Evaluation of serum s-IgE/total IgE ratio in predicting clinical response to allergen-specific immunotherapy

Gabriele Di Lorenzo*, Pasquale Mansueto, Maria Luisa Pacor, Manfredi Rizzo, Francesco Castello, Nicola Martinelli, Vito Ditta, Claudia Lo Bianco, Maria Stefania Leto-Barone, Alberto D'Alcamo, Gaetana Di Fede, Giovam Battista Rini, Anne Marie Ditto

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

168 Scopus citations


Background: To date, no predictive tests for the clinical response to allergen-specific immunotherapy (ASI) are available. Therefore an in vivo or in vitro test would be of great value. Objective: We sought to evaluate pretreatment parameters used in diagnosing allergic rhinitis and determining serum specific IgE (s-IgE) levels, serum total IgE (t-IgE) levels, and blood eosinophil counts and to identify whether can be used to predict clinical improvement in monosensitized patients with allergic rhinitis with or without asthma treated with immunotherapy. Methods: We analyzed 279 patients who had undergone 4 years of ASI administered either by means of the subcutaneous immunotherapy (76 patients) or sublingual immunotherapy (203 patients) routes. Serum t-IgE and s-IgE levels, blood eosinophil counts, and serum s-IgE/t-IgE ratios were calculated and tested for correlation with clinical response to ASI. Receiver operating characteristic curves were determined. Predicted probabilities and predictive areas under the curve were calculated. Results: The clinical response to ASI was effective in 145 (52.0%) of 279 total patients, 42 (55.2%) of 76 patients treated with subcutaneous immunotherapy, and 103 (50.7%) of 203 patients treated with sublingual immunotherapy. A significant correlation was found between the serum s-IgE/t-IgE ratio and the clinical response to ASI, with high ratios (>16.2) associated with an effective response. The sensitivity and specificity of the area under the curve of the ratio were higher than those of serum s-IgE and t-IgE alone. Conclusion: The calculation of the serum s-IgE/t-IgE ratio for predicting the clinical response to ASI offers an advantage over measuring t-IgE and s-IgE levels in monosensitized patients for the following allergens: grass, Parietaria judaica, Olea europea, and house dust mite.

Original languageEnglish (US)
Pages (from-to)1103-1110.e4
JournalJournal of Allergy and Clinical Immunology
Issue number5
StatePublished - May 2009


  • Allergen-specific immunotherapy
  • blood eosinophil counts
  • receiver operating characteristic curve
  • serum-specific IgE/serum total IgE ratio
  • specific IgE
  • total IgE

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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