Sensitization profile in patients with respiratory allergic diseases: differences between conventional and molecular diagnosis (a cross-sectional study)
Tóm tắt
Component-resolved diagnosis (CRD) allows to identify single molecular allergen components, and constitutes a routine practice in many allergy units. However, skin prick test (SPT) remains the technique of choice in many otorhinolaryngology departments, thus increasing the risk of using inadequate immunotherapies in patients with respiratory allergies. This study aimed to compare sensitization profiles determined by SPT and CRD in patients with respiratory allergy, and to explore the relationship between sensitization and type and severity of the respiratory disease. Cross-sectional, multicenter study of patients admitted to the Otorhinolaryngology Department due to symptoms of respiratory allergy. Extracts from various house dust mites, pollens, and molds were tested by SPT, whereas IgE against the corresponding antigens were measured by CRD. The analysis included 101 patients. The sensitization profile obtained by SPT had low agreement with that of CRD, particularly to dust mite allergens (Dermatophagoides sp.) and pollens (Plantago lanceolata, Olea europaea, and Cupressus sempervirens). While SPT did not show any significant relationship between sensitization and type/severity of the respiratory disease, CRD allowed to associate Der p 1, Der f 1 and Lep d 2 sensitizations with asthma, and Der p 2, Der f 2 and Lep d 2 sensitizations with more severe symptoms of allergic rhinitis. Compared with SPT, CRD enables to describe a more accurate sensitization profile and to identify associations between symptoms and specific antigens. The routine use of CRD in an otorhinolaryngology setting may benefit the management of patients with respiratory allergy. Trial registration IB 3108/15 (Retrospectively registered)
Tài liệu tham khảo
Dahl R, Andersen PS, Chivato T, Valovirta E, de Monchy J. National prevalence of respiratory allergic disorders. Respir Med. 2004;98:398–403. https://doi.org/10.1016/j.rmed.2003.11.015.
Simoens S. The cost-effectiveness of immunotherapy for respiratory allergy: a review. Allergy Eur J Allergy Clin Immunol. 2012;67:1087–105. https://doi.org/10.1111/j.1398-9995.2012.02861.x.
Meltzer EO, Bukstein DA. The economic impact of allergic rhinitis and current guidelines for treatment. Ann Allergy Asthma Immunol Off Publ Am Coll Allergy Asthma Immunol. 2011;106:S12–6. https://doi.org/10.1016/j.anai.2010.10.014.
Bousquet PJ, Burbach G, Heinzerling LM, Edenharter G, Bachert C, Bindslev-Jensen C, et al. GA2LEN skin test study III: minimum battery of test inhalent allergens needed in epidemiological studies in patients. Allergy Eur J Allergy Clin Immunol. 2009;64:1656–62. https://doi.org/10.1111/j.1398-9995.2009.02169.x.
Roberts G, Peckitt C, Northstone K, Strachan D, Lack G, Henderson J, et al. Relationship between aeroallergen and food allergen sensitization in childhood. Clin Exp Allergy J Br Soc Allergy Clin Immunol. 2005;35:933–40. https://doi.org/10.1111/j.1365-2222.2005.02280.x.
Ferreira F, Wolf M, Wallner M. Molecular approach to allergy diagnosis and therapy. Yonsei Med J. 2014;55:839–52. https://doi.org/10.3349/ymj.2014.55.4.839.
Sastre J, Landivar ME, Ruiz-García M, Andregnette-Rosigno MV, Mahillo I. How molecular diagnosis can change allergen-specific immunotherapy prescription in a complex pollen area. Allergy Eur J Allergy Clin Immunol. 2012;67:709–11. https://doi.org/10.1111/j.1398-9995.2012.02808.x.
Letrán A, Espinazo M, Moreno F. Measurement of IgE to pollen allergen components is helpful in selecting patients for immunotherapy. Ann Allergy Asthma Immunol. 2013;111:295–7. https://doi.org/10.1016/j.anai.2013.07.005.
Lepage-Nefkens I, Van der Maas M, Rijnen M, Hermansson L. A cost-effectiveness model evaluating component-resolved diagnosis (Crd) versus standard testing method (Skin Prick Testing (Spt)) in the diagnosis and treatment of allergic rhinitis in the Netherlands. Value Health. 2015;18:A359. https://doi.org/10.1016/j.jval.2015.09.689.
Kazemi-Shirazi L, Niederberger V, Linhart B, Lidholm J, Kraft D, Valenta R. Recombinant marker allergens: diagnostic gatekeepers for the treatment of allergy. Int Arch Allergy Immunol. 2002;127:259–68. https://doi.org/10.1159/000057742.
