Precision allergy molecular diagnostic applications in anaphylaxis: from triggers to risk stratification and...

Precision allergy molecular diagnostic applications (PAMD@), previously referred to as component-resolved diagnosis (CRD), has progressively transformed the diagnostic approach to anaphylaxis. This review aims to provide an updated overview of its clinical utility, focusing on its role in improving etiologic identification, risk stratification, and patient management in anaphylaxis.

Advances in molecular allergology have expanded the range of available allergen components and improved the diagnostic accuracy of IgE-mediated testing. Specific molecular patterns are now clearly associated with clinically relevant sensitization and severity risk, particularly in food allergy (e.g. seed storage proteins, nsLTPs), hymenoptera venom allergy, cofactor-enhanced anaphylaxis (e.g. ω-5 gliadin or nsLTP), and delayed red meat allergy (α-gal). PAMD@ has demonstrated higher specificity compared with extract-based tests, allowing better discrimination between true allergy and cross-reactivity, reducing unnecessary dietary restrictions and diagnostic challenges. Emerging evidence also supports its role in guiding allergen immunotherapy and refining risk assessment in complex or idiopathic classified cases.

PAMD@ represents a major step toward precision medicine in anaphylaxis, shifting the paradigm from extract-based sensitization profiling to mechanism-based, clinically actionable diagnosis. Its integration into structured diagnostic algorithms enhances clinical decision-making, supports personalized management strategies, and improves patient safety. However, its optimal use requires careful interpretation within the context of clinical history and local sensitization patterns.