Molecular Aspects of Allergen-Specific Immunotherapy in Patients with Seasonal Allergic Rhinitis

Molecular sensitisation patterns to aeroallergens in a Mediterranean paediatric population and their clinical implications

BACKGROUND

Environmental exposures, climate change, and lifestyle factors are key contributors to respiratory allergies. Understanding the connection between allergen exposure and the development of allergic diseases in early life is essential for identifying sensitization patterns and optimizing diagnostic and therapeutic strategies.

OBJECTIVE

This study aims to characterize the allergic sensitization profile in a Mediterranean paediatric population using a component-resolved diagnosis (CRD) approach. Specifically, we analyse the prevalence and serodominance of aeroallergens, examine age-related sensitization patterns, and assess their implications for personalized allergen immunotherapy. Additionally, we highlight the need to incorporate the identified molecular allergens into standardized allergenic extracts to improve diagnostic accuracy and immunotherapy efficacy.

METHODS

We conducted an observational, cross-sectional study including paediatric patients (0-15 years) diagnosed with allergic rhinitis, with or without asthma. Patients were classified according to disease severity following international guidelines. Skin prick tests were performed using standardized extracts, and specific IgE levels were determined with the multiplex assay Allergy Explorer 2 (ALEX2-MADX).

RESULTS

A total of 47 patients were included (mean age: 7.5 years). Sensitization to house dust mites (HDM) was the most prevalent (74.5%), followed by pollen (57.4%) and animal epithelia (44.6%). The most frequently recognized allergens were Der p 23 (59.57%) for HDM, Ole e 1 (36.17%) for olive pollen, and Fel d 1 (27.7%) for cat epithelium. The highest IgE levels were observed in children aged 6-10 years. Polysensitization was present in 66% of patients, with frequent co-recognition of allergens from different sources. The findings emphasize the need to ensure that allergenic extracts used in diagnosis and immunotherapy contain relevant molecular components to enhance treatment precision.

CONCLUSION

A detailed molecular characterization of allergic sensitization in paediatric patients provides valuable insights into aeroallergen exposure and its clinical implications. Our findings reinforce the importance of incorporating relevant molecular allergens into standardized diagnostic and therapeutic extracts to optimize patient management and improve the efficacy of allergen-specific immunotherapy.

Comparative safety analysis of coseasonal versus preseasonal Artemisia annua sublingual immunotherapy for allergic rhinitis

PURPOSE

Patients with seasonal allergic rhinitis (SAR) usually seek treatment when symptoms become unbearable during the pollen season. It remains unclear whether initiating sublingual immunotherapy (SLIT) during the pollen season affects patients' safety. This study aims to compare the tolerability of initiating Artemisia annua SLIT during the pollen season versus before the season.

METHODS

Ninety patients with Artemisia-induced SAR were recruited and equally randomized into the coseasonal initiation treatment (COS-SLIT) group and the preseasonal initiation treatment (PRE-SLIT) group. The COS-SLIT group started SLIT when allergic symptoms occurred during the 2022 pollen season, while the PRE-SLIT group began SLIT four months before the expected season in 2022. Patients were categorized as mild symptoms or moderate-severe symptoms group based on the level of visual analog scale (VAS) scores evaluated during the 2021 pollen season. The incidence, frequency, performance, and alleviating measures of adverse events (AEs) were analyzed after the up-dosing phase (5 weeks), at three months (13 weeks), six months (26 weeks), and twelve months (52 weeks).

RESULTS

A total of 72 patients (32 patients in the COS-SLIT group and 40 patients in the PRE-SLIT) were included in the analysis. Among these patients, 33 reported a total of 78 AEs. No significant difference was found in the frequency and number of patients experiencing AEs between the COS-SLIT and PRE-SLIT groups during the four follow-up periods (all p > 0.05). There were no significant differences in the symptoms or alleviating measures of AEs between the two groups in general (all p > 0.05). Furthermore, the most common AEs in the COS-SLIT group were nasal symptoms (n = 14), lip edema (n = 10), and cough (n = 4), while in the PRE-SLIT group were nasal symptoms (n = 12), lip edema (n = 8), and ocular pruritus (n = 6). Symptomatic drugs were the most common alleviating measures in both groups (61.29% in COS-SLIT and 64.52% in PRE-SLIT, p > 0.05). Patients with mild and moderate-severe symptoms showed comparable tolerability at different initiation timing (all p > 0.05).

