[In vitro study on the individual binding ability of omalizumab with free IgE]

Objective:To investigate the individual binding ability of omalizumab to free IgE and its effect on omalizumab action. Methods:A total of 28 serum samples were collected from patients with allergic rhinitis and divided into groups with high, medium and low concentrations of free IgE. Different doses of omalizumab were administered in vitro for inhibitory binding. Enzyme linked immunosorbent assay was used to detect changes in serum free IgE after inhibition. The inhibition constant of omalizumab on serum free IgE was calculated. At the same time, the binding ability of omalizumab and individual free IgE was analyzed. Results:In general, when 100% serum free IgE was inhibited, the omalizumab required was positively correlated with the original serum free IgE concentration（9.500±7.207, 8.636±7.375, and 0.786±0.857 for the high, medium, and low IgE concentration groups, respectively）. The dose of omalizumab required for inhibition of 50% free IgE in serum was significantly lower（0.049±0.071, 0.046±0.077, 0.048±0.048 in the high, medium, and low IgE concentrations groups, respectively）. The 100% and 50% inhibition constants of serum free IgE in different individuals were different to some extent. Conclusion:Overall, the amount of omalizumab required to achieve the same inhibitory effect is proportional to the IgE concentration. In some sensitive patients, partial binding inhibition of free IgE can occur even when omalizumab is administered at less than the recommended dose. The binding ability of serum free IgE and omalizumab was different in different individuals. If this factor is used as a reference for the individual dose of omalizumab in clinical medicine, it is possible to achieve the expected efficacy more accurately.

[A preliminary study on the biomarkers of local inflammation in allergic rhinitis]

Objective:This study aimed to explore the biomarkers in nasal secretion that can assist in the diagnosis of allergic rhinitis（AR） and can be used to evaluate the therapeutic effect of AR. Methods:Thirty-three patients with AR and 21 healthy controls were included. The nasal secretion of healthy controls and patients with AR（before and after treatment） were collected. The cytology, the concentrations of cytokines（IL-5, IL-6, IL-8, IL-33, IFN-γ） and inflammatory mediators（ECP, MPO） were detected. Then, we compared the differences of various biomarkers between healthy controls and AR patients（before and after treatment group）. And analyzed the correlation between each biomarkers/biomarkers difference value/the percentage of biomarkers difference value and clinical symptom score/ score difference value / the percentage of score difference value. Results:Compared with normal controls, the levels of ECP, IL-5, IL-6, IL-8, IL-33 and IFN-γ in nasal secretion of AR patients were significantly higher than those of normal controls（P<0.05）. There was no significant difference in MPO. After treatment, ECP decreased significantly（P<0.01）, inflammatory cell grade and eosinophil percentage are also decreased（P<0.01）. However, MPO, IL-5, IL-6, IL-8, IL-33 and IFN-γ did not change significantly. The difference value of ECP before and after treatment was correlated with the difference value of VAS score（r=0.348, P=0.047）. The difference value of IL-5 was correlated with the difference value of VAS score and rhinorrhea, the correlation coefficients were 0.406（P=0.019） and 0.429（P=0.013）, respectively. The difference value of eosinophil percentage in nasal secretion before and after treatment was correlated with nasal congestion, and the correlation coefficient was 0.383. The difference value of eosinophil percentage multiplied by inflammatory cell grade before and after treatment was correlated with VAS score（r=0.417, P=0.016） and nasal congestion difference value（r=0.519, P=0.002）. The percentage of difference value of IFN-γ before and after treatment was correlated with the percentage of difference value of VAS score / rhinorrhea / sneeze / total nasal symptom score. Conclusion:ECP, IL-6, IL-8 and IL-33 in nasal secretion are expected to be objective biomarkers for auxiliary diagnosis of AR. And ECP, IL-5, IFN-γ, eosinophil percentage multiplied by grade is expected to be an objective index to judge the improvement of patients' symptoms after treatment.

[Safety comparison of omalizumab and glucocorticoid in rush allergen immunotherapy]

Objective:To observe the safety of omalizumab and glucocorticoid in the dose-increasing phase of rush allergen immunotherapy（RIT）. Method:The clinical data of 88 patients with allergic rhinitis treated with RIT were retrospectively studied, including gender, age, pre-treatment total VAS score, blood EOS%, serum total IgE, local and systemic adverse reactions. Of all patients, fifty-seven were treated with omalizumab combined with RIT（experimental group） and thirty-one were treated with hormone/antiallergic drugs combined with RIT（control group）. The safety of the two groups was compared in the dose-increasing phase. Result:There was no grade Ⅰ systemic adverse reactions during the whole process in the experimental group, while Grade Ⅱ systemic adverse reactions were 4 cases（7.1%） during the period of hospitalization, 2 cases（3.6%） after the first injection after discharge, zero（0） after the second injection after discharge. No local pruritus and induration were observed. During the period of hospitalization, the first and second injection after discharge, control group had grade Ⅰ level systemic adverse reactions were 1 case（3.4%）, 2 cases（6.9%）, 1 case（3.4%） at different time point, respectively. Grade Ⅱ systemic adverse reactions were 5 cases（17.2%）, 1 case（3.4%）, zero（0） at different time point, respectively. Local injection site itching was observed in 8 patients（5 cases were mild and 3 cases were moderate） and 4 cases（13.8%） had induration during hospitalization. Conclusion:Omalizumab combined with RIT not only shortens the duration of dose-increasing phase of specific immunotherapy, but also increases the safety of the dose-increasing phase during hospitalization, the first and second injection after discharge and improves patient compliance.