Alternatives to the allergen-specific nasal provocation test: role of molecular allergens for grasses in poly-sensitized children with seasonal allergic rhinitis

Allergic rhinitis (AR) affects 10-30% of the global population, notably children and adolescents, leading to reduced quality of life and comorbidities like asthma. An Italian multicenter study indicated that 85% of children tested positive for multiple pollen allergens, with Timothy grass predominant. IgE antibodies against Phleum Pratense, Bermuda grass, olive, and cypress are highly prevalent in southern Europe, where overlapping pollination periods complicate the identification of specific seasonal allergens in poly-sensitized patients. For some patients, allergen-specific immunotherapy is necessary when symptomatic therapy is insufficient. Molecular diagnostics and nasal provocation testing (NPT) are crucial to identify relevant allergens. NPT remains the gold standard for documenting clinical relevance in seasonal AR, but is challenging in poly-sensitized children. Non-invasive strategies, e-Diary for symptoms, and IgE-specific activity analysis are being explored. This summary reviews the predictive value of clinical and biological data for NPT outcomes in pediatric patients co-sensitized to grasses and other seasonal pollens. Clinical data assessed with the visual analogue scale can predict NPT outcomes. Biological data, including specific IgE levels and skin prick tests, have shown varying predictive values. Combining clinical scores and biological markers, such as IgE-specific activity for grass-pollen molecules, enhances prediction accuracy for positive NPT outcomes