Giovanna Stringari1, Salvatore Tripodi2, Carlo Caffarelli3, Arianna Dondi4, Riccardo Asero5, Andrea Di Rienzo Businco2, Annamaria Bianchi6, Paolo Candelotti6, Giampaolo Ricci7, Federica Bellini7, Nunzia Maiello8, Michele Miraglia del Giudice8, Tullio Frediani9, Simona Sodano9, Iride Dello Iacono10, Francesco Macrì9, Ilaria Peparini9, Carlotta Povesi Dascola3, Maria Francesca Patria11, Elena Varin12, Diego Peroni13, Pasquale Comberiati13, Loredana Chini14, Viviana Moschese14, Sandra Lucarelli9, Roberto Bernardini15, Giuseppe Pingitore16, Umberto Pelosi17, Mariangela Tosca18, Anastasia Cirisano19, Diego Faggian20, Alessandro Travaglini21, Mario Plebani20, Paolo Maria Matricardi22. 1. 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. 2. Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy. 3. Pediatric Department, Unit of Allergy and Immunology in Evolutive Age, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy. 4. Pediatric Unit, Department for Mother and Child, Ramazzini Hospital, Carpi, Italy; Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. 5. Allergy Unit, Clinica San Carlo, Paderno Dugnano, Milan, Italy. 6. Pediatric Unit, Mazzoni Hospital, Ascoli Piceno, Italy. 7. Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. 8. Pediatric Department, Second University, Naples, Italy. 9. Pediatric Department, La Sapienza University, Rome, Italy. 10. Pediatric Unit, Fatebenefratelli Hospital, Benevento, Italy. 11. Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 12. Pediatric Clinic 2, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 13. Pediatric Unit, G.B. Rossi Hospital, Verona, Italy. 14. Unit of Pediatric Allergy and Immunology, Policlinico of Tor Vergata, University of Rome Tor Vergata, Rome, Italy. 15. Pediatric Unit, San Giuseppe Hospital, Empoli, Italy. 16. Pediatric Unit, Grassi Hospital, Rome, Italy. 17. Pediatric Unit, Santa Barbara Hospital, Iglesias, Italy. 18. Pulmonary Disease and Allergy Unit, G. Gaslini Hospital, Genoa, Italy. 19. Pediatric Unit, Crotone, Italy. 20. Department of Laboratory Medicine, University of Padua, Padua, Italy. 21. Department of Biology, University of Rome "Tor Vergata," Rome, Italy. 22. Department of Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany. Electronic address: paolo.matricardi@charite.de.
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.
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.
Authors: Anna Pomés; Maksymilian Chruszcz; Alla Gustchina; Wladek Minor; Geoffrey A Mueller; Lars C Pedersen; Alexander Wlodawer; Martin D Chapman Journal: J Allergy Clin Immunol Date: 2015-07 Impact factor: 10.793