How molecular diagnosis may modify immunotherapy prescription in multi-sensitized pollen-allergic children

Main Article Content

G. Del-Río Camacho
A.M. Montes Arjona
J. Fernández-Cantalejo Padial
J. Rodríguez Catalán

Keywords

Component-resolved diagnosis, Immunotherapy, Recombinant allergens, Molecular allergy diagnosis, Pollen allergy, Children

Abstract

Introduction: Specific immunotherapy (SIT) is used to treat asthma and allergic rhinitis, and a dose-response relationship has been found for SIT efficacy, creating a need to accurately select the allergen used in therapy. This need is especially pronounced in poly-sensitized children living in areas where different pollen allergen sources coexist in the same season, as this circumstance complicates diagnostic efforts. In such cases, component-resolved diagnosis (CRD) can increase diagnostic accuracy and aid in SIT prescription.


Materials and Methods: We hypothesized that CRD results would lead to modifications in classical immunotherapy prescription based on sources such as medical history, season of symptom presentation, and skin testing. We studied a sample of children indicated for immunotherapy in whom classical methods had not pointed out the most relevant allergen due to sensitization to more than two pollens. We used a small panel of recombinant allergens, analyzing the percentage of changes to prescription considering the findings of molecular studies.


Results: Of the 70 children included, CRD led to modified immunotherapy prescription in 54.3%. Indications of single-allergen therapy increased from 18% to 51% when CRD was included. The decision to prescribe immunotherapy was reversed following CRD in 9.3% of cases.


Discussion: CRD use alters the choice of specific immunotherapy in poly-sensitized children. A wide panel of recombinant allergens may not be necessary to improve immunotherapy indication using molecular techniques; rather, a smaller panel adapted to include those allergens prevalent in the geographical area in question appears to be sufficient for more effective immunotherapy, also leading to an improved cost-benefit ratio.

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References

1. Kim JM, Lin SY, Suáres-Cuervo C, Celladurai Y, Ramnathan M, Segal JB, et al. Allergen-specific immunotherapy for pediatric asthma and rhinoconjuntivitis: a systematic review. Pediatrics. 2013;131:1155-67.

2. Pifferi M, Baldini G, Marrazzini G, Baldini M, Ragazzo V, Pietrobelli A, et al. Benefits of immunotherapy with a standardized Dermatophagoides pteronyssinus extract in asthmatic children: a three-year prospective study. Allergy. 2002;57:785-90, 7.

3. Calderon MA, Laerenas D, Kleine-Tebbe J, Jacobsen L, Passalacqua G, Eng PA, et al. European Academy of Allergy and Clinical Immunology task force report on ‘‘dose-response relationship in allergen-specific immunotherapy’’. Allergy. 2011;66:1345-59.

4. Adkinson NF, Eggleston PA, Eney D, Goldstein EO, Schuberth KC, Bacon JR, et al. A controlled trial of immunotherapy for asthma in allergic children. N Engl J Med. 1997;336:324-31.

5. Calderon MA, Cox L, Casale TB, Moingeon P, Demoly P. Multiple-allergen and single-allergen immunotherapy strategies in polysensitized patients: Looking at the published evidence. J Allergy Clin Immunol. 2012;129:929-34.

6. Alvarez-Cuesta E, Bousquet J, Canonica W, Durham SR, Malling HJ, Valovirta E. Standards for practical allergen-specific immunotherapy. Allergy. 2006;61:1-20.

7. Sastre J. Molecular diagnosis and immunotherapy. Curr Opin Allergy Clin Immunol. 2013;13:646-50.

8. Bousquet J, Heinzerling L, Bachert C, Papadopoulos NG, Bousquet PJ, Canonica GW, et al. Practical guide to skin prick test in allergy to aeroallergens. Allergy. 2012;67:18-24.

9. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). - PubMed - NCBI [Internet]. [cited 2018 Feb 4]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18331513.

10. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2017. Available from: www.ginasthma.org.

11. 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. 2012;67:709-11.

12. Stringari G, Tripodi S, Cafarelli C, Dondi A, Asero R, Di Rienzo Businco A, et al. (I-PAN). The effect of component-resolved diagnosis on specific immunotherapy prescription in children with hay fever. J Allergy Clin Immunol. 2014;134:75-81.

13. Moreno C, Justicia JL, Quiralte J, Moreno-Ancillo A, IglesiasCadarso A, Torrecillas M, et al. Olive, grass or both? Molecular diagnosis for the allergen immunotherapy selection in polysensitized pollinic patients. Allergy. 2014;69:1357-63.

14. Passalacqua G, Melioli G, Bonifazi F, Bonini S, Maggi E, Senna G, et al., and the Italian ISAC Study Group. The additional values of microarray allergen assay in the management of polysensitized patients with respiratory allergy. Allergy. 2013;68: 1029-33.

15. Wolthers OD. Component-resolved diagnosis in pediatrics. ISRN Pediatrics 2012. 2012: 806920.