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.
|Autori:||Stringari, Giovanna; Tripodi, Salvatore; Caffarelli, Carlo; Dondi, Arianna; Asero, Riccardo; Businco Andrea Di, Rienzo; Bianchi, Annamaria; Candelotti, Paolo; Ricci, Giampaolo; Bellini, Federica; Maiello, Nunzia; Giudice Michele Miraglia, Del; Frediani, Tullio; Sodano, Simona; Iacono Iride, Dello; Macrì, Francesco; Peparini, Ilaria; Dascola Carlotta, Povesi; Patria Maria, Francesca; Varin, Elena; Peroni, Diego; Comberiati, Pasquale; Chini, Loredana; Moschese, Viviana; Lucarelli, Sandra; Bernardini, Roberto; Pingitore, Giuseppe; Pelosi, Umberto; Md, ; Tosca, Mariangela; Cirisano, Anastasia; Faggian, Diego; Travaglini, Alessandro; Plebani, Mario; Matricardi Paolo, Maria; Network The Italian Pediatric, Allergy|
|Titolo:||The effect of component-resolved diagnosis on specific immunotherapy prescription in children with hay fever|
|Anno del prodotto:||2014|
|Digital Object Identifier (DOI):||10.1016/j.jaci.2014.01.042|
|Appare nelle tipologie:||1.1 Articolo in rivista|