Predictive Factors for Clinical Response to Allergy Immunotherapy in Children with Asthma and Rhinitis

Abstract

Background: To date, no predictive methods for the clinical response to allergy immunotherapy (AIT) are available. We sought to evaluate the pretreatment parameters used in diagnosing allergic asthma and/or rhinitis including allergen skin-prick test responses, serum specific and total IgE (sIgE and tIgE) levels and blood eosinophil counts, and to identify whether these can be used to predict clinical effectiveness in children treated with immunotherapy. Methods: This study involved 185 children who had undergone 3 years of standardized-quality house-dust mite subcutaneous immunotherapy. Clinical characteristics and laboratory parameters were analyzed. A multivariate unconditional logistic regression model and receiver operating characteristic curves were used. Predicted probabilities and predictive areas under the curve were calculated. Results: The clinical response to AIT was effective in 129/185 (69.7%) patients. Four variables were associated with clinical response by multivariate logistic analysis: tobacco smoke exposure [odds ratio (OR) 2.845 and 95% confidence interval (CI) 1.147-7.058; p = 0.024], a family history of atopy (OR 2.881 and 95% CI 1.240-6.692; p = 0.014), a serum tIgE level ≥965 kU/l (OR 5.917 and 95% CI 2.320-15.089; p = 0.000) and an sIgE/tIgE ratio ≥6% (OR 0.336 and 95% CI 0.124-0.911; p = 0.032). The sensitivity and specificity of the area under the curve of the serum tIgE were higher than those of serum sIgE and sIgE/tIgE ratio alone. Conclusion: Tobacco smoke exposure, atopic family history, serum tIgE and sIgE/tIgE ratio were in significant correlation with clinical response to AIT in children, which may be helpful for patient selection before immunotherapy. The serum tIgE is superior to both the serum sIgE/tIgE ratio and sIgE levels alone in predicting clinical effectiveness.

Early Intervention Improves Clinical Responses to House Dust Mite Immunotherapy in Allergic Rhinitis Patients

“…However, we failed to establish the correlation between these variables and AIT responses. We testified to several predictive indicators presented in previous studies, such as sIgE level (cutoff 10 kU/L), sIgE/tIgE ratio (cutoff 16%) and tIgE level (cutoff 965 kU/L) [6,7,25], and here, interestingly, we found that there were no differences between the AIT responder and nonresponder groups. This discrepancy also exists in other studies [9], indicating the heterogeneity of different studies (e.g.…”

“…Available surrogate indicators to predict clinical responses are imperative and of great value in clinical practice. Although several studies have evaluated the role of relevant pretreatment factors including the levels of specific and total IgE (sIgE and tIgE), and also the sIgE/tIgE ratio, in predicting effective AIT, the results across studies are inconsistent [6,7,8,9]. Additionally, most studies are retrospectively designed and so the results have to be interpreted with caution.…”

Specific allergen immunotherapy for the treatment of allergic asthma: a review of current evidence

“…Four basal variables were associated with clinical response: tobacco smoke exposure, atopic family history, serum tIgE and sIgE/ tIgE ratio. The serum tIgE was superior to both the serum sIgE/tIgE ratio and sIgE levels alone in predicting clinical effectiveness [49].…”

“…-Serum allergen-specific IgE is a predictive biomarker for adequate response to AIT (LE 3, grade C) [44][45][46][47][48][49]. -Functional assays of inhibitory IgG4 and IgE-blocking factor may be useful surrogates of clinical response (LE 1b, grade B) [18,50].…”

Patterns of Sensitization to Inhalant Allergens in Japanese Lower-Grade Schoolchildren and Related Factors

“…examination findings [2] . However, while a number of studies have demonstrated an association between allergic sensitization and allergic diseases and described the distribution of serum IgE in children with allergic diseases [3] , to our knowledge few large-scale epidemiological studies have been conducted describing the distribution of serum IgE in elementary schoolchildren [4] .…”