mimmunМедицинская иммунологияMedical Immunology (Russia)1563-06252313-741XSPb RAACI10.15789/1563-0625-CII-3064mimmun-3252Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESИзменение уровней IgE, IgE Bet v 1 и IgG4 после успешной аллерген-специфической терапии сублингвальным препаратом березыChanges in IgE, IgE Bet v 1 and IgG4 levels after successful allergen-specific therapy with a sublingual birch preparationСмолкинЮ. С.SmolkinYu. S.

Д.м.н., профессор кафедры клинической иммунологии и аллергологии 

PhD, MD (Medicine), Professor, Department of Clinical Immunology and Allergology, Academy of Postgraduate Education 

 Moscow 

МасальскийС. С.MasalskiyS. S.

К.м.н., доцент кафедры акушерства, гинекологии и педиатрии; ассистент кафедры иммунологии с курсом дополнительного профессионального образования 

PhD (Medicine), Associate Professor, Department of Obstetrics, Gynecology and Pediatrics, Moscow Medical University “Reaviz”; Assistant Professor

 Moscow; Stavropol  

КуропатниковаЕ. А.KuropatnikovaE. A.

Аспирант кафедры клинической иммунологии и аллергологии  

 Москва 

Postgraduate Student, Department of Clinical Immunology and Allergology 

 Moscow 

БарычеваЛ. Ю.BarychevaL. Yu.

 – д.м.н., профессор, заведующая кафедрой иммунологии с курсом дополнительного профессионального образования  

 г. Ставрополь 

PhD, MD (Medicine), Professor, Head, Department of Immunology with a Course of Continuing Professional Education

 Stavropol  

КозьмоваН. А.KozmovaN. A.

Ассистент кафедры иммунологии с курсом дополнительного профессионального образования  

 г. Ставрополь 

Assistant Professor, Department of Immunology with a Course of Continuing Professional Education 

 Stavropol 

Академия постдипломного образования ФГБУ «Федеральный научно-клинический центр специализированных видов медицинской помощи и медицинских технологий Федерального медико-биологического агентства»РоссияAcademy of Postgraduate Education, Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological AgencyRussian FederationМосковский медицинский университет «Реавиз»; ФГБОУ ВО «Ставропольский государственный университет» Министерства здравоохранения РФРоссияMoscow Medical University “Reaviz”; Stavropol State Medical UniversityRussian FederationФГБОУ ВО «Ставропольский государственный университет» Министерства здравоохранения РФРоссияStavropol State Medical UniversityRussian Federation202506062025273613624Copyright © Смолкин Ю.С., Масальский С.С., Куропатникова Е.А., Барычева Л.Ю., Козьмова Н.А., 20252025Смолкин Ю.С., Масальский С.С., Куропатникова Е.А., Барычева Л.Ю., Козьмова Н.А.Smolkin Y.S., Masalskiy S.S., Kuropatnikova E.A., Barycheva L.Y., Kozmova N.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.mimmun.ru/mimmun/article/view/3252

