The usefulness of the basophil activation test for monitoring the effectiveness of wasp venom immunotherapy in different age groups

IF 4 2区 医学 Q2 ALLERGY
Andrzej Bozek, Martyna Miodonska, Aleksandra Mitka, Dominika Sadowska, Janne Winterstein, Radosław Gawlik, Marita Nittner-Marszalska
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Currently, VIT is the only causative and, in some cases, can be life-saving.<span><sup>1</sup></span></p><p>AIT has been proven to be effective for most age groups, including patients over 60 years old.<span><sup>2</sup></span> However, limited studies have confirmed the safety and effectiveness of VIT in these populations.<span><sup>2</sup></span> This is particularly important in cases of anaphylactic reactions following an insect sting, which is an indication for VIT also in the oldest patients.<span><sup>3</sup></span></p><p>Therefore, evaluating of the effectiveness of VIT and the rate at which tolerance to the venom develops is of key importance. The basophil activation test (BAT) can be the optimal tool for such an evaluation. The BAT is a valuable tool for final qualification for VIT and often resolves doubts.<span><sup>4, 5</sup></span> The most diagnostically valuable method for assessing the effectiveness of VIT is the live insect sting challenge (SP). However, SP has significant limitations, including the necessity of conducting it in highly specialized centers, the risk of complications, including those related to the application of the full, unfractionated dose of the allergen, and the potential risk of reactivating the allergic state. Unlike SP, the BAT for assessing VIT effectiveness is free of these limitations.<span><sup>6</sup></span></p><p>The authors would like to present an assessment of the efficacy of VIT for wasp venom after 1 year of treatment in different age groups, comparing the efficacy in young and old patients to identify potential differences. 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Similar trends were observed after next 6 months, and a comparable decrease in basophil activity was maintained at the level after 12 months. The results are presented in Figure 1A–C. After analyzing the BAT results after 6 and 12 months, no significant differences were found between age groups or vaccine types. In the entire study group of patients, 4.9% had negative (regardless of the interview and positive tests and IgE against bees) BAT results, while 3.6% showed no notable improvement after VIT compared to baseline. The obtained BAT values are presented for exposure to 1 μg/mL, as previous data indicate that this criterion provides the optimal balance of sensitivity and specificity when using standardized calibration curves.<span><sup>7</sup></span></p><p>A few observations have been made regarding monitoring of VIT effectiveness using BAT, but not in the older homogeneous group. 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引用次数: 0

Abstract

To the Editor,

Allergen immunotherapy (AIT) remains a well-established and widely used approach for treating immediate type allergies including allergic rhinitis and conjunctivitis, certain forms of allergic asthma, select food allergies, and allergic reactions to Hymenoptera insect venom immunotherapy (VIT). Currently, VIT is the only causative and, in some cases, can be life-saving.1

AIT has been proven to be effective for most age groups, including patients over 60 years old.2 However, limited studies have confirmed the safety and effectiveness of VIT in these populations.2 This is particularly important in cases of anaphylactic reactions following an insect sting, which is an indication for VIT also in the oldest patients.3

Therefore, evaluating of the effectiveness of VIT and the rate at which tolerance to the venom develops is of key importance. The basophil activation test (BAT) can be the optimal tool for such an evaluation. The BAT is a valuable tool for final qualification for VIT and often resolves doubts.4, 5 The most diagnostically valuable method for assessing the effectiveness of VIT is the live insect sting challenge (SP). However, SP has significant limitations, including the necessity of conducting it in highly specialized centers, the risk of complications, including those related to the application of the full, unfractionated dose of the allergen, and the potential risk of reactivating the allergic state. Unlike SP, the BAT for assessing VIT effectiveness is free of these limitations.6

The authors would like to present an assessment of the efficacy of VIT for wasp venom after 1 year of treatment in different age groups, comparing the efficacy in young and old patients to identify potential differences. This builds of an earlier observational study, which confirmed comparable efficacy after 6 months of VIT initiation in people aged 18–35 and over 60 years in the BAT test.7 These results were independent of the type of vaccine used Venomenhal (Hal Allergy) or Diater.

