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Clinical Characteristics of Chronic Urticaria (CU) Patients Having Anti- IgE or IgE Receptor Auto- antibodies (Chronic Autoimmune Urticaria) Versus Chronic Idiopathic Urticaria (CIU) Patients without these Auto-antibodies
Abstracts AB163
J ALLERGY CLIN IMMUNOL VOLUME 127, NUMBER 2
Impact OF Allergen Specific Immunotherapy on Allergen Threshold for Basophil Activation and Inhibitory IgG Antibodies in Birch Pollen Allergic Patients M. Kosnik1, N. Lalek1, M. Silar1, P. Korosec1, L. M. DuBuske2; 1University Clinic of Respiratory and Allergic Diseases, Golnik, SLOVENIA, 2 Immunology Research Institute of New England, Gardner, MA. RATIONALE: Changes in specific responsiveness of effectors cells, such as mast cells and basophils, might be an important mechanism of allergenspecific immunotherapy (SIT). METHODS: 14 patients with severe birch pollen allergic rhinoconjunctivitis were studied, 9 received subcutaneous birch immunotherapy (perennial scheme, allergoid HAL). For IgG inhibition tests and additional 8 birch allergic patients were assessed. Basophil threshold sensitivity was measured by CD63 expression to 4 different log allergen concentrations. Basophil activation test (BAT) was performed before SIT and after the first maintenance SIT dose, and also at the beginning and peak of the birch pollen season. IgG was measured before and after the SIT. RESULTS: There was no change in maximal basophil response when using allergen at concentrations of 5 and 50 mg/mL with median CD 63 expression over 70%.There was significant decreases in basophil response at sub-maximal birch pollen concentrations (0.5 mg/mL): 23.4% of CD63 positive basophils before SIT, 4.3% after 2 months and <4% after 5 months of SIT which correlated with reduction in symptoms. Patient serum after immunotherapy inhibited basophil CD 63 basophils expression in birch allergic patients not treated with SIT, the effect of post SIT serum disappearing after IgG removal. CONCLUSION: Birch pollen SIT induced production of IgG antibodies associated with reduction of allergen specific basophil sensitivity which correlated with symptom improvement.
620
Component Resolved Diagnosis Using An Immunoassay Platform For Multiplex Measurement Of sIgE In Multisensitised Allergic Patients O. Luengo, M. Labrador, M. Guilarte, T. Garriga, A. Sala, V. Cardona; Hospital Vall d’Hebron, Barcelona, SPAIN. RATIONALE: To evaluate the clinical value of a multiplex immunoassay platform in allergy diagnosis of multi-sensitized patients in our Mediterranean population. METHODS: Specific IgE (sIgE) to 103 allergen molecules was determined using the ImmunoCAP ISAC platform in 55 well characterized multi-sensitised patients. Complementary molecular sIgE testing was assessed in a subset of patients together with inhibition studies. RESULTS: ISAC revealed new, clinically valuable information in 50/55 patients. Some common allergens were not directly identified by the ISAC test. Follow-up testing with recombinant molecules and inhibition assays revealed that in the majority of patients (85.7%), allergy to nuts and legumes was due to LTPs, with concomitant sIgE abs to peach LTP (Pru p3). Pla a3 sIgE was positive in 55% of missed plane tree allergic patients, most of whom also had rosaceae allergy. ISAC inhibition studies with melon were performed in 3/4 sera of cucurbitaceae allergic patients, revealing complete inhibition of profilins (Phl p12, Mer a11, Ole e2). sIgE to Can f5 was positive in all 5 missed dog allergic patients. CONCLUSIONS: The ISAC results revealed refined information in 90% of our patients, mostly due to cross-reacting allergens. In our Mediterranean population Ara h9 is a major allergen in peanut allergic patients and Pla a3 is linked to plane tree and rosaceae fruit allergy. Pru p3 is a good marker of LTP sensitization, as profilins are for cucurbitaceae allergy. Can f5 is a major allergen for dog allergic patients. Adding these allergens to the current ISAC chip will improve its clinical utility.
621
Functional Activity of CD41 T Cells in Patients with IgE Dependent versus IgE Independent Atopic Dermatitis (AD) G. N. Drannik1, V. V. Driianska1, A. I. Kurchenko1, I. F. Kurchenko1, L. M. DuBuske2; 1National Medical University, Dept. Clinical Immunology and Allergology, Kiev, UKRAINE, 2Immunology Research Institute of New England, Gardner, MA. RATIONALE: Patients with various clinical presentations of atopic dermatitis (AD) may have differences in the balance of cytokines produced by CD41 T cells. METHODS: 65 patients with IgE-dependent AD (Group 1), 62 patients with IgE-independent AD (Group 2) and 30 healthy normal donor subjects (N) were assessed for cytokine production by Th1 cells (IL-2, IFN-g), Th2 cells (IL-4, IL-5), and Treg cells (IL-10, TGF-b) by ELISA using a STAT FAX-303 PLUS (Immunotech; Diaclon, France; DRG, Germany). RESULTS: Patients with acute AD in Group 1 had increased production of IL-2, IL-4, IL-5 and IL-10 in comparison with the control (N) group by 1.5; 1.9; 2.8; and 1.5 fold, respectively (p<0.05). IFN-g and TGF-b production in Group 1 patients were less than in N by 1.5 and 1.3 fold, respectively, while in Group 2 were greater than N by 1.7 and 2 fold and greater than Group 1 by 2.5 and 3 fold, respectively, with statistically significant reduction in IL-10 (125.4 62.8) production in comparison with N (137.4 63.8) as well as Group 1 (175.4 69.5 pg/ml). In Group 2 patients with chronic AD, IL-10 production was greater than normal controls (165.3 67.5) but in Group 1 the production of IL-10 and TGF-b did not differ from normal controls. CONCLUSIONS: Acute IgE-dependent AD is characterized by increased Th2 activity and reduced Th1 and Treg cytokine production, while acute IgE independent AD has less enhanced Th2 activity but relatively more Th1 and Treg activity noted by production of IFN-g and TGF-b, respectively.
622
Clinical Characteristics of Chronic Urticaria (CU) Patients Having Anti- IgE or IgE Receptor Auto- antibodies (Chronic Autoimmune Urticaria) Versus Chronic Idiopathic Urticaria (CIU) Patients without these Auto-antibodies A. Blaziene1, A. Chomiciene1, L. DuBuske2; 1Vilnius University, Clinic of Chest Diseases, Allergology and Radiology, Vilnius, LITHUANIA, 2 Immunology Research Institute of New England, Gardner, MA. RATIONALE: Term chronic autoimmune urticaria (CAU) has frequently been applied to these CU patients. Patients with CAU generally have more severe and difficult-to-control symptoms than those with chronic idiopathic urticaria (CIU) without these antibodies. This investigation evaluates the differences of disease activity, length of disease and treatment efficacy in patients with CAU versus CIU patients without these antibodies. METHODS: 128 patients with CU were studied having a mean age of 43613 years. The autologous serum skin test and basophil activation tests assessing basophil CD63 and CD203c expression were performed in all patients and in control subjects without CU. 116 CU patients completed the European Academy of Allergology and Clinical Immunology (EAACI) questionnaire for chronic urticaria to assess their disease activity using a 3 point score. RESULTS: Autologous serum skin tests were positive in 33.6% of CU patients. Sera from 36.7% CU patients induced up-regulation of CD63 and sera from 45.3% of CU patients induced up regulation of CD203c. The mean length of CU disease was 38670 months. Most CU patients (60.4%) evaluated their disease activity as high. There was no correlation between duration of CU, disease activity and ASST, CD63 or CD203c expression results (p>0.05). In 44.5% of CU patients conventional treatment with antihistamines was ineffective, most commonly in patients with positive autologous serum skin tests (p50.028). CONCLUSIONS: There was no significant correlation between results of tests for CAU (autologous serum skin tests and basophil activation tests including CD63 and CD203c expression tests) and disease activity or length of urticaria.
MONDAY
619
J ALLERGY CLIN IMMUNOL VOLUME 127, NUMBER 2
Impact OF Allergen Specific Immunotherapy on Allergen Threshold for Basophil Activation and Inhibitory IgG Antibodies in Birch Pollen Allergic Patients M. Kosnik1, N. Lalek1, M. Silar1, P. Korosec1, L. M. DuBuske2; 1University Clinic of Respiratory and Allergic Diseases, Golnik, SLOVENIA, 2 Immunology Research Institute of New England, Gardner, MA. RATIONALE: Changes in specific responsiveness of effectors cells, such as mast cells and basophils, might be an important mechanism of allergenspecific immunotherapy (SIT). METHODS: 14 patients with severe birch pollen allergic rhinoconjunctivitis were studied, 9 received subcutaneous birch immunotherapy (perennial scheme, allergoid HAL). For IgG inhibition tests and additional 8 birch allergic patients were assessed. Basophil threshold sensitivity was measured by CD63 expression to 4 different log allergen concentrations. Basophil activation test (BAT) was performed before SIT and after the first maintenance SIT dose, and also at the beginning and peak of the birch pollen season. IgG was measured before and after the SIT. RESULTS: There was no change in maximal basophil response when using allergen at concentrations of 5 and 50 mg/mL with median CD 63 expression over 70%.There was significant decreases in basophil response at sub-maximal birch pollen concentrations (0.5 mg/mL): 23.4% of CD63 positive basophils before SIT, 4.3% after 2 months and <4% after 5 months of SIT which correlated with reduction in symptoms. Patient serum after immunotherapy inhibited basophil CD 63 basophils expression in birch allergic patients not treated with SIT, the effect of post SIT serum disappearing after IgG removal. CONCLUSION: Birch pollen SIT induced production of IgG antibodies associated with reduction of allergen specific basophil sensitivity which correlated with symptom improvement.
620
Component Resolved Diagnosis Using An Immunoassay Platform For Multiplex Measurement Of sIgE In Multisensitised Allergic Patients O. Luengo, M. Labrador, M. Guilarte, T. Garriga, A. Sala, V. Cardona; Hospital Vall d’Hebron, Barcelona, SPAIN. RATIONALE: To evaluate the clinical value of a multiplex immunoassay platform in allergy diagnosis of multi-sensitized patients in our Mediterranean population. METHODS: Specific IgE (sIgE) to 103 allergen molecules was determined using the ImmunoCAP ISAC platform in 55 well characterized multi-sensitised patients. Complementary molecular sIgE testing was assessed in a subset of patients together with inhibition studies. RESULTS: ISAC revealed new, clinically valuable information in 50/55 patients. Some common allergens were not directly identified by the ISAC test. Follow-up testing with recombinant molecules and inhibition assays revealed that in the majority of patients (85.7%), allergy to nuts and legumes was due to LTPs, with concomitant sIgE abs to peach LTP (Pru p3). Pla a3 sIgE was positive in 55% of missed plane tree allergic patients, most of whom also had rosaceae allergy. ISAC inhibition studies with melon were performed in 3/4 sera of cucurbitaceae allergic patients, revealing complete inhibition of profilins (Phl p12, Mer a11, Ole e2). sIgE to Can f5 was positive in all 5 missed dog allergic patients. CONCLUSIONS: The ISAC results revealed refined information in 90% of our patients, mostly due to cross-reacting allergens. In our Mediterranean population Ara h9 is a major allergen in peanut allergic patients and Pla a3 is linked to plane tree and rosaceae fruit allergy. Pru p3 is a good marker of LTP sensitization, as profilins are for cucurbitaceae allergy. Can f5 is a major allergen for dog allergic patients. Adding these allergens to the current ISAC chip will improve its clinical utility.
