Debiasi Markus, Pichler Herbert, Klinglmüller Florian, Boztug Heidrun, Schmidthaler Klara, Rech Jonas, Scherer David, Lupinek Christian, Valenta Rudolf, Kacinska-Pfaller Ewa, Geyeregger Rene, Fritsch Gerhard, Haas Oskar A, Peters Christina, Lion Thomas, Akdis Mübeccel, Matthes Susanne, Akdis Cezmi A, Szépfalusi Zsolt, Eiwegger Thomas
Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
Department of Pediatrics and Adolescent Medicine, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria.
Allergy. 2020 Sep;75(9):2243-2253. doi: 10.1111/all.14278. Epub 2020 Jun 23.
Currently, no estimates can be made on the impact of hematopoietic stem cell transplantation on allergy transfer or cure of the disease. By using component-resolved diagnosis, we prospectively investigated 50 donor-recipient pairs undergoing allogeneic stem cell transplantation. This allowed calculating the rate of transfer or maintenance of allergen-specific responses in the context of stem cell transplantation.
Allergen-specific IgE and IgG to 156 allergens was measured pretransplantation in 50 donors and recipients and at 6, 12 and 24 months in recipients post-transplantation by allergen microarray. Based on a mixed effects model, we determined risks of transfer of allergen-specific IgE or IgG responses 24 months post-transplantation.
After undergoing stem cell transplantation, 94% of allergen-specific IgE responses were lost. Two years post-transplantation, recipients' allergen-specific IgE was significantly linked to the pretransplantation donor or recipient status. The estimated risk to transfer and maintain individual IgE responses to allergens by stem cell transplantation was 1.7% and 2.3%, respectively. Allergen-specific IgG, which served as a surrogate marker of maintaining protective IgG responses, was highly associated with the donor's (31.6%) or the recipient's (28%) pretransplantation response.
Hematopoietic stem cell transplantation profoundly reduces allergen-specific IgE responses but also comes with a considerable risk to transfer allergen-specific immune responses. These findings facilitate clinical decision-making regarding allergic diseases in the context of hematopoietic stem cell transplantation. In addition, it provides prospective data to estimate the risk of transmitting allergen-specific responses via hematopoietic stem cell transplantation.
目前，无法评估造血干细胞移植对过敏传递或疾病治愈的影响。通过使用组分分辨诊断，我们前瞻性地研究了50对接受异基因干细胞移植的供受者对。这使得能够计算在干细胞移植背景下过敏原特异性反应的传递或维持率。
通过过敏原微阵列在50名供者和受者移植前以及受者移植后6个月、12个月和24个月测量针对156种过敏原的过敏原特异性IgE和IgG。基于混合效应模型，我们确定了移植后24个月过敏原特异性IgE或IgG反应传递的风险。
接受干细胞移植后，94%的过敏原特异性IgE反应消失。移植后两年，受者的过敏原特异性IgE与移植前供者或受者状态显著相关。通过干细胞移植传递和维持个体对过敏原的IgE反应的估计风险分别为1.7%和2.3%。作为维持保护性IgG反应替代标志物的过敏原特异性IgG与供者（31.6%）或受者（28%）移植前反应高度相关。
造血干细胞移植可显著降低过敏原特异性IgE反应，但也存在传递过敏原特异性免疫反应的相当大风险。这些发现有助于在造血干细胞移植背景下针对过敏性疾病进行临床决策。此外，它提供了前瞻性数据以估计通过造血干细胞移植传递过敏原特异性反应的风险。