В качестве маркеров эффективности аллерген-специфической иммунотерапии (АСИТ) используется клиническая оценка эффективности. Она субъективна и зависит от восприятия, ожиданий от терапии и объективных колебаний концентрации пыльцы. Необходимо иметь объективные маркеры для контроля терапии. Проведено одноцентровое поперечное исследование 26 пациентов с аллергическим ринитом (АР) с сенсибилизацией к березе в 2 группах до терапии (группа АСИТ 0) и после 2 курсов (группа АСИТ 2). Вмешательство: терапия аллергеном березы Staloral 2 курса, не менее 5 месяцев, доза – 120-240 IR в сутки. АСИТ была эффективна. Использование медикаментов было ниже после АСИТ. После 2 курсов АСИТ наблюдалось уменьшение тяжести АР: среднетяжелое течение – 15% и 85% легкое течение, p = 0,001. Медиана общего IgE до терапии – 455,1 (154,8-537,4) МЕ/мл, после 2 курсов АСИТ – 136,2 (88,0-484,7) МЕ/мл, p = 0,27. Байесовский анализ подтверждает, что после терапии можно с умеренной вероятностью определить общий IgE ниже, чем до лечения (BF = 4,9). Специфические IgE к Bet v 1 до терапии имели медианные значения 100 (36,5-100,0) кЕ/л. Более половины обследуемых имели высокие показатели (> 100 кЕ/л), находившиеся за границами возможностей тест-системы. Пациенты в группе АСИТ 2 имели медиану sIgE 53,5 (38,8-100,0) (p = 0,71). Байесовский анализ поддерживает вероятность того, что IgE Bet v 1 снижается со слабой силой, BF = 3,4. В общей группе пациентов с АР определен показатель IgG4 Bet v 1. В группе без АСИТ медиана IgG4 – 0,60 (0,16-1,0) мг/л, после АСИТ достоверно специфический IgG к березе повышался 2.16 (1,44-3,00) мг/л, p = 0,02. Вероятность повышения была умеренной (BF = 4,41). ROCанализ модели «определение IgG4 при повторном курсе АСИТ» показывает хорошие возможности для диагностики. Площадь под кривой составила 0,87, p = 0,018. Измерение уровней sIgE и IgG4 может быть полезным для оценки эффективности АСИТ и понимания иммунологических процессов. Дальнейшие исследования и стандартизация методологии могут усилить значимость этих маркеров в клинической практике.

Evaluation of clinical effect is used as a marker of efficiency in patients wwith allergic rhinitis (AR) subjected to allergen-specific immunotherapy (AIT). This assessment is subjective and may be influenced by individual perception, expectations, and fluctuations in pollen concentrations. Therefore, development of objective markers is necessary to monitor therapy outcomes. A single-center, cross-sectional study was conducted in 26 patients with AR sensitized to birch, having been divided in two groups: those who had not yet received ASIT (AIT0) and those who had completed two courses of treatment (AIT2). The treatment was performed in two courses of birch allergy immunotherapy with the Staloral allergen, administered for, at least, 5 months at a dose of 120–240 international units (IR) per day. After two courses of AIT, a significant decrease in medication usage was observed. Moreover, a marked improvement in AR severity was noted, with 85% of patients exhibiting mild grade, and only 15% experienced a moderate course of the disorder, compared to the AIT0 group (p = 0.001). The median total IgE level before therapy was 455.1 IU/mL (154.8-537.4), and after two courses of ASIT it was 136.2 IU/mL (88-484.7), p = 0.27. According to Bayesian analysis, it is likely that the total IgE will be lower after therapy, at a moderate probability (BF = 4.9). The median IgE level specific to Bet v1 before therapy was 100 kU/L (36.5-100), with high levels (> 100, beyond the range of test) detected in more than a half of the patients. Patients in the AIT+2 group had a median sIgE of 53.5 kU/L (38.8-100), p = 0.71. Bayesian analysis suggests that IgE levels decrease with a weak probability (BF = 3.4). In the total group of patients with allergic rhinitis, IgG4 Bet v1 was determined. In the group without ASIT, the median IgG4 level was 0.60 (0.16-1.0) mg/L, after ASIT, the specific IgG to birch was significantly increased to 2.16 (1.44-3.00) mg/L, p = 0.02, with moderate probability for increase (BF = 4.41). After ASIT, specific IgG to birch significantly increased to 2.16 mg/L (1.44-3.0), p = 0.02 and a moderate increase probability (BF = 4.41). ROC analysis of “IgG4 with repeated AIT course” model showed a good diagnostic potential, with AUC value of 0.87 and p = 0.018. Measurement of sIgE levels and IgG4 may be useful for assessing the efficacy of ASIT and understanding the immune changes. Further research and standardization of diagnostic technique may enhance the significance of these markers in clinical practice.

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The authors declare that there are no conflicts of interest present.