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. 2019 Jun;49(6):808-818.
doi: 10.1111/cea.13361. Epub 2019 Feb 27.

Clinical and immunological differences between asymptomatic HDM-sensitized and HDM-allergic rhinitis patients

Mihaela Zidarn  1   2 , Maša Robič  1 , Anja Krivec  1 , Mira Šilar  1 , Yvonne Resch-Marat  3 , Susanne Vrtala  3 , Peter Kopač  1 , Nissera Bajrović  1 , Rudolf Valenta  3   4   5 , Peter Korošec  1
Affiliations

Clinical and immunological differences between asymptomatic HDM-sensitized and HDM-allergic rhinitis patients

Mihaela Zidarn et al. Clin Exp Allergy. 2019 Jun.

Abstract

Background: Confirmation of the clinical relevance of sensitisation is important for the diagnosis of allergic rhinitis.

Objective: To investigate the usefulness of an in vitro basophil activation test and component-resolved diagnosis in distinguishing between symptomatic allergic rhinitis patients and asymptomatic sensitization to house dust mites (HDMs).

Methods: Thirty-six subjects with a positive skin prick test (SPT) for HDM were divided into a symptomatic (n = 17) and an asymptomatic (n = 19) group on the basis of their clinical history and a nasal provocation test. A basophil CD63 response to in vitro stimulation with Dermatophagoides pteronyssinus whole allergen extract and the IgE reactivity profiles for Der p 1, 2, 4, 5, 7, 10, 11, 14, 15, 18, 21, 23 were evaluated. Serum IgE and IgG specific to D pteronyssinus whole allergen extract and total IgE were measured.

Results: There were no statistically significant differences in the levels of IgE (IgE levels were higher in symptomatic patients with P = 0.055) and IgG specific to D pteronyssinus and total IgE. Symptomatic patients showed a lower threshold for in vitro basophil activation (3.33 ng/mL vs 33.3 ng/mL), a higher area under the curve (AUC) of basophil activation (171 vs 127) (P = 0.017), a higher response to positive control with anti-FcεRI stimulation (97% vs 79%) (P < 0.001), a recognition of more HDM allergens (4 vs 2) and more frequent sensitization to rDer p 7 (P = 0.016) and rDer p 23 compared to asymptomatic subjects (P = 0.018). There was a positive correlation (r = 0.63; P < 0.001) between the number of recognized allergens and the AUC of basophil activation.

Conclusion and clinical relevance: In the subjects studied, the differences in the basophil response to D pteronyssinus allergen extract, number of recognized HDM allergens and reactivity to rDer p 7 and rDer p 23 distinguish symptomatic from asymptomatic HDM sensitisation better than SPT or allergen extract-specific IgE. Information regarding the clinical relevance of sensitization is important for the prescription of allergen-specific immunotherapy.

Keywords: CD63; allergic rhinitis; basophil activation; component-resolved diagnosis; house dust mite.

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Conflict of interest statement

Conflicts of Interest

RV has received research funding from Biomay AG, Vienna, Austria and Viravaxx, Vienna, Austria and serves as a consultant for both companies. Other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of patient inclusion. AR Q, allergic rhinitis questionnaire; HDM, house dust mite; NPT, nasal provocation test; SPT, skin prick test
Figure 2
Figure 2
A, Comparison of basophil CD63 response at different concentrations of Dermatophagoides pteronyssinus in symptomatic patients and asymptomatic subjects. B, Box plot showing the area under the curve of the CD63 basophil response after in vitro activation with increasing allergen concentrations
Figure 3
Figure 3
IgE reactivity to individual HDM allergens in symptomatic patients with HDM-related allergic rhinitis and asymptomatic subjects with HDM sensitization. Fisher's exact test was used for assessing the frequencies of natural and recombinant HDM allergen
Figure 4
Figure 4
A, Comparison of the AUC of basophil response to in vitro stimulation with Dermatophagoides pteronyssinus extract between groups of subjects with increasing numbers of recognized HDM allergens in all subjects with positive SPT for HDM allergen. B, Correlation between the number of recognized HDM allergens and the AUC. AR Q, allergic rhinitis questionnaire; HDM, house dust mite; NPT, nasal provocation test; SPT, skin prick test
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