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The effect of component-resolved diagnosis on specific immunotherapy prescription in children with hay fever
- Publication Year :
- 2014
-
Abstract
- 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 GA2LEN-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. © 2014 American Academy of Allergy, Asthma and Immunology.
- Subjects :
- Male
Allergy
component-resolved diagnosis
Profilin
Gene Expression
Immunoglobulin E
Allergic rhinitis
Profilins
Mugwort
Outpatient clinic
Immunology and Allergy
Child
Sensitization
panallergens
biology
Skin Test
Allergen
Medicine (all)
Plants
medicine.anatomical_structure
panallergen
pollen
Child, Preschool
Hay fever
Cross Reaction
Female
IgE
Allergic rhinitis, children, component-resolved diagnosis, IgE, panallergens, pollen, profilin, specific immunotherapy
specific immunotherapy
Human
medicine.medical_specialty
Adolescent
Immunology
Cross Reactions
component-resolved diagnosi
NO
children
Internal medicine
medicine
Allergic rhiniti
Humans
Medical prescription
Skin Tests
Settore MED/38 - Pediatria Generale e Specialistica
business.industry
Rhinitis, Allergic, Seasonal
Plant
Allergens
medicine.disease
Desensitization, Immunologic
biology.protein
Allergists
profilin
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....90d8a8dc186e3f7535dd51430faeb96b