Department of Faculty Therapy, Endocrinology, Allergology and Immunology, Ural State Medical University, Ekaterinburg, Russia.
Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
Front Immunol. 2022 Sep 21;13:941492. doi: 10.3389/fimmu.2022.941492. eCollection 2022.
Molecular therapies, including anti-IgE, biologicals and small molecules are increasingly used for treatment of asthma. The effectiveness of these therapies may be increased with biomarkers. Aim of this study was to assess the value of measuring cumulative IgE levels specific for respiratory allergens to increase the efficacy of anti-IgE therapy for severe bronchial asthma. One hundred and thirty seven patients with severe asthma were recruited from 2016 to 2022. Standard empirical allergy diagnosis (i.e., anamnesis, skin testing, allergen-specific IgE measurement), blood eosinophil counting, measurement of total IgE and of cumulative IgE-specific for respiratory allergens by Phadiatop™ were performed. Thirty four patients with severe allergic asthma, for whom all three diagnostic methods were performed, were then used to analyze the efficacy of anti-IgE treatment in patients stratified in two groups according to cumulative IgE levels specific for respiratory allergens determined by Phadiatop™. Group #1 patients (n = 8) had cumulative specific IgE values ≥ 0.35 and < 1.53 PAU/l while in group #2 patients (n = 26) they were ≥ 1.53 PAU/l. Treatment with Omalizumab was performed for at least 12 months. The level of asthma control (ACT questionnaire), the number of asthma exacerbations, the quality of life (AQLQ questionnaire), the need for systemic corticosteroids, and the respiratory function (FEV1) was determined by "before-after" analysis for each group, followed by a comparison of the dynamics between groups. In group 2 patients with an initial allergen-specific IgE level ≥ 1.53 kUA/L, the efficacy of Omalizumab treatment was better regarding asthma control, number of exacerbations, and quality of life than in group 1 patients. Our study provides evidence that measuring cumulative levels of IgE specific for respiratory allergens could be a useful screening method for detecting an allergic phenotype of severe asthma and may serve as biomarker to enhance the success of IgE-targeted therapy.
分子疗法，包括抗 IgE、生物制剂和小分子，越来越多地用于治疗哮喘。这些疗法的有效性可以通过生物标志物来提高。本研究的目的是评估测量针对呼吸道过敏原的累积 IgE 水平以提高抗 IgE 治疗严重支气管哮喘的疗效。从 2016 年到 2022 年，从 137 名严重哮喘患者中招募。进行了标准的经验性过敏诊断（即病史、皮肤测试、过敏原特异性 IgE 测量）、血嗜酸性粒细胞计数、总 IgE 测量和通过 Phadiatop™测量针对呼吸道过敏原的累积 IgE 特异性。然后，使用针对严重过敏性哮喘的 34 名患者（对所有三种诊断方法均进行了分析），根据 Phadiatop™确定的针对呼吸道过敏原的累积特异性 IgE 水平，将患者分为两组，分析抗 IgE 治疗的疗效。组 #1 患者（n = 8）的累积特异性 IgE 值≥0.35 和 <1.53 PAU/l，而组 #2 患者（n = 26）的累积特异性 IgE 值≥1.53 PAU/l。奥马珠单抗治疗至少 12 个月。使用“前后”分析确定每组的哮喘控制水平（ACT 问卷）、哮喘加重次数、生活质量（AQLQ 问卷）、对全身皮质类固醇的需求以及呼吸功能（FEV1），然后比较两组之间的动态变化。在初始过敏原特异性 IgE 水平≥1.53 kUA/L 的组 2 患者中，奥马珠单抗治疗在哮喘控制、发作次数和生活质量方面的疗效优于组 1 患者。我们的研究提供了证据，表明测量针对呼吸道过敏原的累积 IgE 水平可能是一种有用的筛查方法，用于检测严重哮喘的过敏表型，并可作为增强 IgE 靶向治疗成功的生物标志物。
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