Baseline serum double-mite (D1+D2) sIgE/tIgE ratio as a predictor of early-phase response to dual-mite subcutaneous immunotherapy in allergic rhinitis
Main Article Content
Keywords
allergen immunotherapy, predictive biomarker, specific IgE, total IgE, treatment outcome
Abstract
Background: Subcutaneous immunotherapy (SCIT) for allergic rhinitis (AR) requires long-term treatment, and its phased efficacy often influences patient adherence. Identifying early biomarkers, such as serum-specific IgE to total IgE (sIgE/tIgE) ratio, may support individualized management.
Objective: To determine the predictive value of baseline double-mite (D1+D2) sIgE/tIgE ratio for phased dual-mite SCIT response in AR patients.
Methods: We prospectively enrolled 194 AR patients sensitized to Dermatophagoides pteronyssinus (D1) and Dermatophagoides farinae (D2) who received dual-mite SCIT between September 2022 and January 2023. Baseline serum tIgE and sIgE (D1+D2) were measured, and the combined sIgE/tIgE ratio was calculated. Treatment response was evaluated by reduction in visual analogue scale (VAS) scores at months 6 and 12, with the efficacy distribution compared between the two time points using the Chi-square test. Univariable and multivariable logistic regression identified predictors of achieving at least an effective response, and receiver operating characteristic (ROC) analysis was applied for sIgE/tIgE ratio when indicated.
Results: SCIT efficacy improved over time, with a significant shift in response distribution between 6 and 12 months (χ² = 10.084, P = 0.006). At 6 months, multivariable analysis showed that both higher baseline VAS score (OR = 0.954, 95% CI: 0.929–0.980, P < 0.001) and higher sIgE/tIgE ratio (OR = 0.985, 95% CI: 0.972–0.999, P = 0.036) were independently associated with lower likelihood of achieving at least effective response. ROC analysis indicated a cutoff sIgE/tIgE ratio of 26.62% for predicting poor short-term response. At month 12, only baseline VAS score remained a significant predictor (OR = 1.038, 95% CI: 1.005–1.072, P = 0.025).
Conclusion: SCIT efficacy progressively improves over the first year. A higher baseline sIgE (D1+D2)/tIgE ratio (>26.62%) predicts poorer short-term response, highlighting the value of objective biomarkers for early response assessment and individualized management.
References
2. Li Q, Zhang X, Feng Q, Zhou H, Ma C, Lin C, et al. Common allergens and immune responses associated with allergic rhinitis in China. J Asthma Allergy. 2023 Aug 17;16:851-–861. https://doi.org/10.2147/JAA.S420328
3. Jeong KY, Park JW. Allergens of regional importance in Korea. Front Allergy. 2021 Mar 5;2:652275. https://doi.org/10.3389/falgy.2021.652275
4. Sousa L, Martín-Sierra C, Pereira C, Loureiro G, Tavares B, Pedreiro S, et al. Subcutaneous immunotherapy induces alterations in monocytes and dendritic cells homeostasis in allergic rhinitis patients. Allergy Asthma Clin Immunol. 2018 Nov 15;14:45. https://doi.org/10.1186/s13223-018-0271-8
5. Sohn MH. Efficacy and safety of subcutaneous allergen immunotherapy for allergic rhinitis. Allergy Asthma Immunol Res. 2018 Jan;10(1):1-–3. https://doi.org/10.4168/aair.2018.10.1.1
6. Chang ML, Cui C, Liu YH, Pei LC, Shao B. Analysis of total immunoglobulin E and specific immunoglobulin E of 3,721 patients with allergic disease. Biomed Rep. 2015 Jul;3(4):573-–577. https://doi.org/10.3892/br.2015.455
7. Yao H, Wang L, Zhou X, Jia X, Xiang Q, Zhang W. Predicting the therapeutic efficacy of AIT for asthma using clinical characteristics, serum allergen detection metrics, and machine learning techniques. Comput Biol Med. 2023 Nov;166:107544. https://doi.org/10.1016/j.compbiomed.2023.107544
