Manzanares Bárbara, González Rafael, Serrano Pilar, Navas Ana, Alonso Corona, Fernandez Lourdes, Jurado Aurora, Moreno-Aguilar Carmen
Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofia University Hospital/ University of Córdoba, Córdoba, Spain.
Department of Immunology and Allergy, Reina Sofia University Hospital, Córdoba, Spain.
Front Allergy. 2023 Oct 4;4:1241650. doi: 10.3389/falgy.2023.1241650. eCollection 2023.
Specific IgE (sIgE) is merely a sensitization marker that cannot be used for allergy diagnosis if there are no associated clinical symptoms. As of 2023, there is still no evidence regarding the quantity of sIgE necessary to confirm or exclude clinical disease. Therefore, this study aimed to calculate cut-offs for sIgE, allowing us to effectively diagnose olive or grass pollen allergy and select allergenic immunotherapy (AIT) candidate patients in a region under high olive and grass allergenic pressure.
An observational retrospective study consisting of the review of electronic medical records from 1,172 patients diagnosed with seasonal rhino-conjunctivitis and suspected allergy to olive or grass pollen. Symptoms correlated with sIgE to Poaceae and Oleaceae whole extracts and sIgE to genuine allergenic components were evaluated. Optimal cut-off values were calculated using receiver operating characteristic curves. Relevant clinical symptoms and AIT indications were taken into consideration when determining the clinical allergy diagnosis.
sIgE to Lolium showed the best area under the curve (AUC) for both diagnosis (0.957) and an indication of AIT (0.872). The optimal cut-off values for grass diagnosis and AIT indication were 1.79 kUA/L and 8.83 kUA/L, respectively. A value of 5.62 kUA/L was associated with a positive likelihood ratio (LR) of 10.08 set for grass allergy. Olea sIgE showed the best AUC for the diagnosis (0.950). The optimal cut-off for diagnosis was 2.41 kUA/L. A value of 6.49 kUA/L was associated with a positive LR of 9.98 to confirm olive pollen allergy. In regard to immunotherapy, Ole e 1 sIgE showed the best AUC (0.860). The optimal cut-off was 14.05 kUA/L. Ole e 1 sIgE value of 4.8 kUA/L was associated with a 0.09 negative LR to exclude olive AIT indication.
The sIgE cut-offs found in this population under high olive and grass allergenic pressure reduce the gap between sensitization and clinical allergy, providing a new tool for the diagnosis of seasonal allergic rhinitis/asthma and helping to discriminate patients who will benefit from AIT.
特异性IgE（sIgE）仅仅是一种致敏标志物，如果没有相关临床症状，则不能用于过敏诊断。截至2023年，仍没有关于确认或排除临床疾病所需sIgE量的证据。因此，本研究旨在计算sIgE的临界值，以便我们能够在橄榄和草花粉致敏压力较高的地区有效诊断橄榄或草花粉过敏，并选择变应原免疫疗法（AIT）的候选患者。
一项观察性回顾性研究，包括对1172例被诊断为季节性鼻结膜炎且怀疑对橄榄或草花粉过敏的患者的电子病历进行回顾。评估了与禾本科和木犀科全提取物的sIgE以及与真正变应原成分的sIgE相关的症状。使用受试者工作特征曲线计算最佳临界值。在确定临床过敏诊断时考虑了相关临床症状和AIT指征。
黑麦草的sIgE在诊断（曲线下面积[AUC]为0.957）和AIT指征（AUC为0.872）方面均显示出最佳AUC。草过敏诊断和AIT指征的最佳临界值分别为1.79 kUA/L和8.83 kUA/L。5.62 kUA/L的值与设定的草过敏阳性似然比（LR）为10.08相关。油橄榄的sIgE在诊断方面显示出最佳AUC（0.950）。诊断的最佳临界值为2.41 kUA/L。6.49 kUA/L的值与确认橄榄花粉过敏的阳性LR为9.98相关。关于免疫疗法，油橄榄1的sIgE显示出最佳AUC（0.860）。最佳临界值为14.05 kUA/L。4.8 kUA/L的油橄榄1 sIgE值与排除橄榄AIT指征的阴性LR为0.09相关。
在高橄榄和草花粉致敏压力人群中发现的sIgE临界值缩小了致敏与临床过敏之间的差距,为季节性变应性鼻炎/哮喘的诊断提供了一种新工具，并有助于鉴别将从AIT中获益的患者。
