title: The effect of component-resolved diagnosis on specific immunotherapy prescription in children with hay fever.
abstract: BACKGROUND
  Sensitization to profilins and other cross-reacting molecules might hinder proper specific immunotherapy (SIT) prescription in polysensitized patients with pollen-related allergic rhinitis (AR). In these patients, component-resolved diagnosis (CRD) might modify SIT prescription by improving the identification of the disease-eliciting pollen sources.
  
  
  OBJECTIVE
  We sought to measure the effect of CRD on SIT prescription in children with pollen-related AR.
  
  
  METHODS
  Children (n = 651) with moderate-to-severe pollen-related AR were recruited between May 2009 and June 2011 in 16 Italian outpatient clinics. Skin prick test (SPT) reactivity to grass, cypress, olive, mugwort, pellitory, and/or Betulaceae pollen was considered clinically relevant if symptoms occurred during the corresponding peak pollen season. IgE sensitization to Phl p 1, Phl p 5, Bet v 1, Cup a 1, Art v 1, Ole e 1, Par j 2, and Phl p 12 (profilin) was measured by using ImmunoCAP. SIT prescription was modeled on SPT responses first and then remodeled considering also CRD according to GA(2)LEN-European Academy of Allergology and Clinical Immunology guidelines and the opinions of 14 pediatric allergists.
  
  
  RESULTS
  No IgE to the respective major allergens was detected in significant proportions of patients with supposed clinically relevant sensitization to mugwort (45/65 [69%]), Betulaceae (146/252 [60%]), pellitory (78/257 [30%]), olive (111/390 [28%]), cypress (28/184 [15%]), and grass (56/568 [10%]). IgE to profilins, polcalcins, or both could justify 173 (37%) of 464 of these SPT reactions. After CRD, the SPT-based decision on SIT prescription or composition was changed in 277 (42%) of 651 or 315 (48%) of 651 children according to the European or American approach, respectively, and in 305 (47%) of 651 children according to the opinion of the 14 local pediatric allergists.
  
  
  CONCLUSIONS
  In children with pollen-related AR, applying CRD leads to changes in a large proportion of SIT prescriptions as opposed to relying on clinical history and SPT alone. The hypothesis that CRD-guided prescription improves SIT efficacy deserves to be tested.
authors.affiliation: Department of Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany; Pediatric Department, Unit of Allergy and Immunology in Evolutive Age, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Stringari
authors.affiliation: Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tripodi
authors.affiliation: Pediatric Department, Unit of Allergy and Immunology in Evolutive Age, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Caffarelli
authors.affiliation: Pediatric Unit, Department for Mother and Child, Ramazzini Hospital, Carpi, Italy; Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors.forename: Arianna
authors.initials: A
authors.lastname: Dondi
authors.affiliation: Allergy Unit, Clinica San Carlo, Paderno Dugnano, Milan, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Asero
authors.affiliation: Pediatric Allergology Unit, Sandro Pertini Hospital, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Rienzo Businco
authors.affiliation: Pediatric Unit, Mazzoni Hospital, Ascoli Piceno, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Bianchi
authors.affiliation: Pediatric Unit, Mazzoni Hospital, Ascoli Piceno, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Candelotti
authors.affiliation: Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Ricci
authors.affiliation: Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Bellini
authors.affiliation: Pediatric Department, Second University, Naples, Italy.
authors.forename: Nunzia
authors.initials: N
authors.lastname: Maiello
authors.affiliation: Pediatric Department, Second University, Naples, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Miraglia del Giudice
authors.affiliation: Pediatric Department, La Sapienza University, Rome, Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Frediani
authors.affiliation: Pediatric Department, La Sapienza University, Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Sodano
authors.affiliation: Pediatric Unit, Fatebenefratelli Hospital, Benevento, Italy.
authors.forename: Iride
authors.initials: I
authors.lastname: Dello Iacono
authors.affiliation: Pediatric Department, La Sapienza University, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Macrì
authors.affiliation: Pediatric Department, La Sapienza University, Rome, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Peparini
authors.affiliation: Pediatric Department, Unit of Allergy and Immunology in Evolutive Age, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Povesi Dascola
authors.affiliation: Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Maria Francesca
authors.initials: MF
authors.lastname: Patria
authors.affiliation: Pediatric Clinic 2, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Varin
authors.affiliation: Pediatric Unit, G.B. Rossi Hospital, Verona, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Peroni
authors.affiliation: Pediatric Unit, G.B. Rossi Hospital, Verona, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Comberiati
authors.affiliation: Unit of Pediatric Allergy and Immunology, Policlinico of Tor Vergata, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Chini
authors.affiliation: Unit of Pediatric Allergy and Immunology, Policlinico of Tor Vergata, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Viviana
authors.initials: V
authors.lastname: Moschese
authors.affiliation: Pediatric Department, La Sapienza University, Rome, Italy.
authors.forename: Sandra
authors.initials: S
authors.lastname: Lucarelli
authors.affiliation: Pediatric Unit, San Giuseppe Hospital, Empoli, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bernardini
authors.affiliation: Pediatric Unit, Grassi Hospital, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pingitore
authors.affiliation: Pediatric Unit, Santa Barbara Hospital, Iglesias, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Pelosi
authors.affiliation: Pulmonary Disease and Allergy Unit, G. Gaslini Hospital, Genoa, Italy.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Tosca
authors.affiliation: Pediatric Unit, Crotone, Italy.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Cirisano
authors.affiliation: Department of Laboratory Medicine, University of Padua, Padua, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Faggian
authors.affiliation: Department of Biology, University of Rome "Tor Vergata," Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Travaglini
authors.affiliation: Department of Laboratory Medicine, University of Padua, Padua, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Plebani
authors.affiliation: Department of Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany. Electronic address: paolo.matricardi@charite.de.
authors.forename: Paolo Maria
authors.initials: PM
authors.lastname: Matricardi
mesh_terms: D000293:Adolescent; D000485:Allergens / Q000737:chemistry / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D003429:Cross Reactions; D003888:Desensitization, Immunologic / Q000379:methods*; D005260:Female; D015870:Gene Expression; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D010944:Plants / Q000276:immunology; D011058:Pollen / Q000737:chemistry / Q000276:immunology*; D051304:Profilins / Q000235:genetics / Q000276:immunology; D006255:Rhinitis, Allergic, Seasonal / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D012882:Skin Tests
chemical_list: D000485:Allergens; D051304:Profilins; D007073:Immunoglobulin E
keywords: Allergic rhinitis; IgE; children; component-resolved diagnosis; panallergens; pollen; profilin; specific immunotherapy