Association between biomarkers and house dust mite sublingual immunotherapy in allergic asthma

Abstract

Background House dust mite (HDM) sublingual immunotherapy (SLIT) has demonstrated efficacy in clinical trials of patients with asthma. Airway inflammation is a characteristic of respiratory allergy, but its relationship to SLIT remains unclear. Objective We evaluate the association between clinical outcomes with pulmonary function and biomarkers in before and after HDM SLIT (UMIN Number 000022390). Methods One hundred twelve patients with asthma sensitized to HDM were randomized to add‐on 6 standardized quality (SQ)‐HDM SLIT to pharmacotherapy or pharmacotherapy alone for 48 weeks. At baseline and end of study, biomarkers, blood eosinophils, serum IgE, serum periostin, fractional exhaled nitric oxide (FeNO), and spirometry and clinical symptoms were measured. Association between biomarkers and an increase in FEV1 of 120 mL or greater were analysed. Results Sublingual immunotherapy (SLIT) demonstrated a significant reduction of serum periostin (P < .001), FeNO (P < .01), and increase in HDM‐specific IgE (P < .05), FEV1 (P < .001) and improvement of clinical symptom scores, when compared to pharmacotherapy. The change in FEV1 correlated with the changes in serum periostin (r = .696, P < .001) and the changes in FeNO (r = .682, P < .001). The independent predictor of improvement in airflow limitation was changed in serum periostin (r2 = .753, P = .013) and FeNO (P = .038). Based on cut‐off values derived by receiver operating characteristic analysis (periostin 30.9 ng/mL, FeNO 28.0 ppb), patients were distinguished responders from non‐responders, but with no predictive value for blood eosinophils or total IgE. The proportion of patients with both high periostin and FeNO levels was significantly higher in responder than in non‐responder (P = .026). Conclusions and Clinical Relevance Adding HDM SLIT to pharmacotherapy resulted in reduced serum periostin and FeNO, and improved pulmonary function. Serum periostin and FeNO may be useful biomarkers for prediction of SLIT.

Clinical evaluation of rush immunotherapy using house dust mite allergen in Japanese asthmatics

“…The asthma phenotypes for which AIT is effective remain to be established. Hoshino et al [ 31 ] reported that HDM-SLIT is effective in asthma with high FeNO or high serum periostin levels, suggesting that the effect of AIT may be higher in type 2-dominant asthma. Di Lorenzo et al [ 32 ] reported that the therapeutic effect of AIT is high in patients with a specific IgE/total IgE of 16.2 or higher.…”

Relationship between Saliva and Sublingual Immunotherapy

“…Other immunoglobulins such as IgA and IgG are not reported to be pre-SLIT prognostic biomarkers. Pre-SLIT serum periostin, which is induced by type 2 cytokines in inflammatory diseases, is also reported as a biomarker for predicting SLIT in allergic rhinitis or asthma [11,12]. Baseline levels of IL-10 and IL-35, both of which are produced by Treg cells, are shown to be significantly correlated with the clinical efficacy of SLIT [8].…”

“…Although elevated serum-specific IgE accompanied by allergic symptoms is needed to start SLIT, a clear association has not been shown between the pre-treatment-specific IgE level and clinical response. Some reports show that serum-specific IgE and the specific IgE-to-total IgE ratio before treatment can be prognostic biomarkers [8,9], but others show no evidence to support serum IgE as a prognostic biomarker [10,11]. Other immunoglobulins such as IgA and IgG are not reported to be pre-SLIT prognostic biomarkers.…”

Developments in the field of allergy in 2020 through the eyes of Clinical and Experimental Allergy

“…Other work covered the issue of product availability for venom immunotherapy in the UK, 115 epidemiology of allergic and respiratory disease 116‐119 , 120 , 121 occupational allergies, 122‐124 advances in allergy diagnostics 125‐133 , 134 , 135 , 136 , animal model work 137 138 , 139 , 140 , 141 , investigation of infant airway epithelium, 142 a possible association between tree pollen exposure and reduced lung function 143 and evaluations of allergy service delivery 144‐147 …”