Genetic and T2 biomarkers linked to the efficacy of HDM sublingual immunotherapy in asthma

BACKGROUND

Hypersensitivity to house dust mite (HDM) allergens is a common cause of allergic asthma symptoms and can be effectively treated with allergy immunotherapy (AIT).

OBJECTIVE

To investigate whether genetic and type 2 (T2) inflammatory biomarkers correlate with disease severity in subjects with allergic asthma, and whether this can be modified by AIT.

METHODS

MITRA (NCT01433523) was a phase III, randomised, double-blind, placebo-controlled trial of HDM sublingual immunotherapy (SLIT)-tablets in adults with HDM allergic asthma. Post hoc analyses of the study population (N=742) evaluated associations between T2 inflammatory (blood eosinophils, eosinophil cationic protein (ECP), total IgE and tryptase) and genetic (single-nucleotide polymorphisms, SNP) biomarkers (n=582) for the primary study endpoint (time to first moderate/severe asthma exacerbation). SNP associations were verified in HDM-positive subgroup from an independent 3-year Severe Asthma Research Programme (SARP3) subject cohort.

RESULTS

An increased asthma exacerbation risk in subjects homozygous for SNP rs7216389 (chromosomal locus 17q12-21) was reduced (p=0.037) by treatment with HDM SLIT (HR=0.37 (95% CI 0.22 to 0.64), p<0.001). The associations between exacerbation risk and 17q12-21 SNPs were replicated in the SARP3 HDM-positive subgroup. High levels of T2 biomarkers were associated with increased risk of asthma exacerbations in the placebo group. HDM SLIT-tablet treatment reduced this risk (blood eosinophils: HR=0.50 (95% CI 0.30 to 0.85); ECP: HR=0.45 (95% CI 0.29 to 0.87); tryptase: HR=0.45 (95% CI 0.25 to 0.80)). The treatment effect was higher (p=0.006) for subjects with a higher number of elevated T2 biomarkers.

CONCLUSIONS

HDM SLIT-tablet AIT is efficacious in HDM-sensitised asthma subjects with a genetic asthma predisposition and/or an underlying T2 endotype.

TRIAL REGISTRATION NUMBER

NCT01433523.

Long-Term Efficacy and Safety of Subcutaneous Immunotherapy in Monosensitized and Polysensitized Children With Allergic Rhinitis

OBJECTIVE

To evaluate the efficacy and safety of dust mite subcutaneous immunotherapy (SCIT) in monosensitized and polysensitized children with allergic rhinitis (AR).

STUDY DESIGN

Prospective cohort study.

SETTING

Tertiary referral center.

METHODS

One hundred thirty children were enrolled and categorized into 2 groups: monosensitized to only dust mites and polysensitized to at least 1 additional allergen beyond dust mites. All patients received SCIT targeting dust mites for 3 years, followed by a 5-year monitoring period. The Total Nasal Symptom Score (TNSS), Symptom and Medication Score (SMS), Visual Analogue Scale (VAS), and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) were assessed before SCIT (T0); at 1 (T1) and 2 (T2) years of SCIT; immediately after SCIT (T3); and 2 years post-SCIT (T5). Safety was assessed based on adverse events (AEs).

RESULTS

Fifty-one monosensitized and 50 polysensitized children completed the study. At T3, 47 monosensitized and 46 polysensitized children were effectively treated, with no significant between-group difference in efficacy (P > .05). The TNSS, SMS, VAS scores, and RQLQ score were significantly lower at T1, T2, T3, and T5 than at T0 in both groups (P < .05). The differences in the TNSS, SMS, VAS score, and RQLQ score between the 2 groups were nonsignificant at T0, T1, T2, and T3 (P > .05), but significant at T5 (P < .05). No serious AEs were reported.

CONCLUSION

Monosensitized and polysensitized children exhibited similar beneficial efficacy and safety after 3 years of dust mite SCIT. Monosensitized children derived more benefits 2 years after discontinuation.

Short-term and long-term efficacy of sublingual immunotherapy in different courses for house dust mite-induced allergic rhinitis

PURPOSE

Sublingual immunotherapy (SLIT) has been proven to be an effective and safe treatment for patients with house dust mite (HDM)-induced allergic rhinitis (AR) to achieve short-term and long-term efficacy. This study aimed to investigate the relationship between SLIT duration and long-term efficacy.