In the second part of observation, the study group was slightly reduced (drop-out due to patients' resignation despite the effectiveness of the treatment and the lack of adverse effects), and its final characteristics are presented in Table 1.

The methodology of the BAT assessment and the entire study protocol were described and consistent with the published first part of the study.7

The effectiveness of VIT was evaluated using BAT, revealing a statistically significant decrease in CD63 reactivity in the mean of about 86%–88% from the base for older patients similarly, as in young 84%–85% (p > 0.05) after 6 months of VIT. Similar trends were observed after next 6 months, and a comparable decrease in basophil activity was maintained at the level after 12 months. The results are presented in Figure 1A–C. After analyzing the BAT results after 6 and 12 months, no significant differences were found between age groups or vaccine types. In the entire study group of patients, 4.9% had negative (regardless of the interview and positive tests and IgE against bees) BAT results, while 3.6% showed no notable improvement after VIT compared to baseline. The obtained BAT values are presented for exposure to 1 μg/mL, as previous data indicate that this criterion provides the optimal balance of sensitivity and specificity when using standardized calibration curves.7

A few observations have been made regarding monitoring of VIT effectiveness using BAT, but not in the older homogeneous group. Most authors present BAT as a helpful method for the final qualification for VIT.4-6, 8 A significant decrease in the activity of stimulated basophils after starting immunotherapy and the maintenance of this trend after a year of treatment is consistent with the observations of other authors.8, 9

Previous observations have shown a decrease of basophil activation using mostly submaximal concentrations of insect venom extracts in study up to 18 months after the start of VIT. In contrast, a lower basophil reactivity was found in these studies after 2 years of treatment.8, 9

Therefore, this present study will continue to obtain long-term results, particularly in older patients, to order to assess the long-term effectiveness of VIT in this group.

Andrzej Bozek: Conceptualization; methodology; software; data curation; supervision; formal analysis; writing—review and editing; investigation. Martyna Miodonska: Validation; methodology; investigation; software; supervision; data curation. Aleksandra Mitka: Investigation; validation; visualization; project administration; formal analysis; supervision; data curation. Dominika Sadowska: Investigation; funding acquisition; writing—original draft; writing—review and editing; validation; formal analysis. Janne Winterstein: Conceptualization; validation; supervision; resources; data curation; writing—review and editing; funding acquisition. Radosław Gawlik: Supervision; data curation; software; validation; investigation. Marita Nittner-Marszalska: Conceptualization; investigation; funding acquisition; validation; methodology; writing—review and editing; project administration; resources; supervision.

The authors declare no conflicts of interest.