8. Brożek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017 Oct;140(4):950-–958.
9. Hao Q, Chen Z, Yin Y, Cao Y, Deng J. Efficacy of subcutaneous specific immunotherapy for allergic rhinitis combined with asthma: a retrospective analysis. Am J Transl Res. 2024 Oct 15;16(10):5933-–5942. https://doi.org/10.62347/JOAN8017
10. López JF, Bel Imam M, Satitsuksanoa P, Lems S, Yang M, Hwang YK, et al. Mechanisms and biomarkers of successful allergen-specific immunotherapy. Asia Pac Allergy. 2022 Oct 31;12(4):e45. https://doi.org/10.5415/apallergy.2022.12.e45
11. Weinfeld D, Westin U, Hellkvist L, Mellqvist UH, Jacobsson I, Cardell LO. A preseason booster prolongs the increase of allergen specific IgG4 levels, after basic allergen intralymphatic immunotherapy, against grass pollen seasonal allergy. Allergy Asthma Clin Immunol. 2020 Apr 28;16:31. https://doi.org/10.1186/s13223-020-00427-z
12. Penagos M, Eifan AO, Durham SR, Scadding GW. Duration of allergen immunotherapy for long-term efficacy in allergic rhinoconjunctivitis. Curr Treat Options Allergy. 2018;5(3):275-–290. https://doi.org/10.1007/s40521-018-0176-2
13. Yeğit OO, Demir S, Ünal D, Olgaç M, Terzioğlu K, Eyice Karabacak D, et al. Adherence to subcutaneous immunotherapy with aeroallergens in real-life practice during the COVID-19 pandemic. Allergy. 2022 Jan;77(1):197-–206. https://doi.org/10.1111/all.14876
14. Ren L, Wang C, Xi L, Gao Y, Zhang Y, Zhang L. Long-term efficacy of HDM-SCIT in pediatric and adult patients with allergic rhinitis. Allergy Asthma Clin Immunol. 2023 Mar 11;19(1):20. https://doi.org/10.1186/s13223-023-00781-8
15. Fritzsching B, Contoli M, Porsbjerg C, Buchs S, Larsen JR, Elliott L, et al. Long-term real-world effectiveness of allergy immunotherapy in patients with allergic rhinitis and asthma: Results from the REACT study, a retrospective cohort study. Lancet Reg Health Eur. 2021 Nov 30;13:100275. https://doi.org/10.1016/j.lanepe.2021.100275
16. Wang N, Song J, Sun SR, Zhu KZ, Li JX, Wang ZC, et al. Immune signatures predict response to house dust mite subcutaneous immunotherapy in patients with allergic rhinitis. Allergy. 2024 May;79(5):1230-–1241. https://doi.org/10.1111/all.16068
17. Di Lorenzo G, Mansueto P, Pacor ML, Rizzo M, Castello F, Martinelli N, et al. Evaluation of serum s-IgE/total IgE ratio in predicting clinical response to allergen-specific immunotherapy. J Allergy Clin Immunol. 2009 May;123(5):1103-–10, 1110.e1-–4. https://doi.org/10.1016/j.jaci.2009.02.012
18. Pascal M, Moreno C, Dávila I, Tabar AI, Bartra J, Labrador M, et al. Integration of in vitro allergy test results and ratio analysis for the diagnosis and treatment of allergic patients (INTEGRA). Clin Transl Allergy. 2021 Aug;11(7):e12052. https://doi.org/10.1002/clt2.12052
19. León B. Understanding the development of Th2 cell-–driven allergic airway disease in early life. Front Allergy. 2023 Jan 10;3:1080153. https://doi.org/10.3389/falgy.2022.1080153
20. Akdis CA, Akdis M. Mechanisms of allergen-–specific immunotherapy and immune tolerance to allergens. World Allergy Organ J. 2015 May 14;8(1):17. https://doi.org/10.1186/s40413-015-0063-2
