Di Lorenzo Gabriele, Mansueto Pasquale, Pacor Maria Luisa, Rizzo Manfredi, Castello Francesco, Martinelli Nicola, Ditta Vito, Lo Bianco Claudia, Leto-Barone Maria Stefania, D'Alcamo Alberto, Di Fede Gaetana, Rini Giovam Battista, Ditto Anne Marie
Dipartimento di Medicina Clinica e delle Patologie Emergenti, Università degli Studi di Palermo, Palermo, Italy.
J Allergy Clin Immunol. 2009 May;123(5):1103-10, 1110.e1-4. doi: 10.1016/j.jaci.2009.02.012. Epub 2009 Apr 7.
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.
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.
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.
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.
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.
迄今为止，尚无针对变应原特异性免疫疗法（ASI）临床反应的预测性检测方法。因此，体内或体外检测将具有重要价值。
我们试图评估用于诊断变应性鼻炎和测定血清特异性IgE（s-IgE）水平、血清总IgE（t-IgE）水平及血液嗜酸性粒细胞计数的治疗前参数，并确定其是否可用于预测接受免疫疗法治疗的单纯致敏变应性鼻炎患者（无论有无哮喘）的临床改善情况。
我们分析了279例接受了4年ASI治疗的患者，治疗途径为皮下免疫疗法（76例患者）或舌下免疫疗法（203例患者）。计算血清t-IgE和s-IgE水平、血液嗜酸性粒细胞计数以及血清s-IgE/t-IgE比值，并检测其与ASI临床反应的相关性。绘制受试者工作特征曲线。计算预测概率和曲线下预测面积。
在279例患者中，145例（52.0%）对ASI临床反应有效，皮下免疫疗法治疗的76例患者中有42例（55.2%）有效，舌下免疫疗法治疗的203例患者中有103例（50.7%）有效。发现血清s-IgE/t-IgE比值与ASI临床反应之间存在显著相关性，高比值（>16.2）与有效反应相关。该比值曲线下面积的敏感性和特异性高于单独的血清s-IgE和t-IgE。
计算血清s-IgE/t-IgE比值以预测ASI的临床反应，相较于测量单纯致敏患者对以下变应原的t-IgE和s-IgE水平具有优势：草、墙草、油橄榄、屋尘螨。
