Allergic cross‐reactivity: from gene to the clinic

A large number of allergenic proteins have now their complete cDNA sequences determined and in some cases also the 3D structures. It turned out that most allergens could be grouped into a small number of structural protein families, regardless of their biological source. Structural similarity among proteins from diverse sources is the molecular basis of allergic cross‐reactivity. The clinical relevance of immunoglobulin E (IgE) cross‐reactivity seems to be influenced by a number of factors including the immune response against the allergen, exposure and the allergen. As individuals are exposed to a variable number of allergenic sources bearing homologous molecules, the exact nature of the antigenic structure inducing the primary IgE immune response cannot be easily defined. In general, the ‘cross‐reactivity’ term should be limited to defined clinical manifestations showing reactivity to a source without previous exposure. ‘Co‐recognition’, including by definition ‘cross‐reactivity’, could be used to describe the large majority of the IgE reactivity where co‐exposure to a number of sources bearing homologous molecules do not allow unequivocal identification of the sensitizing molecule. The analysis of reactivity clusters in diagnosis allows the interpretation of the patient's reactivity profile as a result of the sensitization process, which often begins with exposure to a single allergenic molecule.