear diagnosis
∗ Total IgE has to be tested separately.
∗ To avoid fragmented approach, ALEX gives a near complete
picture of your patient’s situation including total IgE.
∗ More than 150 allergen extracts and more than 100 molecular
allergens are at your disposal.
∗ Exclusively available molecular allergens include risk
markers from storage protein families and other new
markers.
 INDICATION FOR IMMUNOTHERAPY
∗ Specific immunotherapy is a causal treatment for
allergic diseases especially in inhalative- and venom
allergies.
∗ With a diagnostic approach that only uses extracts, often
multiple allergen sources show a positive test result.
∗ These results can either indicate a true co-sensitization
or a cross-sensitization.
∗ To resolve this dilemma molecular allergens are used.
 PATIENT’S BENEFIT

∗ As a Patient you profit from this comprehensive

approach by getting the therapy and the advice
you need in the quickest way possible: