Supplementary Material for: Formation of IgE-Allergen-CD23 Complex Changes in Children Treated with Subcutaneous Immunotherapy for Japanese Cedar Pollinosis

<b><i>Background:</i></b> Subcutaneous immunotherapy (SCIT) is used to treat Japanese cedar (JC) pollinosis. The formation of IgE-allergen-CD23 complex after SCIT for JC pollinosis has not yet been fully elucidated. <b><i>Objective:</i></b> The objective of this study was to investigate the formation of IgE-allergen-CD23 complex after SCIT for JC pollinosis. <b><i>Methods:</i></b> Eleven patients were treated with 3-year SCIT for JC pollinosis at Sa­gamihara National Hospital from 2013 to 2014. Nasal and ocular symptoms (in terms of symptom scores) during the scattering of JC pollen and immunological changes were investigated. Levels of JC pollen-specific antibodies (IgE and IgG₄) were measured by ImmunoCAP assays. To detect the changes in allergen-presenting ability of B cells, the levels of IgE-allergen-CD23 complexes in serum were measured by a cell-free, enzyme-linked immunosorbent-facilitated antigen-binding assay. <b><i>Results:</i></b> The median (interquartile range) age of the subjects was 8 (6–10) years. Three patients (27%) had comorbid atopic dermatitis, and 5 patients (45%) had comorbid bronchial asthma. Before starting SCIT, the total IgE level was 373 (75–2,870) kU/L, and the level of JC pollen-specific IgE was 77.2 (15.4–528) kU_A/L. Symptom scores improved significantly from the year after treatment. JC pollen-specific IgE levels did not change after 3 years of treatment. JC pollen-specific IgG₄ levels increased significantly throughout the treatment period. The levels of IgE-allergen-CD23 complexes decreased significantly after 3 years of treatment. <b><i>Conclusion:</i></b> The ability of IgE-allergen complexes to bind to CD23 decreased after SCIT, suggesting that increasing levels of IgE-blocking antibodies, including IgG₄, may play an important role in the mechanism of SCIT.