Ann Allergy Asthma Immunol. 2013 Oct;111(4):295-7.

Measurement of IgE to pollen allergen components is helpful in selecting patients for immunotherapy.

Letrán A, Espinazo M, Moreno F.

Clínica Dr. Lobatón. Cádiz. Spain.

a_letran@yahoo.es

 

ABSTRACT

Background: Pollen allergy still represents an important cause of allergic morbidity worldwide. Accuracy diagnostic methods are important in order to find the disease- causing allergen.

Objectives: To describe the sensitization patterns of our spring pollinosis patients and to make a real-life evaluation of the usefulness of a predeterminated IgE molecular profile comparing with other sensitization methods in immunotherapy composition choices.

Methods:  A total of 175 patients with spring pollinosis diagnosis complete skin prick test study with Olea europea, Phleum pratense, palm profilin and peach peel and in vitro study consist of application of specific recombinant IgE protocol (nOle e1, rPhl p1-5b, rPhl p12, rPhl p7 and Pru p3). Immunotherapy choices comparing both methods were realized.

Results: We found a high nOle e1 and rPhl p1-5b sensitizations. Profilin, polcalcin and lipid transfer proteins seems not to be relevant in Olive-Grass pollen sensitization differential diagnosis in our area. Afterwards application of component resolved diagnosis we change immunotherapy choices in more than 50% of our patients.

Conclusions: Our results support the necessity of the habitual use of this kind of protocol in our allergological routine practice.

 

SUPPLEMENT:

Grass pollen is the most important allergen source causing spring hay fever worldwide (1). Due to high pollen counts, olive pollen represents the main allergenic spring pollen in the majority of southern areas in Spain (2). Currently allergen immunotherapy is consolidated as an etiological treatment which by allergen immuno-modulation prevents progression of the disease with long-lasting therapeutic effects (3). The identification of the disease-causing allergen is a fundamental requirement to assure correct prescription of treatment but identification is not possible using only skin prick test (SPT) in cases of parallel pollination like grass and olive pollens (4).  To ensure this, recombinant allergen in vitro techniques have provided the possibility to study principal allergens and cross reactivity processes involved in allergic reactions (5).

The main objective of our study was to make a real-life comparison of immunotherapy composition between election based on SPT quantitative results and election based on recombinant IgE protocol. We selected 175 seasonal pollen allergic rhinoconjunctivitis and/or asthma diagnosis immunotherapy candidates from our daily practice that completed both in vivo and in vitro studies. Results corroborated our initial hypothesis: With the consideration of only two parallel pollens and without second in vitro diagnostic step, we would prescribe incorrect immunotherapy composition in more than 50% of our patients. We support the necessity of the use of this kind of protocol in our allergological routine practice as a regular complement to skin tests.

 

REFERENCES:

1)  Burney P, Malmberg E, Chinn S, Jarvis D, Luczynska C, Lai E. The distribution of total and specific serum Ig E in the European Community Respiratory Health Survey. J Allergy Clin Immunol. 1997; 99: 314-22.

2)  Rodriguez R, Villalba M, Batanero et al. Olive pollen recombinant allergens: Value in diagnosis and immunotherapy. J Invest Allergol Clin Immunol 2007; 17, S1: 56-62.

3) Burks AW, Calderon MA, Casale T et al. Update on allergy immunotherapy: American Academy of Allergy, Asthma & Immunology/European Academy of Allergy and Clinical Immunology/PRACTALL consensus report. J Allergy Clin Immunol. 2013;131(5):1288-96.

4) 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(5):709-11.

5) Canonica GW, Ansotegui IJ, Pawankar R, et al. AWAO-ARIA-GA2LEN consensus document on molecular-based allergy diagnostics. World Allergy Organ J. 2013;6:17.

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