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.

The effect of component-resolved diagnosis on specific immunotherapy prescription in children with hay fever / G., Stringari; S., Tripodi; Caffarelli, Carlo; A., Dondi; R., Asero; A., Di Rienzo Businco; A., Bianchi; P., Candelotti; G., Ricci; F., Bellini; N., Maiello; M., Miraglia del Giudice; T., Frediani; S., Sodano; I., Dello Iacono; F., Macri; I., Peparini; C., Povesi Dascola; M. F., Patria; E., Varin; D., Peroni; P., Comberiati; L., Chini; V., Moschese; S., Lucarelli; R., Bernardini; G., Pingitore; U., Pelosi; M., Tosca; A., Cirisano; D., Faggian; A., Travaglini; M., Plebani; P. M., Matricardi. - In: JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. - ISSN 0091-6749. - 134:1(2014), pp. 75-81. [10.1016/j.jaci.2014.01.042]

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

CAFFARELLI, Carlo;
2014-01-01

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.
The effect of component-resolved diagnosis on specific immunotherapy prescription in children with hay fever / G., Stringari; S., Tripodi; Caffarelli, Carlo; A., Dondi; R., Asero; A., Di Rienzo Businco; A., Bianchi; P., Candelotti; G., Ricci; F., Bellini; N., Maiello; M., Miraglia del Giudice; T., Frediani; S., Sodano; I., Dello Iacono; F., Macri; I., Peparini; C., Povesi Dascola; M. F., Patria; E., Varin; D., Peroni; P., Comberiati; L., Chini; V., Moschese; S., Lucarelli; R., Bernardini; G., Pingitore; U., Pelosi; M., Tosca; A., Cirisano; D., Faggian; A., Travaglini; M., Plebani; P. M., Matricardi. - In: JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. - ISSN 0091-6749. - 134:1(2014), pp. 75-81. [10.1016/j.jaci.2014.01.042]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11381/2751906
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