Early Changes in House Dust Mite Component Specific Immunoglobulin Levels Predict the One-Year Efficacy of Allergen Immunotherapy in Patients With Allergic Rhinitis
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引用次数: 0
Abstract
Background
The efficacy of subcutaneous immunotherapy (SCIT) in allergic rhinitis (AR) patients varies. Component-resolved diagnostics (CRD) may serve as a useful tool to predict therapeutic responses.
Methods
Forty-three house dust mite (HDM)-sensitized AR patients undergoing SCIT were enrolled. Clinical data and serum samples were collected at baseline (V1), 15 weeks (V2), and 1 year (V3). The levels of specific immunoglobulin E (sIgE) and sIgG4 to nine HDM components were measured, and a predictive model was established. An independent prospective cohort of 23 patients was used for validation.
Results
The most prevalent sensitizing components were Dermatophagoides pteronyssinus (Der p) 1, Dermatophagoides farinae (Der f) 1, Der p 2, Der f 2, and Der p 23. The responders had a significantly higher Combined Symptom and Medication Score (CSMS) at baseline than did the nonresponders. At V2, the responders showed a greater increase in serum levels of Der f 1 sIgE, higher levels of Der p 23 sIgG4, and greater incremental changes in Der p 23 sIgG4 levels. A composite model based on V1 CSMS, ∆15w Der f 1 sIgE, and ∆15w Der p 23 sIgG4 achieved an area under the receiver operating characteristic curve (AUC) of 0.896 (cutoff: 0.455), with 83.3% sensitivity and 84.0% specificity. In the validation cohort, the model showed a 75.0% positive predictive value, 86.7% negative predictive value, and 82.6% overall accuracy.
Conclusion
A composite biomarker model based on HDM component responses enabled early prediction of SCIT efficacy, supporting more personalized treatment strategies for AR management.
背景皮下免疫治疗(SCIT)对变应性鼻炎(AR)患者的疗效各不相同。成分解析诊断(CRD)可以作为预测治疗反应的有用工具。方法对43例屋尘螨(HDM)致敏AR患者行SCIT治疗。在基线(V1)、15周(V2)和1年(V3)收集临床资料和血清样本。测定9种HDM成分的特异性免疫球蛋白E (sIgE)和sIgG4水平,并建立预测模型。一项由23名患者组成的独立前瞻性队列研究用于验证。结果最常见的致敏成分为翼状螨(Der p) 1、粉状螨(Der f) 1、Der p2、Der f2和Der p23。应答者在基线时的综合症状和药物评分(CSMS)明显高于无应答者。在V2时,应答者血清中Der f1 sIgE水平升高,Der p23 sIgG4水平升高,Der p23 sIgG4水平增加。基于V1 csm、∆15w Der f 1 sIgE和∆15w Der p 23 sIgG4的复合模型的受试者工作特征曲线下面积(AUC)为0.896(截止值为0.455),敏感性为83.3%,特异性为84.0%。在验证队列中,该模型的阳性预测值为75.0%,阴性预测值为86.7%,总体准确率为82.6%。结论基于HDM成分反应的复合生物标志物模型可以早期预测SCIT疗效,为AR管理提供更个性化的治疗策略。
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.