Basophil sensitivity reflects long-term clinical outcome of subcutaneous immunotherapy in grass pollen-allergic patients

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BACKGROUND: Allergic rhinoconjunctivitis is a public health problem. Allergen Immunotherapy is an effective and safe treatment, that modifies the natural course of allergic disease and induces long-term tolerance.

OBJECTIVE: To correlate basophil and antibody biomarkers of subcutaneous immunotherapy to clinical outcomes and cellular changes in target tissue.

METHODS: Adults suffering from allergic rhinoconjunctivitis due to grass pollen allergy were randomized to receive subcutaneous immunotherapy (n=18) or to an open control group (n=6). Patients reported daily symptom and medication scores and weekly rhinitis related quality of life scores during four pollen seasons. Biomarkers were measured every 3 months for three years treatment and every 6 months in the follow-up year. Nasal and cutaneous allergen challenge tests were performed annually. Leucocyte subsets were assessed in nasal mucosa biopsies at baseline and after treatment.

RESULTS: Subcutaneous immunotherapy led to a 447-fold decrease in basophil sensitivity during the first treatment year. This remained hundredfold lower than baseline during the 3 year-treatment period and tenfold lower during the follow-up year (n=18, p=0.03). Decrease in basophil sensitivity after three weeks of treatment predicted long-term improvement in seasonal combined symptom and medication scores (ῥ=-0.69, p=0.0027) during three years of treatment. AUC of IgE blocking factor correlated to nasal allergen challenge (ῥ =0.63, p=0.0012) and SPT (ῥ =0.45, p=0.03). Plasma cell numbers in the nasal mucosa increased during treatment (p=0.02).

CONCLUSION: Decrease in basophil sensitivity after three weeks of subcutaneous allergen immunotherapy predicted the clinical outcome of this treatment.

TidsskriftAllergy: European Journal of Allergy and Clinical Immunology
Antal sider11
StatusE-pub ahead of print - 7 mar. 2020

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