Melioli G, Passalacqua G, Canonica GW, Baena-Cagnani CE, Matricardi P. Component-resolved diagnosis in pediatric allergic rhinoconjunctivitis and asthma. Curr Opin Allergy Clin Immunol. 2013;13:446–51. https://doi.org/10.1097/ACI.0b013e32836274d8.
Van Gasse AL, Mangodt EA, Faber M, Sabato V, Bridts CH, Ebo DG. Molecular allergy diagnosis: status anno 2015. Clin Chim Acta Int J Clin Chem. 2015;444:54–61. https://doi.org/10.1016/j.cca.2015.02.012.
Letrán A, Espinazo M, Moreno F. Measurement of IgE to pollen allergen components is helpful in selecting patients for immunotherapy. Ann Allergy Asthma Immunol Off Publ Am Coll Allergy Asthma Immunol. 2013;111:295–7. https://doi.org/10.1016/j.anai.2013.07.005.
Caballero Martínez F, Plaza V, Quirce Gancedo S, Fernández Benítez M, Gómez Ruiz F, López Viña A, et al. External assessment of the GEMA2009 recommendations by a multidisciplinary expert panel on asthma. Arch Bronconeumol. 2010;46:411–9. https://doi.org/10.1016/j.arbres.2010.05.004.
Executive Committee GEMA 2009. GEMA 2009 (Spanish guideline on the management of asthma). J Investig Allergol Clin Immunol. 2010;20(Suppl 1):1–59.
Bousquet J, Schünemann HJ, Samolinski B, Demoly P, Baena-Cagnani CE, Bachert C, et al. Allergic rhinitis and its impact on asthma (ARIA): achievements in 10 years and future needs. J Allergy Clin Immunol. 2012;130:1049–62. https://doi.org/10.1016/j.jaci.2012.07.053.
Dreborg S. Skin testing. The safety of skin tests and the information obtained from using different methods and concentrations of allergen. Allergy. 1993;48:473–5.
Petersen AB, Gudmann P, Milvang-Grønager P, Mørkeberg R, Bøgestrand S, Linneberg A, et al. Performance evaluation of a specific IgE assay developed for the ADVIA centaur immunoassay system. Clin Biochem. 2004;37:882–92. https://doi.org/10.1016/j.clinbiochem.2004.06.010.
Lizaso MT, García BE, Tabar AI, Lasa E, Echechipía S, Lvarez MJ, et al. Comparison of conventional and component-resolved diagnostics by two different methods (Advia-Centaur/Microarray-ISAC) in pollen allergy. Ann Allergy Asthma Immunol. 2011;107:35–41. https://doi.org/10.1016/j.anai.2011.03.017.
Orovitg A, Guardia P, Barber D, de la Torre F, Rodríguez R, Villalba M, et al. Enhanced diagnosis of pollen allergy using specific immunoglobulin E determination to detect major allergens and panallergens. J Investig Allergol Clin Immunol. 2011;21:253–9.
Boi M, Llorens L. Annual pollen spectrum in the air of Palma de Mallorca (Balearic Islands, Spain). Aerobiologia. 2013;29:385–97. https://doi.org/10.1007/s10453-013-9288-0.
Barber D, de la Torre F, Feo F, Florido F, Guardia P, Moreno C, et al. Understanding patient sensitization profiles in complex pollen areas: a molecular epidemiological study. Allergy. 2008;63:1550–8. https://doi.org/10.1111/j.1398-9995.2008.01807.x.
Pfaar O, Demoly P, Gerth van Wijk R, Bonini S, Bousquet J, Canonica GW, et al. Recommendations for the standardization of clinical outcomes used in allergen immunotherapy trials for allergic rhinoconjunctivitis: an EAACI position paper. Allergy. 2014;69:854–67. https://doi.org/10.1111/all.12383.
Wahn U. Preventing new sensitization and asthma onset by allergen immunotherapy: the current evidence. Curr Opin Allergy Clin Immunol. 2017;17:443–6. https://doi.org/10.1097/ACI.0000000000000399.
Petalas K, Durham SR. Allergen immunotherapy for allergic rhinitis. Rhinology. 2013;51:99–110. https://doi.org/10.4193/Rhino12.086.
Cipriani F, Mastrorilli C, Tripodi S, Ricci G, Perna S, Panetta V, et al. Diagnostic relevance of IgE sensitization profiles to eight recombinant Phleum pratense molecules. Allergy. 2018;73:673–82. https://doi.org/10.1111/all.13338.
Segura N, Abos T, Compaired JA, Compés E, Guallar I, Morales M, et al. Influence of profilin on sensitisation profiles determined by cutaneous tests and IgE to major allergens in polysensitised patients. Clin Transl Allergy. 2016;6:23. https://doi.org/10.1186/s13601-016-0114-y.