Abstract
Accessibility to more precise diagnostic techniques such as component resolved diagnostics (CRD), provides us with an important advance in diagnostic aspects as well as treatment. The subject of this study aims to better understand the profiles of sensitization to Der p 1, Der p 2 and Der p 23 and to know to what extent their use could help us in optimizing the decision-making for their treatment with Specific Immunotherapy. Cross-sectional study of subjects older than 5 years, diagnosed with allergy to HDM using skin prick test and sIgE, with symptoms of rhinitis and/or asthma. Total and specific IgE was determined to D. pteronyssinus, nDer p 1, rDer p 2 and rDer p 23 using ImmunoCAP. 240 patients were recruited (97.1% rhinitis and 46.25% rhinitis and asthma). Four different phenotypes were observed: positive or negative for sIgE nDer p 1 and/or IgE rDer p 2. 17% of these patients sIgE were double negative for Der p 1 and Der p 2 (increasing with age and with significantly lower sIgE levels than the rest of the groups). Using ROC curves, value less than 2.18 KUA/L for D. pteronyssinus sIgE gave us a sensitivity and specificity of 0.882 and 0.985, respectively, to double negative IgE nDer p 1 and IgE rDer p 2 group. Despite positive SPT and sIgE to D. pteronyssinus, 17% of the studied population is IgE nDer p 1 and IgE rDer p 2 double negative, with a cut-off value of 2.18 KU/L, which is very relevant for taking of decisions in prescription of AIT. The double positive population sIgE nDer p 1 and IgE rDer p 2 is associated with asthma compared to the other groups and this does not seem to be influenced by IgE rDer p 23.
Highlights
Accessibility to more precise diagnostic techniques such as component resolved diagnostics (CRD), provides us with an important advance in diagnostic aspects as well as treatment
Prevalence of sensitization and levels of specific IgE (sIgE) to D. pteronyssinus (Dptr) and their components nDer p 1, rDer p 2 and rDer p 23. 67% of the patients were found sensitized Double Positive (DP), 17% were not sensitized to nDerp[1] and rDerp[2] (DN) and IgEDerp[1] positive and IgEDerp[2] negative patients (DP1) and IgEDerp[1] negative and IgEDerp[2] positive patients (DP2) were found sensitized in a 7% and 9% respectively, being DN significantly higher than the proportion of DP1 or DP2 patients (Fig. 1a)
It is necessary a standardization of the allergenic extracts used in diagnosis, like is showed by Brunetto et al.[12] and Casset et al.[13], we have taken the same House dust mite (HDM) extract used in the article published by Jiménez-Feijoo et al.[14], where the authors showed that all patients sensitized exclusively to rDer p 23 had a positive Skin-Prick Test (SPT) to D. pteronyssinus, so we can consider that the extract used is useful in our population
Summary
Accessibility to more precise diagnostic techniques such as component resolved diagnostics (CRD), provides us with an important advance in diagnostic aspects as well as treatment. Despite positive SPT and sIgE to D. pteronyssinus, 17% of the studied population is IgE nDer p 1 and IgE rDer p 2 double negative, with a cut-off value of 2.18 KU/L, which is very relevant for taking of decisions in prescription of AIT. Measurement of specific antibodies to HDM extracts could be a safe and routine procedure with high value estimates of sensitivity and specificity in both nDer p 1 (Derp1) and rDer p 2 (Derp2) supported the use in the diagnosis of Dptr and optimizing immunotherapy outcome[5]. The aim of the present study was to investigate the profile of Derp[1], Derp[2] and Der p 23 (Derp23) allergens in mite-sensitized patients and draw practical conclusions for daily practice or involvement in making decisions for immunotherapy
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