呼吸道过敏原特异性IgE累积水平与重度哮喘奥马珠单抗治疗反应性的关系

Correaltion between cumulative specific IgE for respiratory allergens and the efficacy of Omalizumab for severe asthma

目的分析呼吸道过敏原特异性免疫球蛋白E(sIgE)累积水平与重度哮喘奥马珠单抗治疗反应性的关系。方法选择2020年10月至2022年6月我院收治的经奥马珠单抗治疗重度哮喘患者106例,根据国际疾病分类,过敏性哮喘57例,非过敏性哮喘40例和混合型哮喘9例。采用标准经验过敏诊断(过敏记忆、皮肤点刺试验、传统途径的总IgE和过敏原sIgE测定)、血液嗜酸性粒细胞计数、Phadiatop TM测试对呼吸道过敏原sIgE累积水平。34例过敏性哮喘患者经奥马珠单抗治疗12个月,评估临床疗效。结果在过敏性和混合性严重哮喘患者中,通过Phadiatop TM测试确定的呼吸道过敏原sIgE累积水平高于非过敏性哮喘患者(P<0.001)。区分过敏性哮喘和非过敏性哮喘的受试者工作特征曲线下面积为0.891±0.038,最佳临界值0.24 kAU/L。Phadiatop TM测试≥0.24 kAU/L为阳性,过敏记忆+Phadiatop TM测试阳性诊断过敏性哮喘的患病率为84.21%(48/57),高于过敏记忆+sIgE阳性(56.14%,32/57),P=0.001。34例经奥马珠单抗治疗过敏性哮喘患者中,8例症状控制良好,Phadiatop TM测试≥1.55 kAU/L可良好预测奥马珠单抗治疗反应,最佳灵敏度和特异性分别为100.0%和76.90%。结论Phadiatop TM测试优于TIgE水平的测量和用于识别重度过敏性哮喘患者的过敏诊断经典假设驱动方法,可提高IgE靶向哮喘治疗的临床疗效。

Objective To evaluate the relationship between the cumulative level of respiratory allergen specific immunoglobulin E(sIgE)and the reactivity of omalizumab in severe asthma.Methods All of 1060patients with severe asthma who received omalizumab in our hospital from October 2020 to June 2022 were retrospectively included.According to the International Classification of Diseases,there were 57 cases of allergic asthma,40 cases of non-allergic asthma and 9 cases of mixed asthma.Standard empirical allergy diagnosis(anaphylaxis memory,skin prick test,total IgE and allergen sIgE determination by traditional route),blood eosinophilic count,Phadiatop TM test for measurement of respiratory allergen sIgE accumulation levels were performed.34 patients with allergic asthma were treated with omalizumab for 12 months to evaluate the clinical efficacy.Results Accumulative levels of respiratory allergen sIgE determined by Phadiatop TM testing were significantly higher in patients with allergic and mixed severe asthma than in patients with non-allergic asthma(P<0.001).The area under the subject operating characteristic curve to distinguish allergic asthma from non-allergic asthma was calculated as 0.891±0.038,and the optimal cutoff value was 0.24 kAU/L.Phadiatop TM test≥0.24 kAU/L was regarded as positive,and the prevalence of allergic asthma diagnosed by positive anaphylactic memory+Phadiatop TM test was 84.21%(48/57),slightly higher than that diagnosed by positive anaphylactic memory+sIgE(56.14%,32/57),P=0.001.Among 34 patients with allergic asthma who received omalizumab treatment,8 patients had good symptom control.Phadiatop TM test≥1.55 kAU/L could predict omalizumab treatment response well,and the optimal sensitivity and specificity were 100.0%and 76.90%,respectively.Conclusion The Phadiatop TM test appears to outperform the measurement of TIgE levels and the classical hypothesis-driven approach to allergy diagnosis used to identify patients with severe allergic asthma,and may improve the clinical efficacy of IGE-targeted asthma therapy.