Suppression spontaneous and induced expression of CD203c basophils after subcutaneous immunotherapy with ragweed and mugwort allergens

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Abstract

BACKGROUND: The basophil activation test (BAT) reflects the presence of immunoglobulin E on the cell surface and can be a tool for monitoring the effectiveness of allergen-specific immunotherapy. Spontaneous and allergen-induced BAT levels may likely change after effective subcutaneous immunotherapy, and this is of clinical importance.

AIMS: To determine the basophil activation markers in patients sensitized to weed pollen during subcutaneous immunotherapy

MATERIALS AND METHODS: This clinical study of 2 years included 60 patients with allergic rhinitis who underwent subcutaneous immunotherapy with weed allergens for two seasons. The proportion of basophil-expressing CD203c, spontaneously and after exposure to a trigger allergen, was determined. BAT was performed before treatment and after the first and second courses of preseason subcutaneous immunotherapy (0, 3, and 15 months of treatment). The effectiveness of subcutaneous immunotherapy was assessed by the dynamics of the symptom scale (Rhinoconjunctivitis total symptom score [RTSS]) and the drug assessment (Daily medical score [DMS]).

RESULTS: Subcutaneous immunotherapy with water–salt extracts was effective. The median RTSS in patients after two courses decreased from 13.0 [10.0; 15.0] to 4.5 [3.00; 7.25] points (p <0.001) and DMS score from 2.0 [2.0; 2.0] to 1.0 [1.0; 2.0] points (p <0.001). Spontaneous BAT remained unchanged after the first course of allergen-specific immunotherapy. The mean BAT values before therapy and after the first course of subcutaneous immunotherapy did not differ (8.15% [6.10; 11.9] vs. 9.0% [6.30; 12.0]). The spontaneous BAT decreased after the second course of treatment (8.15% [6.10; 11.9] vs. 6.20% [4.27; 9.00], χ2=15.5, p <0.001). Allergen-induced BAT significantly decreased from the first year of treatment. The overall change in the total group for BAT with ragweed after the first course of subcutaneous immunotherapy was 11.25% (95% confidence interval [CI]: 7.10–15.10, p <0.001). The overall difference in the induced ВAT test at the end of therapy reached 8.63% (95% CI: 5.30–12.05, p <0.001). The indices of induced BAT decreased by 12.0% after the first course of therapy with mugwort allergens (95% CI: 6.95–17.90, p <0.001), and the difference from the initial values after the second course was 9.67% (95% CI: 6.85–15.90, p <0.001).

CONCLUSIONS: Subcutaneous immunotherapy with ragweed and mugwort allergens was effective. The change in spontaneous and induced BAT is associated with a positive effect of allergen-specific immunotherapy.

About the authors

Liudmila Yu. Barycheva

Stavropol State Medical University

Author for correspondence.
Email: for_ludmila@inbox.ru
ORCID iD: 0000-0002-4069-0566
SPIN-code: 8946-3393

MD, Dr. Sci. (Med.), Professor

Russian Federation, Stavropol

Liudmila V. Dushina

Stavropol State Medical University; Stavropol Regional Clinical Consultative and Diagnostic Center

Email: dushina.stv@gmail.com
ORCID iD: 0000-0001-5806-972X
SPIN-code: 3599-5095

MD, Cand. Sci. (Med.)

Russian Federation, Stavropol; Stavropol

Sergey S. Masalskiy

Association Pediatric Allergist and Immunologist Russia; Scientific-Clinical Consultative Center of Allergology and Immunology

Email: masalsky85@gmail.com
ORCID iD: 0000-0002-2048-5709
SPIN-code: 1709-2182

MD, Cand. Sci. (Med.)

Russian Federation, Moscow; Moscow

Yuri S. Smolkin

Association Pediatric Allergist and Immunologist Russia; Scientific-Clinical Consultative Center of Allergology and Immunology; Academy of Postgraduate Education of the Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies

Email: smolking@df.ru
ORCID iD: 0000-0001-7876-6258
SPIN-code: 7068-4939

MD, Dr. Sci. (Med.)