Abstract Image

嗜碱性粒细胞活化试验对监测不同年龄组蜂毒免疫治疗效果的有用性
致编辑,过敏原免疫疗法(AIT)仍然是一种完善和广泛使用的治疗即时型过敏的方法,包括过敏性鼻炎和结膜炎,某些形式的过敏性哮喘,特定食物过敏,以及膜翅目昆虫毒液免疫疗法(VIT)的过敏反应。目前,VIT是唯一的病因,在某些情况下,可以挽救生命。ait已被证明对大多数年龄组有效,包括60岁以上的患者然而,有限的研究已经证实了VIT在这些人群中的安全性和有效性这在昆虫叮咬后出现过敏反应的情况下尤其重要,这也是老年患者进行VIT的指征。因此,评估VIT的有效性和对毒液产生耐受性的速度是至关重要的。嗜碱性粒细胞活化试验(BAT)是进行此类评估的最佳工具。BAT是最终确定VIT资格的宝贵工具,通常可以解决疑问。4,5评估VIT有效性的最有诊断价值的方法是活体昆虫刺痛攻击(SP)。然而,SP有明显的局限性,包括必须在高度专业化的中心进行,并发症的风险,包括与应用全剂量、未分离的过敏原有关的并发症,以及重新激活过敏状态的潜在风险。与SP不同,用于评估VIT有效性的BAT没有这些限制。作者希望对VIT在不同年龄组治疗1年后对黄蜂毒液的疗效进行评估,比较年轻和老年患者的疗效,以确定潜在的差异。这建立在早期的一项观察性研究的基础上,该研究在BAT测试中证实了18-35岁和60岁以上人群在VIT启动6个月后的疗效相当这些结果与使用Venomenhal (Hal Allergy)或Diater的疫苗类型无关。在观察的第二部分,研究组的人数略有减少(治疗有效但患者退出,无不良反应),其最终特征如表1所示。描述了BAT评估的方法和整个研究方案,并与已发表的研究第一部分保持一致。使用BAT评估VIT的有效性,显示CD63反应性在老年患者中平均下降约86%-88%,在年轻患者中同样下降84%-85% (p &gt;VIT治疗6个月后0.05)。在接下来的6个月后观察到类似的趋势,并且在12个月后,嗜碱性粒细胞活性保持在相同的水平。结果如图1A-C所示。在分析6个月和12个月后的BAT结果后,没有发现年龄组或疫苗类型之间的显着差异。在整个研究组中,4.9%的患者BAT结果为阴性(不考虑面谈和阳性测试以及对蜜蜂的IgE),而3.6%的患者在VIT后与基线相比没有显着改善。得到的BAT值为暴露于1 μg/mL时的值,因为先前的数据表明,当使用标准化校准曲线时,该标准提供了灵敏度和特异性的最佳平衡。关于使用BAT监测VIT有效性的一些观察结果,但没有在老年同质组中进行。大多数作者认为BAT是一种有助于最终确定vita资格的方法。4- 6,8在开始免疫治疗后,受刺激的嗜碱性粒细胞活性显著下降,并且在治疗一年后这种趋势保持不变,这与其他作者的观察结果一致。先前的观察表明,在VIT开始后的18个月里,使用大多数亚最大浓度的昆虫毒液提取物可以减少嗜碱性粒细胞的激活。相反,在这些研究中,治疗2年后发现了较低的嗜碱性粒细胞反应性。因此,本研究将继续获得长期结果,特别是在老年患者中,以评估VIT在该组中的长期有效性。安德烈·博泽克:概念化;方法;软件;数据管理;监督;正式的分析;写作——审阅和编辑;调查。Martyna Miodonska:验证;方法;调查;软件;监督;数据管理。Aleksandra Mitka:调查;验证;可视化;项目管理;正式的分析;监督;数据管理。多米尼克·萨多夫斯卡:调查;资金收购;原创作品草案;写作——审阅和编辑;验证;正式的分析。Janne Winterstein:概念化;验证;监督;资源;数据管理;写作——审阅和编辑;融资收购。Radosław Gawlik:监督;数据管理;软件;验证;调查。 Marita Nittner-Marszalska:概念化;调查;资金收购;验证;方法;写作——审阅和编辑;项目管理;资源;监督。作者声明无利益冲突。
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来源期刊
Clinical and Translational Allergy
Clinical and Translational Allergy Immunology and Microbiology-Immunology
CiteScore
7.50
自引率
4.50%
发文量
117
审稿时长
12 weeks
期刊介绍: Clinical and Translational Allergy, one of several journals in the portfolio of the European Academy of Allergy and Clinical Immunology, provides a platform for the dissemination of allergy research and reviews, as well as EAACI position papers, task force reports and guidelines, amongst an international scientific audience. Clinical and Translational Allergy accepts clinical and translational research in the following areas and other related topics: asthma, rhinitis, rhinosinusitis, drug hypersensitivity, allergic conjunctivitis, allergic skin diseases, atopic eczema, urticaria, angioedema, venom hypersensitivity, anaphylaxis, food allergy, immunotherapy, immune modulators and biologics, animal models of allergic disease, immune mechanisms, or any other topic related to allergic disease.
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