621
Functional Activity of CD41 T Cells in Patients with IgE Dependent versus IgE Independent Atopic Dermatitis (AD) G. N. Drannik1, V. V. Driianska1, A. I. Kurchenko1, I. F. Kurchenko1, L. M. DuBuske2; 1National Medical University, Dept. Clinical Immunology and Allergology, Kiev, UKRAINE, 2Immunology Research Institute of New England, Gardner, MA. RATIONALE: Patients with various clinical presentations of atopic dermatitis (AD) may have differences in the balance of cytokines produced by CD41 T cells. METHODS: 65 patients with IgE-dependent AD (Group 1), 62 patients with IgE-independent AD (Group 2) and 30 healthy normal donor subjects (N) were assessed for cytokine production by Th1 cells (IL-2, IFN-g), Th2 cells (IL-4, IL-5), and Treg cells (IL-10, TGF-b) by ELISA using a STAT FAX-303 PLUS (Immunotech; Diaclon, France; DRG, Germany). RESULTS: Patients with acute AD in Group 1 had increased production of IL-2, IL-4, IL-5 and IL-10 in comparison with the control (N) group by 1.5; 1.9; 2.8; and 1.5 fold, respectively (p<0.05). IFN-g and TGF-b production in Group 1 patients were less than in N by 1.5 and 1.3 fold, respectively, while in Group 2 were greater than N by 1.7 and 2 fold and greater than Group 1 by 2.5 and 3 fold, respectively, with statistically significant reduction in IL-10 (125.4 62.8) production in comparison with N (137.4 63.8) as well as Group 1 (175.4 69.5 pg/ml). In Group 2 patients with chronic AD, IL-10 production was greater than normal controls (165.3 67.5) but in Group 1 the production of IL-10 and TGF-b did not differ from normal controls. CONCLUSIONS: Acute IgE-dependent AD is characterized by increased Th2 activity and reduced Th1 and Treg cytokine production, while acute IgE independent AD has less enhanced Th2 activity but relatively more Th1 and Treg activity noted by production of IFN-g and TGF-b, respectively.
622
Clinical Characteristics of Chronic Urticaria (CU) Patients Having Anti- IgE or IgE Receptor Auto- antibodies (Chronic Autoimmune Urticaria) Versus Chronic Idiopathic Urticaria (CIU) Patients without these Auto-antibodies A. Blaziene1, A. Chomiciene1, L. DuBuske2; 1Vilnius University, Clinic of Chest Diseases, Allergology and Radiology, Vilnius, LITHUANIA, 2 Immunology Research Institute of New England, Gardner, MA. RATIONALE: Term chronic autoimmune urticaria (CAU) has frequently been applied to these CU patients. Patients with CAU generally have more severe and difficult-to-control symptoms than those with chronic idiopathic urticaria (CIU) without these antibodies. This investigation evaluates the differences of disease activity, length of disease and treatment efficacy in patients with CAU versus CIU patients without these antibodies. METHODS: 128 patients with CU were studied having a mean age of 43613 years. The autologous serum skin test and basophil activation tests assessing basophil CD63 and CD203c expression were performed in all patients and in control subjects without CU. 116 CU patients completed the European Academy of Allergology and Clinical Immunology (EAACI) questionnaire for chronic urticaria to assess their disease activity using a 3 point score. RESULTS: Autologous serum skin tests were positive in 33.6% of CU patients. Sera from 36.7% CU patients induced up-regulation of CD63 and sera from 45.3% of CU patients induced up regulation of CD203c. The mean length of CU disease was 38670 months. Most CU patients (60.4%) evaluated their disease activity as high. There was no correlation between duration of CU, disease activity and ASST, CD63 or CD203c expression results (p>0.05). In 44.5% of CU patients conventional treatment with antihistamines was ineffective, most commonly in patients with positive autologous serum skin tests (p50.028). CONCLUSIONS: There was no significant correlation between results of tests for CAU (autologous serum skin tests and basophil activation tests including CD63 and CD203c expression tests) and disease activity or length of urticaria.
MONDAY
619