The effect of component-resolved diagnosis on specific immunotherapy prescription in children with hay fever

• Published in: Journal of allergy and clinical immunology Vol. 134; no. 1; pp. 75 - 81.e2
• Main Authors: Stringari, Giovanna, MD, Tripodi, Salvatore, MD, Caffarelli, Carlo, MD, Dondi, Arianna, MD, Asero, Riccardo, MD, Di Rienzo Businco, Andrea, MD, Bianchi, Annamaria, MD, Candelotti, Paolo, MD, Ricci, Giampaolo, MD, Bellini, Federica, MD, Maiello, Nunzia, MD, Miraglia del Giudice, Michele, MD, Frediani, Tullio, MD, Sodano, Simona, MD, Dello Iacono, Iride, MD, Macrì, Francesco, MD, Peparini, Ilaria, MD, Povesi Dascola, Carlotta, MD, Patria, Maria Francesca, MD, Varin, Elena, MD, Peroni, Diego, MD, Comberiati, Pasquale, MD, Chini, Loredana, MD, Moschese, Viviana, MD, Lucarelli, Sandra, MD, Bernardini, Roberto, MD, Pingitore, Giuseppe, MD, Pelosi, Umberto, MD, PhD, Tosca, Mariangela, MD, Cirisano, Anastasia, MD, Faggian, Diego, Biol Sci, Travaglini, Alessandro, MSc, Plebani, Mario, MD, Matricardi, Paolo Maria, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2014; Elsevier; Elsevier Limited
• Subjects: Adolescent; Allergens - chemistry; Allergens - immunology; Allergic rhinitis; Allergies; Allergy and Immunology; Asthma; Betulaceae; Biological and medical sciences; Child; Child, Preschool; children; component-resolved diagnosis; Cross Reactions; Cupressus; Desensitization, Immunologic - methods; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Gene Expression; Humans; IgE; Immunoglobulin E - blood; Immunopathology; Immunotherapy; Male; Medical sciences; Non tumoral diseases; Olea; Otorhinolaryngology. Stomatology; panallergens; Pediatrics; Plants - immunology; Pollen; Pollen - chemistry; Pollen - immunology; profilin; Profilins - genetics; Profilins - immunology; Rhinitis, Allergic, Seasonal - diagnosis; Rhinitis, Allergic, Seasonal - immunology; Rhinitis, Allergic, Seasonal - pathology; Rhinitis, Allergic, Seasonal - therapy; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Skin Tests; specific immunotherapy; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Italy; EAACI; European Academy of Allergology and Clinical Immunology; profilin; pollen; IgE; Skin prick test; component-resolved diagnosis; AR; Allergic Rhinitis and its Impact on Asthma; CRD; children; Allergic rhinitis; SPT; ARIA; panallergens; specific immunotherapy; SIT; Human; Prescription; Allergy; Immunopathology; Nose disease; Rhinitis; Panallergen; Immunology; Treatment; Immunotherapy; ENT disease; Pollen; Diagnosis; Profilin; Child
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2014.01.042

Background Sensitization to profilins and other cross-reacting molecules might hinder proper specific immunotherapy (SIT) prescription in polysensitized patients with pollen-related allergic rhinitis (AR). In these patients, component-resolved diagnosis (CRD) might modify SIT prescription by improving the identification of the disease-eliciting pollen sources. Objectives We sought to measure the effect of CRD on SIT prescription in children with pollen-related AR. Methods Children (n = 651) with moderate-to-severe pollen-related AR were recruited between May 2009 and June 2011 in 16 Italian outpatient clinics. Skin prick test (SPT) reactivity to grass, cypress, olive, mugwort, pellitory, and/or Betulaceae pollen was considered clinically relevant if symptoms occurred during the corresponding peak pollen season. IgE sensitization to Phl p 1, Phl p 5, Bet v 1, Cup a 1, Art v 1, Ole e 1, Par j 2, and Phl p 12 (profilin) was measured by using ImmunoCAP. SIT prescription was modeled on SPT responses first and then remodeled considering also CRD according to GA2 LEN–European Academy of Allergology and Clinical Immunology guidelines and the opinions of 14 pediatric allergists. Results No IgE to the respective major allergens was detected in significant proportions of patients with supposed clinically relevant sensitization to mugwort (45/65 [69%]), Betulaceae (146/252 [60%]), pellitory (78/257 [30%]), olive (111/390 [28%]), cypress (28/184 [15%]), and grass (56/568 [10%]). IgE to profilins, polcalcins, or both could justify 173 (37%) of 464 of these SPT reactions. After CRD, the SPT-based decision on SIT prescription or composition was changed in 277 (42%) of 651 or 315 (48%) of 651 children according to the European or American approach, respectively, and in 305 (47%) of 651 children according to the opinion of the 14 local pediatric allergists. Conclusions In children with pollen-related AR, applying CRD leads to changes in a large proportion of SIT prescriptions as opposed to relying on clinical history and SPT alone. The hypothesis that CRD-guided prescription improves SIT efficacy deserves to be tested.