Diagnostics of allergic rhinitis under dupilumab therapy

Abstract

Background: Allergic rhinits is a prevalent condition, affecting a substantial proportion of the population. This study investigates the impact of ongoing biologic therapy, specifically with Dupilumab, on allergy diagnostics in patients with allergic rhinits.

Methods: Various tests, including the Skin Prick Test, serum IgE levels and Allergy Screening Panels, were examined for their effectiveness in detecting sensitizations during biologic treatment.

Results: The results indicate a significant decline in total IgE levels following biologic therapy initiation, aligning with previous findings on Dupilumab's inhibitory effects on IL-4 and IL-13. However, the specific IgE to total IgE ratio for major allergens was not significantly reduced. Comparing diagnostic tools, the Skin Prick Test demonstrates an impressive retention rate of sensitizations (98%) during Dupilumab treatment, outperforming the Allergy Screening Panel, which shows a 75% detection rate. Notably, the panel displays limitations in capturing lower sensitization levels.

Conclusion: In summary, this study underscores that, despite the influence of biologic therapy on certain markers, standard allergy tests remain viable while emphasizing the importance of considering specific IgE levels rather than relying solely on CAP classes. The Skin Prick Test in particular proves to be a reliable tool for identifying sensitizations during Dupilumab treatment. The results offer valuable guidance for the diagnostic management of Allergic rhinits in individuals subjected to Dupilumab treatment.

Keywords: Allergic rhinitis; Allergy diagnostics; Biologics; Chronic rhinosinusitis; Dupilumab.

Fig. 1

Mean value with standard deviation of tIgE during ongoing biologic treatment given in percentage of baseline value in 6th-month intervals with a mean observation period of 28 months

Fig. 2

Mean value of the quotient of sIgE and tIgE given in percentage with standard deviation before [7] and during ongoing biologic treatment (black) for the allergens, poaceae (Phl p 1), betulaceae (Bet v 1), HDM (consisting of Der p 1, Der p 2 and Der p 23), and animal dander (dog native and cat native). Total number of 64 sensitizations with 18 sensitizations for poaceae, 14 sensitizations for betulaceae, 15 sensitizations for HDM and 18 sensitizations for animal dander

Fig. 3

Detection rate of pre-existing sensitizations for poaceae (n = 17 with CAP class ≥ 1 and n = 17 with > 0.1 kU/l), betulaceae (n = 14 with CAP class ≥ 1 and n = 14 with > 0.1 kU/l), animal epithelia (n = 13 with CAP class ≥ 1 and n = 18 with > 0.1 kU/l) and HDM (n = 12 with CAP class ≥ 1 and n = 15 with > 0.1 kU/l) via serological sIgE measurement during biologic treatment with regard to CAP class ≥ 1 [7] and total value > 0.1 kU/l (black) given in percent

Fig. 4

Detection rate of pre-exisiting sensitizations for grass mix (n = 18), birch (n = 13), hazel (n = 13), alder (n = 14), ash (n = 0, data not shown), mugwort (n = 3), plantain (n = 6), HDM (n = 27 consisting of D. pteronyssinus, D. farina and D. microceras), animal dander (n = 12 consisting of cat, dog and horse), aspergillus (n = 1), alternaria (n = 3) via Allergy Screening Panel during biologic treatment, given in percent

Fig. 5

Detection rate of pre-existing sensitizations for grass mix (n = 16), alder (n = 12), hazel (n = 12), birch (n = 12), ash (n = 3), mugwort (n = 1), plantain (n = 3), dermatophagoides pteronyssinus (n = 7), dermatophagoides farinae (n = 7), lepidoglyphus (n = 2), cat (n = 9), dog (n = 7), alternaria (n = 4), aspergillus (n = 1) via Skin Prick Test during biologic treatment, given in percent