Molecular diagnosis and immunotherapy selection in a Portuguese population sensitized to grass and olive pollens
Diagnóstico molecular e seleção de imunoterapia numa população portuguesa sensibilizada ao pólen de gramíneas e de oliveira
Joana Cosme; Amélia Spínola Santos; Manuel Branco Ferreira; Manuel Pereira Barbosa; Maria Conceição Pereira Santos
Abstract
Introduction: Phleum pratense (Phl p) and Olea europaea (Ole e) are common allergenic pollen. Objectives: To describe the sensitization patterns to Phl p and Ole e allergens in a subset of allergic rhinitis patients with positive skin prick tests (SPTs) to these pollens and compare the allergen immunotherapy (AIT) choice before and after determination of molecular components. Methods: Candidates to pollen immunotherapy with positive SPTs to both Phl p and Ole e were recruited. All of them underwent an SPT with a panel of aeroallergens and measurements of serum specific IgE (sIgE) to Phl p, Ole e, Phl p1, Phl p5, Phl p7, Phl p12, Ole e1, Ole e7, and Bet v2. Results: Forty adults were included. Of these, 83% and 65% were sIgE-positive to Phl p and Ole e, using the 0.35 kUA/L and 0.70 kUA/L cut-offs, respectively. Moreover, 42.5% of patients had positive sIgE to Phl p1 and/or Phl p5, 2.5% only to Ole e1, and 47.5% to both (0.35 kUA/L cutoff). By increasing the cut-off to 0.7 kUA/L, 55% of patients were sensitized to Phl p1 and/or Phl p5, and no patient was sensitized only to Ole e1. After component-resolved diagnosis, AIT choice was changed in 15 (37.5%) patients, with a decrease in the number of prescriptions of AIT with both grass and olive pollens and with olive alone, together with an increase in the prescriptions of AIT with grass pollen alone. Conclusion: Genuine sensitization to Olea europaea was reduced, and the sensitization patterns were heterogeneous. Knowledge of pattern of sensitization to molecular components changed immunotherapy prescription in more than one third of the patients.
Keywords
Resumo
Introdução: Os polens de Phleum pratense (Phl p) e de Olea europaea (Ole e) são fontes alergênicas comuns. Objetivos: Descrever os padrões de sensibilização aos alergênios destes dois polens num subconjunto de pacientes com rinite alérgica polínica e comparar a escolha de imunoterapia, antes e depois da determinação de alergênios moleculares para Phl p e Ole e. Métodos: Foram recrutados candidatos para imunoterapia com polens, com testes cutâneos positivos para Phl p e Ole e. Todos realizaram um painel de testes em picada a aeroalergênios e determinação de IgE séricas específicas para Phl p, Ole e, rPhl p1, rPhl p5, rPhl p7, rPhl p 12, rOle e 1, nOle e 7, rBet v2. Resultados: Foram incluídos 40 adultos. Em relação à sIgE para Phl p e Ole e, 83% e 65% dos pacientes apresentaram positividade para ambos, usando o cut-off de 0,35 kUA/L e 0,70 kUA/L, respectivamente. A positividade para Phl p1 e/ou Phl p 5 foi encontrada em 42,5%, para Ole e 1 apenas em 2,5%, enquanto 47,5% apresentaram sIgE positivo para ambos (cut-off corte de 0,35 kUA/L). Aumentando o cut-off para 0,7 kUA/L, 55% foram sensibilizados para Phl p1 e/ou Phl p5, nenhum paciente foi sensibilizado apenas para Ole e 1. Após a determinação dos alergênios para os componentes moleculares, a escolha de imunoterapia foi alterada em 15 (37,5%) pacientes, com uma diminuição no número de vacinas para Phleum + Olea e apenas para Olea e um aumento na prescrição de vacinas para Phleum. Conclusão: A sensibilização genuína do Olea europaea foi reduzida e os padrões de sensibilização foram heterogêneos. O conhecimento da sensibilização aos componentes moleculares dos alergênios mudou a prescrição de imunoterapia em mais de um terço dos pacientes.
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Referências
1. D'Amato G, Cecchi L, Bonini S, Nunes C, Annesi-Maesano I, Behrendt H. Allergenic pollen and pollen allergy in Europe. Allergy. 2007;62:976-90.
2. Soriano JB, Anto JM, Sunyer J, Tobias A, Kogevinas M, Almar E, et al. Risk of asthma in the general Spanish population attributable to specific immunoresponse. Spanish Group of the European Community Respiratory Health Survey. Int J Epidemiol. 1999;28:728‑34.
