Assessing cross-reactivity in allergen immunotherapy

Knowledge of patterns of pollen cross-reactivity is crucial for formulation of immunotherapy vaccines. As phylogenetic relationships have become better clarified through the use of tools such as gene sequencing, it is apparent that cross-reactivity reflects taxonomy in the vast majority of cases. Contradictory observations of unexpected cross-reactivity between distantly related plants require explanation. There are many proteins, presumably performing vital functions, tightly preserved throughout the evolutionary tree from plants to animals. Examples are profilins, lipid transfer proteins, and pathogenesis-related proteins. These may function as panallergens. The small differences that exist between these ubiquitous proteins may explain why these are frequently minor allergens, not reacting in the majority of allergic sera. This article summarizes cross-reactivity from older studies using crude pollen extracts as well as newer research of purified or recombinant allergenic proteins. The patterns of cross-allergenicity that emerge should be helpful in guiding therapeutic decisions.