Heterogeneity of antibody responses among clinical responders during grass pollen sublingual immunotherapy
Article first published online: 22 NOV 2013
© 2013 John Wiley & Sons Ltd
Clinical & Experimental Allergy
Volume 43, Issue 12, pages 1362–1373, December 2013
How to Cite
Clinical & Experimental Allergy, 2013 (43) 1362–1373., , , , , , , , , , , ,
- Issue published online: 22 NOV 2013
- Article first published online: 22 NOV 2013
- Accepted manuscript online: 23 AUG 2013 12:06AM EST
- Manuscript Accepted: 15 AUG 2013
- Manuscript Revised: 17 JUL 2013
- Manuscript Received: 30 APR 2013
- grass pollen;
- sublingual immunotherapy
During allergen-specific sublingual immunotherapy (SLIT), the relevance of changes in specific IgE and IgG antibody titres to treatment efficacy remains to be evaluated at an individual patient level.
To investigate whether antibody responses can be used as biomarkers for SLIT efficacy.
Comprehensive quantitative, qualitative and functional analyses of allergen-specific IgA, IgE, IgG1-4 and IgM responses were performed using purified Phl p 1 to 12 allergens in sera, saliva and nasal secretions from 82 grass pollen allergic patients. These patients were enrolled in a randomized, double-blind placebo-controlled study and assessed in an allergen challenge chamber (ClinicalTrials.gov NCT00619827). Antibody responses were monitored in parallel to clinical responses before and after daily sublingual treatment for 4 months with either a grass pollen or a placebo tablet.
A significant mean improvement (i.e. 33–40.6%) in rhinoconjunctivitis total symptom scores was observed in SLIT recipients, irrespective of their baseline patterns of IgE sensitization (i.e. narrow, intermediate, broad) to grass pollen allergens. SLIT did not induce any de novo IgE sensitization. Clinical responders encompassed both immunoreactive patients who exhibited strong increases in titres, affinity and/or blocking activity of grass-pollen-specific IgGs (representing 17% of treated patients), as well as patients with no detectable antibody responses distinguishing them from the placebo group. No significant changes were detected in antibody titres in saliva and nasal washes, even in clinical responders.
Conclusions and Clinical Relevance
Sublingual immunotherapy with a grass pollen tablet is efficacious irrespective of the patients' baseline sensitization to either single or multiple grass pollen allergens. Seric IgG responses may contribute to SLIT-induced clinical tolerance in a fraction (i.e. 17%) of patients, but additional immune mechanisms are involved in most patients. Consequently, antibody responses cannot be used as a marker of SLIT efficacy at an individual patient level.