Russian Federation, Moscow; Moscow; Moscow

Natalia A. Kozmova

Stavropol State Medical University

Email: kozmova@mail.ru
ORCID iD: 0000-0003-0971-5347
SPIN-code: 5236-9634
Russian Federation, Stavropol

Elena A. Kuropatnikova

Scientific-Clinical Consultative Center of Allergology and Immunology; Academy of Postgraduate Education of the Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies

Email: Lenysionok@mail.ru
ORCID iD: 0000-0001-5764-6441
SPIN-code: 2065-9023
Russian Federation, Moscow; Moscow

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2. Fig. 2. Representation of sensitization to major allergens, number of patients (n=60).Note: Major allergens: nAmb a 1 ― Ambrosia; nArt v 1 ― Artemisia; rPhl p 1, 5 ― Phleum; Bet v 1 ― Betula.

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3. Fig. 3. Dynamics of symptom changes: a ― after the 1st course of subcutaneous immunotherapy on the RTSS scale (RTSS_0 ― indicators pre-treatment, RTSS_1 ― indicators after the 1st course of subcutaneous immunotherapy); b ― after the 2nd course of subcutaneous immunotherapy on the RTSS scale (RTSS_1 ― indicators after the 1st course of subcutaneous immunotherapy, RTSS_2 ― indicators after the 2nd course of subcutaneous immunotherapy).Note: On the Y axis ― the number of RTSS points; on the X ― the number of therapy courses.

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4. Fig. 4. Comparison of median values of spontaneous basophil activation test (BAT) before therapy in patients with different numbers of symptoms.Note: Group 1 ― RTSS quartile 1 (0–10 points); group 2 ― RTSS quartile 2 (10–13 points); group 3 ― RTSS quartile 3 (13–15 points); group 4 ― RTSS quartile 4 (>15 points).

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5. Fig. 5. Dynamics of changes in spontaneous activation of basophils after treatment (ВАТ): a (BAT_spontaneous) ― spontaneous test of basophil activation before therapy; b (BAT_spont_1) ― test after 1st course of subcutaneous immunotherapy; c (BAT_spont_2) ― test after 2nd years of subcutaneous immunotherapy.Note: On the Y axis ― activated basophils, %.

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6. Fig. 6. Comparison of median values of spontaneous activation of basophils (BAT) after the second course of therapy in patients with different numbers of symptoms.Note: On the Y axis ― activated basophils (%). Group 1 ― RTSS quartile 1 (0–10 points); group 2 ― RTSS quartile 2 (10–13 points); group 3 ― RTSS quartile 3 (13–15 points); group 4 ― RTSS quartile 4 (>15 points).

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7. Fig. 7. Comparison of ragweed allergen-induced basophil activation test (BAT) before treatment in groups of patients with different number of symptoms, determined by the RTSS scale and divided by 4 quartiles.Note: On the Y axis ― activated basophils (%). Group 1 ― RTSS quartile 1 (0–10 points); group 2 ― RTSS quartile 2 (10–13 points); group 3 ― RTSS quartile 3 (13–15 points); group 4 ― RTSS quartile 4 (>15 points).

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8. Fig. 8. Comparison of ragweed allergen-induced basophil activation test (BAT) after the second course of subcutaneous immunotherapy in groups of patients with different number of symptoms, determined by the RTSS scale and divided by 4 quartiles.Note: On the Y axis ― activated basophils (%). Group 1 ― RTSS quartile 1 (0–10 points); group 2 ― RTSS quartile 2 (10–13 points); group 3 ― RTSS quartile 3 (13–15 points); group 4 ― RTSS quartile 4 (>15 points).

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9. Fig. 9. Dynamics of changes in average basophil activation test (BAT) values induced by ragweed allergen: a ― differences between tests before therapy and after 1st course of subcutaneous immunotherapy; b ― differences between tests before therapy and after 2nd course of subcutaneous immunotherapy; c ― differences between tests after 1st and 2nd courses of subcutaneous immunotherapy.

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10. Fig. 10. Dynamics of changes in average basophil activation test (BAT) values induced by mugwort allergen: a ― differences between tests before therapy and after 1st course of subcutaneous immunotherapy; b ― differences between tests before therapy and after 2nd course of subcutaneous immunotherapy; c ― differences between tests after 1st and 2nd courses of subcutaneous immunotherapy.

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