变应性鼻炎患儿特异性免疫治疗中成分诊断的作用。

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

机构信息

Department of Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany; Pediatric Department, Unit of Allergy and Immunology in Evolutive Age, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.

Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy.

出版信息

J Allergy Clin Immunol. 2014 Jul;134(1):75-81. doi: 10.1016/j.jaci.2014.01.042. Epub 2014 May 1.

DOI:10.1016/j.jaci.2014.01.042

PMID:24794684

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 GA(2)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.

摘要

背景

对原肌球蛋白和其他交叉反应分子的致敏可能会阻碍多敏患者花粉相关过敏性鼻炎（AR）的正确特异性免疫治疗（SIT）处方。在这些患者中，成分分辨诊断（CRD）可以通过提高对引发疾病花粉源的识别来修改 SIT 处方。

目的

我们旨在测量 CRD 对花粉相关 AR 儿童 SIT 处方的影响。

方法

2009 年 5 月至 2011 年 6 月，在意大利的 16 个门诊诊所招募了 651 名患有中度至重度花粉相关 AR 的儿童。如果症状发生在相应的花粉高峰期，则认为草、柏树、橄榄、艾蒿、荨麻、贝氏花和/或桦木科花粉的皮肤点刺试验（SPT）反应具有临床相关性。通过使用 ImmunoCAP 测量对 Phl p 1、Phl p 5、Bet v 1、Cup a 1、Art v 1、Ole e 1、Par j 2 和 Phl p 12（原肌球蛋白）的 IgE 致敏。首先根据 SPT 反应对 SIT 处方进行建模，然后根据 GA(2)LEN-欧洲过敏与临床免疫学会指南和 14 名儿科过敏专家的意见，考虑到 CRD 进行重塑。

结果

在被认为对艾蒿（45/65 [69%]）、桦木科（146/252 [60%]）、荨麻（78/257 [30%]）、橄榄（111/390 [28%]）、柏树（28/184 [15%]）和草（56/568 [10%]）有临床相关致敏的患者中，显著比例的患者没有相应主要过敏原的 IgE。IgE 到原肌球蛋白、钙调蛋白或两者都可以解释 464 个 SPT 反应中的 173 个（37%）。根据欧洲或美国的方法，在 651 名儿童中的 277 名（42%）或 651 名儿童中的 315 名（48%），根据 14 名当地儿科过敏专家的意见，在 651 名儿童中的 305 名（47%），基于 SPT 的 SIT 处方或成分决定在应用 CRD 后发生了变化。