CONCLUSION

This prospective study demonstrates the comparable safety and tolerability of initiating Artemisia annua SLIT during the pollen season and before the season.

First Vibrational Fingerprint of Parietaria judaica Protein via Surface-Enhanced Raman Spectroscopy

Accurate identification and characterization of allergenic proteins at the molecular level are essential for pinpointing the specific protein structures responsible for allergic reactions, thus advancing the development of precise diagnostic tests. Significant efforts have been focused on novel experimental techniques aimed at deepening the understanding of the underlying molecular mechanisms of these reactions. In this work, we show, for the first time to our knowledge, the unique Raman fingerprint of three Parietaria judaica (Par j) allergenic proteins. These proteins are typically present in pollen and are known to trigger severe respiratory diseases. In our research, we further exploited the surface-enhanced Raman scattering (SERS) effect from an Ag dendrite substrate. This approach provided better discrimination and a comprehensive analysis of the proteins Par j 1, 2, and 4 in hydration conditions, enabling rapid differentiation between them through a spectroscopic study.

Global Ragweed Allergy: Molecular Allergens and Integrated Control Strategies

Originally native to North America, ragweed has become a pervasive invasive species worldwide over the past century, posing a substantial public health risk as a potent allergen. This review explores the key allergens found in common ragweed, assesses global trends in ragweed sensitization, particularly in China, and examines various therapeutic and biological control methods. There are currently 11 identified ragweed allergens, with Amb a 1 and 11 recognized as the primary triggers. Epidemiological data indicate higher rates of sensitization in North America and Europe, with a growing trend observed in China. Ragweed-induced type I hypersensitivity typically presents as seasonal allergic rhinitis, conjunctivitis, and asthma symptoms. Strategies for managing ragweed allergy include allergen avoidance, pharmacotherapy, and allergen immunotherapy (AIT). Biological control using Ophraella communa and Epiblema strenuana effectively limits ragweed proliferation. Accurate allergen identification and personalized treatment can significantly reduce the health burden associated with ragweed. An in-depth understanding of ragweed sensitization patterns and biological control measures is essential for the long-term prevention of ragweed allergies.

Correlation between monocyte and length of in-hospital stay in patients with allergic rhinitis: data from the MIMIC-IV database

BACKGROUND

This study aimed to explore the factors associated with the length of in-hospital stay (LOS) in allergic rhinitis (AR).

METHODS

Patients with AR and related data were identified from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The influencing factors of LOS were determined by correlation analysis and linear regression. We ranked the importance of significant variables. Finally, mediation analysis was performed to explore the potential mediating factors associated with LOS.

RESULTS

This retrospective study enrolled 937 patients diagnosed with AR. Correlation analysis showed that 10 variables were closely correlated with the LOS. Linear regression further showed that albumin, white blood cell (WBC), red blood cell (RBC), red cell distribution width (RDW), total Ca, and monocyte were independently related to the LOS (all P < 0.05). After considering comorbidities, monocyte, albumin, WBC, RBC, total Ca, and Charlson comorbidity index were independent factors for LOS (all P < 0.05). The permutation importance exhibited that monocyte was the most important variable. Finally, mediation analysis demonstrated that WBC played a mediating role in the relationship between monocytes and LOS.

CONCLUSION

Monocyte level is related to the LOS of patients with AR, and their relationship can be mediated by WBC. Medical and nursing staff can stratify AR management according to monocyte levels to make crucial clinical decisions and shorten LOS.

CLINICAL TRIAL

Not applicable.

Allergic Potential of Medicinal Plants From the Asteraceae Family

Background and Aims

The popularity of herbal medicine continues to increase in modern health care practices; therefore, it is imperative to recognize and address potential risks associated with its everyday use. The Asteraceae family is one of the most extensively utilized medicinal plant families due to its abundance and diversity of bioactive secondary metabolites. The aim of this article is to review the current understanding of the allergic potential of the most significant medicinal plant species belonging to the Asteraceae family.

Methods

This review utilized various search engines, including PubMed Central, Cochrane Central, Google Scholar, and others, up to January 2024, considering only articles in English.

