Evaluation of serum s-IgE/total IgE ratio in predicting clinical response to allergen-specific immunotherapy

• Published in: Journal of allergy and clinical immunology Vol. 123; no. 5; pp. 1103 - 1110.e4
• Main Authors: Di Lorenzo, Gabriele, MD, Mansueto, Pasquale, MD, Pacor, Maria Luisa, MD, Rizzo, Manfredi, MD, Castello, Francesco, MD, Martinelli, Nicola, MD, Ditta, Vito, MD, Lo Bianco, Claudia, MD, Leto-Barone, Maria Stefania, MD, D'Alcamo, Alberto, MD, Di Fede, Gaetana, MD, Rini, Giovam Battista, MD, Ditto, Anne Marie, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.05.2009; Elsevier; Elsevier Limited
• Subjects: Adolescent; Adult; Allergen-specific immunotherapy; Allergens - immunology; Allergies; Allergy and Immunology; Asthma; Biological and medical sciences; Blood Cell Count; blood eosinophil counts; Clinical medicine; Colleges & universities; Dermatophagoides pteronyssinus; Desensitization, Immunologic; Eosinophils - immunology; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunoglobulin E - blood; Immunopathology; Judaica; Male; Medical sciences; Medical treatment; Methods; Middle Aged; Olea europaea; Parietaria judaica; Patients; Prognosis; receiver operating characteristic curve; Retrospective Studies; Rhinitis, Allergic, Perennial - immunology; Rhinitis, Allergic, Perennial - therapy; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; serum-specific IgE/serum total IgE ratio; Skin Tests; specific IgE; Spirometry; total IgE; Treatment Outcome; Young Adult; Italy; SLIT; b-eos; s-IgE; ROC; Subcutaneous immunotherapy; Skin prick test; VAS; House dust mite; specific IgE; blood eosinophil counts; receiver operating characteristic curve; Sublingual immunotherapy; HDM; Visual analog scale; Blood eosinophils; Allergen-specific immunotherapy; total IgE; serum-specific IgE/serum total IgE ratio; Receiver operating characteristic; SPT; t-IgE; ASI; SCIT; Immunopathology; Desensitization; Specific IgE; Granulocyte; Eosinophil; Immunology; Treatment; Immunotherapy; Receiver operating characteristic curves; Serum; Blood cell count
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2009.02.012

Background To date, no predictive tests for the clinical response to allergen-specific immunotherapy (ASI) are available. Therefore an in vivo or in vitro test would be of great value. Objective We sought to evaluate pretreatment parameters used in diagnosing allergic rhinitis and determining serum specific IgE (s-IgE) levels, serum total IgE (t-IgE) levels, and blood eosinophil counts and to identify whether can be used to predict clinical improvement in monosensitized patients with allergic rhinitis with or without asthma treated with immunotherapy. Methods We analyzed 279 patients who had undergone 4 years of ASI administered either by means of the subcutaneous immunotherapy (76 patients) or sublingual immunotherapy (203 patients) routes. Serum t-IgE and s-IgE levels, blood eosinophil counts, and serum s-IgE/t-IgE ratios were calculated and tested for correlation with clinical response to ASI. Receiver operating characteristic curves were determined. Predicted probabilities and predictive areas under the curve were calculated. Results The clinical response to ASI was effective in 145 (52.0%) of 279 total patients, 42 (55.2%) of 76 patients treated with subcutaneous immunotherapy, and 103 (50.7%) of 203 patients treated with sublingual immunotherapy. A significant correlation was found between the serum s-IgE/t-IgE ratio and the clinical response to ASI, with high ratios (>16.2) associated with an effective response. The sensitivity and specificity of the area under the curve of the ratio were higher than those of serum s-IgE and t-IgE alone. Conclusion The calculation of the serum s-IgE/t-IgE ratio for predicting the clinical response to ASI offers an advantage over measuring t-IgE and s-IgE levels in monosensitized patients for the following allergens: grass, Parietaria judaica , Olea europea , and house dust mite.