Evaluation of serum s-IgE/total IgE ratio in predicting clinical response to allergen-specific immunotherapy

Abstract

Background: To date, no predictive tests for the clinical response to allergen-specific immunotherapy (ASI) are available. Therefore an in vivo or in vitro test would be of great value. Objective: We sought to evaluate pretreatment parameters used in diagnosing allergic rhinitis and determining serum specific IgE (s-IgE) levels, serum total IgE (t-IgE) levels, and blood eosinophil counts and to identify whether can be used to predict clinical improvement in monosensitized patients with allergic rhinitis with or without asthma treated with immunotherapy. Methods: We analyzed 279 patients who had undergone 4 years of ASI administered either by means of the subcutaneous immunotherapy (76 patients) or sublingual immunotherapy (203 patients) routes. Serum t-IgE and s-IgE levels, blood eosinophil counts, and serum s-IgE/t-IgE ratios were calculated and tested for correlation with clinical response to ASI. Receiver operating characteristic curves were determined. Predicted probabilities and predictive areas under the curve were calculated. Results: The clinical response to ASI was effective in 145 (52.0%) of 279 total patients, 42 (55.2%) of 76 patients treated with subcutaneous immunotherapy, and 103 (50.7%) of 203 patients treated with sublingual immunotherapy. A significant correlation was found between the serum s-IgE/t-IgE ratio and the clinical response to ASI, with high ratios (>16.2) associated with an effective response. The sensitivity and specificity of the area under the curve of the ratio were higher than those of serum s-IgE and t-IgE alone. Conclusion: The calculation of the serum s-IgE/t-IgE ratio for predicting the clinical response to ASI offers an advantage over measuring t-IgE and s-IgE levels in monosensitized patients for the following allergens: grass, Parietaria judaica,

Clinical efficacy and immunological mechanisms of sublingual and subcutaneous immunotherapy in asthmatic/rhinitis children sensitized to house dust mite: an open randomized controlled trial

“…Recently by using VAS, it was shown that a serum sIgE/tIgE ratio is an advantageous tool in predicting the clinical response to allergen-specific immunotherapy [26]. In our study, no correlation was observed between the symptoms-medication scores or VAS and sIgE/tIgE ratio, which might be due to the small sample size.…”

Prophylactic Sublingual Immunotherapy for Japanese Cedar Pollinosis

“…This is in accord with the report by Fujimura et al that patients with low sIgE/tIgE ratios were more responsive to SLIT in treatment for Japanese pollinosis [7]. On the other hand, the report by Di Lorenzo et al reported a contrary result [8]. They reported that a high sIgE/tIgE ratio was associated with an effective response in sublingual and subcutaneous immunotherapy [8].…”

“…On the other hand, the report by Di Lorenzo et al reported a contrary result [8]. They reported that a high sIgE/tIgE ratio was associated with an effective response in sublingual and subcutaneous immunotherapy [8]. The reason of this discrepancy is unclear and the importance of sIgE/tIgE ratio as a biomarker for immunotherapy should be investigated in the future study.…”

Chinese Guideline on allergen immunotherapy for allergic rhinitis

“…In patients who received 4 years of SCIT or SLIT, there was a significant correlation between the serum sIgE/tIgE ratio and the clinical response to ASI, and that a diagnostic serum sIgE/tIgE ratio of 16.2 was found to be the cut-off point beyond which successful immunotherapy outcome could be predicted, with 97.2% clinical sensitivity and 88.1% clinical specificity. Furthermore, measurement of serum sIgE/tIgE ratio was more useful than either sIgE or tIgE individually in predicting treatment efficacy in patients mono-sensitized to grass, Parietaria judaica, Olea europea, and HDM (243). As not many studies have reported the use of sIgE/tIgE ratio as a biomarker for effective immunotherapy, this needs to be confirmed in more randomized double-blind placebo-controlled studies to confirm its suitability in this regard.…”

“…The ratio of serum sIgE to tIgE has recently been studied as a potential predictive marker of immunotherapy (243). In patients who received 4 years of SCIT or SLIT, there was a significant correlation between the serum sIgE/tIgE ratio and the clinical response to ASI, and that a diagnostic serum sIgE/tIgE ratio of 16.2 was found to be the cut-off point beyond which successful immunotherapy outcome could be predicted, with 97.2% clinical sensitivity and 88.1% clinical specificity.…”