Allergenic Profile to Phleum pratense and Immunological Changes Induced after Grass Allergen-Specific Immunotherapy

Background: The introduction of molecular diagnoses has provided evidence of the existence of several different allergenic profiles in grass-sensitised individuals, reflecting the large number of allergens involved. This methodology has become a potent tool for a correct diagnosis and for the selection of the most appropriate immunotherapy. Based on these concepts, the objectives of this study were to determine the sensitisation profile of a grass-allergic population, and to treat them with specific immunotherapy. Methods: Patients suffering from rhinitis and/or asthma associated with grass pollen were recruited. The active group was treated with depigmented-polymerised allergenic extract of mixed grass pollen. sIgE and sIgG4 to Phleum pratense, and to its individual components (Phl p 1, 2, 4, 5b, 6, 7, 11 and 12) were determined at the beginning and end of the study. Results: The inclusion criteria were fulfilled by 139 individuals (36 in the control group and 103 in the active group). Phl p 1 (96.4%) and Phl p 4 (91.2%) were the most recognised allergens, and 15.3% of individuals had positive IgE to cross-reactive carbohydrate determinants. Levels of antigen-specific IgG4 increased significantly after treatment, and the IgE/ IgG4 ratio decreased significantly in all allergens after receiving allergen-specific immunotherapy. Non-significant differences were observed in the control group. Conclusions: A high percentage of sensitisation to Phl p 4 was observed. Immunological efficacy was studied by measuring sIgG4 levels and the IgE/ IgG4 ratio before and after treatment. Sensitisation profiles should be taken into consideration to prepare the most appropriate immunotherapy containing all the relevant and needed allergens. (C) 2014 S. Karger AG, Basel