Modern health care requires a proactive and individualized response to diseases, combining precision diagnosis and personalized treatment. Accordingly, the approach to patients with allergic diseases encompasses novel developments in the area of personalized medicine, disease phenotyping and endotyping, and the development and application of reliable biomarkers. A detailed clinical history and physical examination followed by the detection of IgE immunoreactivity against specific allergens still represents the state of the art. However, nowadays, further emphasis focuses on the optimization of diagnostic and therapeutic standards and a large number of studies have been investigating the biomarkers of allergic diseases, including asthma, atopic dermatitis, allergic rhinitis, food allergy, urticaria and anaphylaxis. Various biomarkers have been developed by omics technologies, some of which lead to a better classification of distinct phenotypes or endotypes. The introduction of biologicals to clinical practice increases the need for biomarkers for patient selection, prediction of outcomes and monitoring, to allow for an adequate choice of the duration of these costly and long-lasting therapies. Escalating healthcare costs together with questions about the efficacy of the current management of allergic diseases require further development of a biomarker-driven approach. Here, we review biomarkers in diagnosis and treatment of asthma, atopic dermatitis, allergic rhinitis, viral infections, chronic rhinosinusitis, food allergy, drug hypersensitivity and allergen immunotherapy with a special emphasis on specific IgE, the microbiome and the epithelial barrier. In addition, EAACI guidelines on biologicals are discussed within the perspective of biomarkers.

Allergy Asthma and Clinical Immunology Service Alfred Health Melbourne Vic Australia

Allergy Unit Regional University Hospital of Malaga IBIMA UMA ARADyAL Malaga Spain

Chair and Institute of Environmental Medicine UNIKA T Technical University of Munich and Helmholtz Zentrum München Augsburg Germany

CK CARE Christine Kühne Center for Allergy Research and Education Davos Switzerland

Department of Allergy and Clinical Immunology Faculty of Medicine Transylvania University of Brasov Brasov Romania

Department of Allergy immunology and Respiratory Medicine Central Clinical School Monash University Melbourne Vic Australia

Department of Clinical Pharmacy and Pharmacology University of Groningen University Medical Center Groningen Groningen Netherlands

Department of Immunology University of Toronto Toronto ON Canada

Department of Otolaryngology Head and Neck Surgery and Department of Allergy Beijing TongRen Hospital Beijing China

Department of Otolaryngology Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore

Department of Otorhinolaryngology Amsterdam University Medical Centres Amsterdam The Netherlands

Department of Otorhinolaryngology Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps Universität Marburg Marburg Germany

Department of Respiratory Medicine 1st Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic

Department of Respiratory Medicine and Allergology Institute for Clinical Science Skane University Hospital Lund University Lund Sweden

Departments of Medicine and Microbiology APC Microbiome Ireland National University of Ireland Cork Ireland

Division of Immunology and Allergy Food Allergy and Anaphylaxis Program The Hospital for Sick Children Departments of Paediatrics and Immunology University of Toronto Toronto ON Canada

Institute of Pathophysiology and Allergy Research Medical University of Vienna Vienna Austria

Otorhinolaryngology Hospital The 1st Affiliated Hospital Sun Yat Sen University Guangzhou China

Sean N Parker Center for Allergy and Asthma Research Stanford University Stanford CA USA

Swiss Institute of Allergy and Asthma Research University Zurich Davos Switzerland

Translational Medicine Program Research Institute Hospital for Sick Children Toronto ON Canada

ZIEL Institute for Food and Health Technical University of Munich Freising Weihenstephan Germany

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