Results

Asteraceae have long been acknowledged as important sensitizers within occupational environments, eliciting both immediate and delayed hypersensitivity reactions. Recent investigations have indicated the presence of panallergens in Asteraceae pollen, predominantly identified in Ambrosia artemisiifolia and Artemisia spp., which are pervasive across many species within the family. These panallergens contribute to cross-reactivity phenomena, serving as primary triggers for pollinosis and pollen-food or pollen-medicine allergy syndrome. In addition, the diverse array of secondary metabolites present in the Asteraceae family, particularly sesquiterpene lactones (SLs), possesses sensitizing properties capable of inducing skin irritation and inflammation. Moreover, SLs have the potential to incite systemic reactions, posing a risk to sensitized individuals upon ingestion. Although extensive cross-reactivity among SLs has been reported, further investigations are warranted to elucidate the underlying mechanisms and implications.

Conclusion

As numerous uncertainties persist regarding critical Asteraceae allergens and sensitizers further research is critical to augment our understanding of the potential risks posed by Asteraceae herbal medicine.

Allergen Testing: A Review of the Indications, Procedures, and Limitations in Ocular Allergy

Allergen-based diagnostics are essential in the management algorithm of allergic diseases. Unlike systemic allergy, where the indications and interpretation of these diagnostic modalities are well established, their utility in ocular allergy is not well-defined. With the rising prevalence of ocular allergies and the need for personalized treatment strategies, there is a growing demand for precision allergen diagnostics. This review describes the commonly used tests with their indications, procedures, and limitations. A review of the literature was carried out on articles on allergen diagnostics in ocular allergy, and after excluding articles that were not relevant, 82 papers were included in the current review. IgE-mediated pathways contribute significantly to seasonal and perennial ocular allergy and partly to vernal keratoconjunctivitis. Most diagnostic techniques aim to detect IgE sensitization. In vivo tests include skin prick (SPT), intradermal, and patch tests. SPT is considered the gold standard and directly evaluates the presence of allergen-specific IgE in the skin. In vitro tests measure total and specific IgE from either tears or sera. Tear IgE measurement is relatively specific for allergic conjunctivitis and can provide insight into the potential allergens responsible for local sensitization. The conjunctival provocation test can help establish true allergy, especially in patients with polysensitization. This review also provides an overview of evidence in literature segregated based on the test employed. This includes 17 studies on only SPT; 42 studies on IgE measured in serum, tears, or both; and 20 studies which have evaluated both SPT and IgE. The pattern of allergen sensitization can guide recommendations for avoidance measures and immunotherapy. Thus, this could create a corticosteroid-sparing therapy avenue in these patients, reducing disease severity and resulting visual morbidity.

Polysensitisation is associated with more severe symptoms: The reality of patients with allergy

BACKGROUND

Studying the sensitisation profiles of patients with allergies allows for a deeper understanding of the disease which may facilitate the selection of the best-personalised allergen immunotherapy. This observational, cross-sectional, multicentre study aimed to demonstrate the heterogeneity of the German population with allergies by analysing specific immunoglobulin E (sIgE) patterns towards aeroallergens and exploring the relationship between sensitisation and clinical symptoms.

METHODS

In total, 500 patients with allergies from different regions of Germany were recruited based on their case histories, clinical allergic symptoms and skin prick test data for aeroallergens. Serum samples were analysed using ImmunoCAP assays to determine sIgE levels for 33 allergenic sources and 43 molecular allergens.

RESULTS

Most patients (81%) were polysensitised. Betula verrucosa pollen was the most common cause of sensitisation (59%), followed by Phleum pratense (58%) and Dermatophagoides pteronyssinus (44%). The highest prevalence rates of molecular allergens were observed for Bet v 1 (84%) from birch pollen, Phl p 1 from grass pollen (82%), Der p 2 (69%) from mites and Fel d 1 (69%) from cat. Polysensitisation was significantly associated with the presence of asthma and the severity of rhinitis symptoms.

CONCLUSIONS

Our findings show a high rate of polysensitisation and emphasise the importance of molecular diagnosis for more precise and comprehensive insights into sensitisation patterns and their association with clinical symptoms. These data may help improve personalised diagnosis and immunotherapy adapted to the needs of individual patients in the region.

