Purpose of review: To summarize recent data on molecular profiles of IgE sensitization in allergic patients and discuss how they can influence our understanding of allergen specific immunotherapy.
Recent findings: In childhood, Immunoglobulin E (IgE) sensitization to grass pollen starts preclinically as a weak, mono or oligomolecular response and evolves rapidly to become strong, polymolecular and associated with clinical manifestations. This immunological phenomenon has been defined 'molecular spreading' and it makes the IgE sensitization profiles to complex allergenic sources highly heterogeneous in the population.
Summary: The recent findings raise new questions: do different molecular sensitization profiles (e.g. to grass pollen) underlie different clinical responses to allergen-specific immunotherapy? Should the allergen-specific immunological intervention be anticipated at earlier stages of the IgE sensitization process? Should the regulatory rules for molecularly designed allergen-specific immunotherapy preparations consider the extreme heterogeneity of sensitization profiles in populations?