RESUMO
Polysensitizations to tree, grass, and weed pollen are found in ~ 20% of pollen-allergic individuals. They are often based on broad IgE cross-reactivities to pollen panallergens belonging to highly conserved protein families: 1. profilins, 2. polcalcins (calcium-binding proteins in pollen), 3. cyclophilins. They represent highly conserved cross-reactive minor allergens present in all pollen species, but also in plant foods and other organisms. Despite being rarely clinically relevant they can hamper allergy diagnostic tests with extracts. In this situation, molecular allergy diagnosis is able to distinguish broad cross-reactivity due to allergen-specific IgE to pollen panallergens (i.e. profilins Bet v 2 or Phl p 12; polcalcins Bet v 4 or Phl p 7; and, in the future, cyclophilins Bet v 7 or Ole e 15) from primary IgE sensitizations to so-called marker allergens represented by important pollen major allergens: Bet v 1 for the birch and beech family (Fagales), Ole e 1 for olive and ash (Oleaceae), Phl p 1 for temperate climate grasses (Poaceae), Art v 1 for mugwort (Artemisia), Amb a 1 for Ambrosia species (Ambrosia). Five typical cases (A - E) with positive skin prick test results to tree, grass, and weed pollen extracts demonstrate typical patterns of IgE sensitization with a variable impact of pollen panallergens: A - profilins, B - polcalcins, C - profilins and polcalcins, D - presumably cyclophilins, E - primary polysensitization to tree, grass, and weed pollen without interference from profilins or polcalcins. Differences between pollen extract-based skin prick test diagnosis and molecular allergen-specific IgE testing are explained using the presented concept. This approach allows to reduce the number of allergen extracts - presuming they are also clinically relevant - for allergen immunotherapy (i.e., only tree and/or grass pollen extracts), particularly in pollen-polysensitized patients.
RESUMO
Encoding and maintenance of information in visual working memory have been extensively studied, highlighting the crucial and capacity-limiting role of fronto-parietal regions. In contrast, the neural basis of recognition in visual working memory has remained largely unspecified. Cognitive models suggest that recognition relies on a matching process that compares sensory information with the mental representations held in memory. To characterize the neural basis of recognition we varied both the need for recognition and the degree of similarity between the probe item and the memory contents, while independently manipulating memory load to produce load-related fronto-parietal activations. fMRI revealed a fractionation of working memory functions across four distributed networks. First, fronto-parietal regions were activated independent of the need for recognition. Second, anterior parts of load-related parietal regions contributed to recognition but their activations were independent of the difficulty of matching in terms of sample-probe similarity. These results argue against a key role of the fronto-parietal attention network in recognition. Rather the third group of regions including bilateral temporo-parietal junction, posterior cingulate cortex and superior frontal sulcus reflected demands on matching both in terms of sample-probe-similarity and the number of items to be compared. Also, fourth, bilateral motor regions and right superior parietal cortex showed higher activation when matching provided clear evidence for a decision. Together, the segregation between the well-known fronto-parietal activations attributed to attentional operations in working memory from those regions involved in matching supports the theoretical view of separable attentional and mnemonic contributions to working memory. Yet, the close theoretical and empirical correspondence to perceptual decision making may call for an explicit consideration of decision making mechanisms in conceptions of working memory.
