Are the Terms Major and Minor Allergens Useful for Precision Allergology?
Caraballo L, Valenta R, Acevedo N, Zakzuk J. Front Immunol. 2021 Mar 8;12:651500.
doi:10.3389/fimmu.2021.651500.
Introduction
Scientific advances in the molecular characterization of IgE-binding molecules, together with the development of precision medicine, have revealed great limitations on classifying allergens as majors and minors, which considers mainly their IgE-binding frequency. This has become more evident with the discovery of strong allergenic activity in molecules with low IgE-binding frequency, which activate non-IgE-mediated inflammatory mechanisms. Therefore, it is necessary to make the pertinent modifications and to outline a different way to interpret the IgE-binding property of allergens, according to precision allergology. This article analyzes the origin and evolution of the current classification, supports the need for a different way to evaluate the clinical importance of allergens and suggests abandoning the practice of classifying them based on their IgE binding frequency. Since house dust mites (HDM) are so important as inducers of asthma and allergic rhinitis, the analysis is based on the IgE-binding components from Dermatophagoides pteronyssinus and Blomia tropicalis. However, the main concepts and the conclusions are valid for most allergens from other sources, even taking into account their peculiarities.