Precision Prediction of Pediatric Subcutaneous Immunotherapy Outcomes Using a Clinical Nomogram for House Dust Mite...

The identification of predictive biomarkers for subcutaneous immunotherapy (SCIT) is of great importance for improving its clinical efficacy. This study aims to construct a nomogram predicting the efficacy of SCIT and to evaluate the predictive value of Der p 1 and Der p 2 for SCIT response.

This study included children with allergic rhinitis (AR) and/or asthma (AS) who received house dust mite (HDM) SCIT at Shenzhen Children's Hospital between 2021 and 2024. Baseline characteristics and laboratory data were retrospectively collected before SCIT. The sIgE to HDM components were measured in children's serum before SCIT. The efficacy of SCIT was assessed with VAS scores. Potential predictors for the efficacy of HDM SCIT were identified with logistic regression analysis. A nomogram predicting the efficacy of HDM SCIT was constructed and internally validated.

Among the 209 children who were successfully followed up after one year of treatment, 166 (79%) responded to HDM SCIT, while 43 (21%) were non-responders. Logistic regression analysis identified that Der p (1+2) sIgE, the Der p (1+2) sIgE/tIgE ratio and asthma as predictors of HDM SCIT efficacy. A nomogram predicting the efficacy of HDM SCIT was developed by incorporating the three predictors. The nomogram achieved an AUC of 0.80 (95% CI=0.72-0.87) and a C-index of 0.80 (95% CI=0.72-0.87). At a cutoff value of 43.87kU_A/L, Der p (1+2) sIgE achieved an AUC of 0.75, superior to tIgE and the Der p (1+2) sIgE/tIgE ratio.

The Der p 1 and Der p 2 were predictors of HDM SCIT. Der p (1+2) sIgE outperformed both the Der p (1+2) sIgE/tIgE ratio and tIgE in predicting the efficacy of HDM SCIT. A nomogram incorporating Der p (1+2) sIgE, the Der p (1+2) sIgE/tIgE ratio and asthma was developed for the visual and quantitative prediction of HDM SCIT efficacy.