Diagnostic Challenges in Complex and Severe Allergic Conditions

Dear Colleagues,

Complex and severe allergic conditions present significant diagnostic difficulties, often leading to delays in accurate diagnosis and appropriate management. While classic allergies are frequently recognizable, conditions such as severe anaphylaxis with atypical presentations, eosinophilic granulomatosis with polyangiitis (EGPA), and pollen food allergy syndrome (PFS) pose unique challenges. Their multifaceted clinical manifestations, overlapping features with other disorders, and the current limitations of standard diagnostic tools often result in diagnostic uncertainty.

A critical challenge lies in the stratification of severe anaphylaxis. Triggers can be elusive, and reactions may be heterogeneous, complicating the identification of high-risk patients and the implementation of effective preventive strategies. In EGPA, diagnosis requires the careful integration of clinical, histological, and laboratory findings to distinguish it from other Hypereosinophilic syndromes or vasculitides. Similarly, PFS, characterized by oropharyngeal symptoms in response to specific plant-derived foods, is often underrecognized, and its links to particular pollen sensitization patterns require clearer delineation for improved diagnosis and patient counseling. The evolving understanding of endotypes within these conditions—driven by insights into immune pathways, biomarkers, and cellular mechanisms—promises to refine our diagnostic approach and move beyond purely clinical definitions.

This Special Issue, “Diagnostic Challenges in Complex and Severe Allergic Conditions,” will highlight the latest research and clinical insights into diagnosing these complex and severe allergic conditions. We will cover topics ranging from novel biomarkers and advanced immunologic testing to clinical phenotyping and the application of new diagnostic criteria. We warmly welcome the submission of original research articles, comprehensive reviews, and case series that explore improved diagnostic strategies for severe anaphylaxis, EGPA, PFS, and other complex allergic diseases. Submissions addressing the integration of multi-parameter diagnostics, the utility of emerging technologies, or strategies to overcome current diagnostic hurdles in clinical practice are particularly encouraged.

Prof. Dr. Yuxiang Zhi
Guest Editor

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