A real-life ImmunoCAT study: impact of molecular diagnosis through ImmunoCAPTM ISAC 112 on immunotherapy prescription in pollen-polysensitized patients in Catalonia, Spain

BACKGROUND

Molecular diagnosis in allergology helps to identify multiple allergenic molecules simultaneously. The use of purified and/or recombinant allergens increases the accuracy of individual sensitization profiles in allergic patients.

OBJECTIVE

To assess the impact of molecular diagnosis through the ImmunoCAPTM ISAC 112 microarray on etiological diagnosis and specific immunotherapy (SIT) prescription. This was compared to the use of conventional diagnoses in pediatric, adolescent, and young adult patients with rhinitis or rhinoconjunctivitis and/or allergic asthma, sensitized to three or more pollen allergens of different botanical species.

METHODS

A multicenter, prospective, observational study was conducted in patients aged 3-25 years who received care at the Allergology service of 14 hospitals in Catalonia from 2017 to 2020. Allergology diagnosis was established based on the patient's clinical assessment and the results of the skin prick test and specific immunoglobulin E assays. Subsequently, molecular diagnosis was conducted using ImmunoCAPTM ISAC® 112 to recombinant and/or purified allergen components.

RESULTS

A total of 109 patients were included; 35 (32.1%) were pediatric patients and 74 (67.9%) were adolescents or young adults (mean age: 18 years), with 58.0% being females. A change of 51.0% was observed in SIT prescription following molecular etiological diagnosis by means of a multi-parameter microarray.

CONCLUSIONS

Molecular diagnosis by means of multi-parameter tests increases the accuracy of etiological diagnosis and helps to define an accurate composition of SIT.

Advocacy of Precision Allergy Molecular Diagnosis in Decision Making for the Eligibility of Customized Allergen Immunotherapy

Allergen immunotherapy (AIT) with aeroallergens is the only disease-modifying treatment for patients with different allergic conditions. Despite the effectiveness of AIT having been proven in both randomized controlled trials and real-world studies, it remains underused in less than 10% of subjects with allergic rhinitis (AR) and/or asthma (A). We aimed to determine the current eligibility for house dust mite (HDM) AIT by means of a precision allergy molecular diagnosis (PAMD@) model in a selected cohort of youngsters with different allergic phenotypes according to the available evidence. A complex response to both HDM and storage mite allergens was depicted regardless of the subjects' basal atopic condition. No solely specific IgE-binding responses to Der p 1, Der p 2, and/or Der p 23 were found in the studied cohort. Despite the patients with A and atopic dermatitis showing significantly higher serum titers to six mite allergens than subjects with AR, no specific molecular profile was regarded as disease specific. Given the increasing complexity of specific IgE responses to the local prevailing aeroallergens, the identification and presence of such molecules are needed in commercially available AIT in the era of precision medicine.

Allergic Rhinitis: Tailoring Immunotherapy Through Innovative Diagnostics

Allergic rhinitis (AR) is a chronic ailment triggered by immunoglobulin E (IgE)-mediated reactions to allergens. Generally, AR is accompanied by asthma and conjunctivitis. The risk factors of AR include both inhalant and occupational allergens and genetic factors. Although AR is not a life-threatening condition, it poses a significant risk of morbidity and hampers work-related performance. Currently, the diagnosis of AR is based on clinical history and physical examination of the patients. Furthermore, several laboratory tests such as skin pricking test (SPT), nasal allergen challenge (NAC), and computed tomography (CT) are also recommended in some cases. Nasal cytology can aid in the differentiation of rhinitis because of allergy or infection. Apart from this, molecular diagnostic modalities such as basophil activation test (BAT) and Immune Solid-Phase Allergy Chip (ISAC) can also be employed for the confirmatory diagnosis of AR. Immunotherapy has demonstrated efficacy in the management of AR, with only mild side effects. With the advancement in the diagnostic realm of AR, personalized treatment approach has also gained significant popularity. Immunotherapy is gaining evidence on becoming a personalized treatment approach for the management of AR. This article provides a comprehensive overview, aiming to bridge the gap between evolving diagnostics and personalized therapeutic strategies for allergic rhinitis.