3. Luengo O, Cardona V. Component resolved diagnosis: when should it be used? Clin Transl Allergy. 2014;4:28.
4. Newson RB, van Ree R, Forsberg B, Janson C, Lötvall J, Dahlén SE, et al. Geographical variation in the prevalence of sensitization to common aeroallergens in adults: the GA(2) LEN survey. Allergy. 2014;69:643-51.
5. Pablos I, Wildner S, Asam C, Wallner M, Gadermaier G. Pollen Allergens for Molecular Diagnosis. Curr Allergy Asthma Rep. 2016;16:1-31.
6. 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.
7. Valenta R, Lidholm J, Niederberger V, Hayek B, Kraft D, Grönlund H. The recombinant allergen-based concept of component-resolved diagnostics and immunotherapy (CRD and CRIT). Clin Exp Allergy. 1999;29:896-904.
8. Rodríguez R, Villalba M, Batanero E, Palomares O, Quiralte J, Salamanca G, et al. Olive pollen recombinant allergens: value in diagnosis and immunotherapy. J Investig Allergol Clin Immunol. 2007;17(Suppl 1):4-10.
9. Moreno C, Justicia JL, Quiralte J, Moreno-Ancillo A, Iglesias-Cadarso 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.
10. Martínez-Cañavate Burgos A, Torres-Borrego J, Molina Terán AB, Corzo JL, García BE, Rodríguez Pacheco R, et al. Molecular sensitization patterns and influence of molecular diagnosis in immunotherapy prescription in children sensitized to both grass and olive pollen. Pediatr Allergy Immunol. 2018;29(4):369-74.
11. De Amici M, Mosca M, Vignini M, Quaglini S, Moratti R. Recombinant birch allergens (Bet v 1 and Bet v 2) and the oral allergy syndrome in patients allergic to birch pollen. Ann Allergy Asthma Immunol. 2003;91:490-2.
12. Bousquet J, Khaltaev N, Cruz AA, Denburg J,Fokkens WJ, Togias A, et al. Allergic Rhinitis and Its Impact on Asthma (ARIA) 2008 update. Allergy. 2008; 63(Suppl 86):8-160.
13. Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald JM, et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J. 2008;31:143‑78.
14. Position paper: Allergen standardization and skin tests. The European Academy of Allergology and Clinical Immunology. Allergy. 1993;48(14 Suppl):48-82.
15. Roberts G, Pfaar O, Akdis CA, Ansotegui IJ, Durham SR, Gerth van Wijk R, et al. EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis. Allergy. 2018;73:765-98.
16. Tanabe S. Epitope peptides and immunotherapy. Curr Protein Pept Sci. 2007;8:109-18.
17. Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Hilger C, Hofmaier S, et al. EAACI Molecular Allergology User's Guide. Pediatr Allergy Immunol. 2016;23:1-250.
18. Rossi RE, Monasterolo G, Monasterolo S. Measurement of IgE antibodies against purified grass-pollen allergens (Phl p 1, 2, 3, 4, 5, 6, 7, 11, and 12) in sera of patients allergic to grass pollen. Allergy. 200;56:1180-5.
19. Darsow U, Brockow K, Pfab F, Jakob T, Petersson CJ, Borres MP, et al. Allergens. Heterogeneity of molecular sensitization profiles in grass pollen allergy - implications for immunotherapy?. Clin Exp Allergy. 2014;44(5):778-86.
20. Scaparrotta A, Verini M, Consilvio NP, Cingolani A, Rapino D, Attanasi M, et al. Sensitization to timothy grass pollen allergenic molecules in children. Multidisciplinary Respiratory Medicine. 2013;8:17.
21. Tripodi S, Frediani T, Lucarelli S, Macrì F, Pingitore G, Di Rienzo Businco A, et al. Molecular profiles of IgE to Phleum pratense in children with grass pollen allergy: implications for specific immunotherapy. J Allergy Clin Immunol. 2012;129(3):834-9.
22. 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.
23. Mari A. Skin test with a timothy grass (Phleum pratense) pollen extract vs. IgE to a timothy extract vs. IgE to rPhl p 1, rPhl p 2, nPhl p 4, rPhl p 5, rPhl p 6, rPhl p 7, rPhl p 11, and rPhl p 12: epidemiological and diagnostic data. Clin Exp Allergy. 2003;33(1):43-51.
24. Scala E, Abeni D, Pomponi D, Paganelli R, Locanto M, Giani M, et al. Ole e 1, Ole e 7, and Ole e 9: Identifying distinct clinical subsets of olive tree–allergic patients. J Allergy Clin Immunol. 2016;137:629‑31.
25. Sastre J, Landivar ME, Ruiz-Garcia 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.
Submetido em:
27/12/2020
Aceito em:
27/03/2021
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