MATERIALS AND METHODS

This study involved 134 patients who underwent SLIT between 2019 and 2021 (in the 2-year group), between 2018 and 2021(in the 3-year group), or between 2017 and 2021 (in the 4-year group). The total nasal symptoms score (TNSS), total medication score (TMS), visual analogue scale (VAS), the Mini Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ) and adverse events (AEs) were assessed at baseline, after treatment (2021) and one year after the treatment completion (2022). The correlation between MiniRQLQ and other indicators was also analyzed.

RESULTS

After SLIT, patients in all three groups showed significant improvements in TNSS, TMS, VAS and MiniRQLQ scores (all p < 0.001). These improvements were sustained even one year after SLIT. Patients who received 3-4 years of SLIT showed significant improvement compared with those who received 2 years of SLIT in all clinical outcomes (all p < 0.01). The analysis showed positive correlations between the MiniRQLQ and TNSS, TMS, and VAS (all p < 0.001). No significant difference was observed in the AE rate in all three groups (p > 0.05).

CONCLUSION

Different duration of HDM SLIT could generate various short-term and long-term clinical efficacy. The MiniRQLQ could be applied to evaluate SLIT efficacy in clinical practice.

Safety and effectiveness of a 300 IR house dust mite sublingual tablet: descriptive 4-year final analysis of a post-marketing surveillance in Japan

Background: Data are limited for clinical outcomes with house dust mite (HDM) allergen immunotherapy beyond 2 years' observation. Materials & methods: A post-marketing drug-use survey assessed the safety and effectiveness of the 300 index of reactivity (IR) HDM tablet during use for up to 4 years in Japan. Results: 538 patients were evaluable for safety and 383 for effectiveness. Most adverse drug reactions (ADRs) occurred early and were local reactions; 5.6% of 249 total events were reported during years 2 to 4 as new ADRs after the interim analysis. The CAP-RAST score was identified as a potential risk factor for ADRs. The proportion of evaluable patients with severe allergic rhinitis symptoms decreased from 46.4% at baseline (n = 317) to 1.0% at 4 years (n = 104). Patients (n = 16) who discontinued 300 IR HDM tablet due to symptomatic improvement had sustained improvement relative to baseline 1 to 2 years later. Conclusion: Long-term use of the 300 IR HDM tablet is safe and effective.

Effect of intralymphatic allergen-specific immunotherapy on house dust mite in a murine model of allergic rhinitis

BACKGROUND

Intralymphatic immunotherapy (ILIT) is a promising alternative for the treatment of patients with allergic rhinitis, providing similar therapeutic efficacy to conventional allergen-specific immunotherapy (AIT). However, the allergic mechanism of ILIT is not completely known.

AIM

The aim of this study was to determine the efficacy of ILIT in a house dust mite (HDM) mouse model of allergic rhinitis.

METHODS

BALB/c mice were divided into four groups: G1, control without allergy; G2, allergy sensitized with HDM; G3, allergy with ILIT (starting with HDM 1.25 μg/mL); and G4, allergy with ILIT (starting with HDM 2.5 μg/mL). After the murine model of allergic rhinitis with HDM was established, mice were administered an intralymphatic injection through the inguinal lymph nodes with HDM.

RESULTS

ILIT decreased serum total IgE level and eosinophil infiltration in the nasal mucosa. ILIT also decreased the expression levels of IL-13, IL-25, IL-33, IFN-γ, IL-6, and IL-17, and increased the expression of FoxP3(+) T reg cells.

CONCLUSIONS AND SIGNIFICANCE

Our results suggest that ILIT regulates the specific immunotherapy immunologic mechanism by downregulating Th1, Th2, and Th17 cytokines and upregulating FoxP3(+) T reg cells in the HDM allergic mouse model.

[The efficacy and safety of standardized dust mite allergen subcutaneous immunotherapy in children with allergic rhinitis during treatment]

Objective: To evaluate the efficacy and safety of standardized dust mite allergen subcutaneous immunotherapy (SCIT) in children with allergic rhinitis (AR) during treatment. Methods: A total of 283 children with AR diagnosed with definite dust mite allergy and completed 2 to 3 years of SCIT who attended the Department of Otorhinolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, from August 2019 to October 2021 were included, including 205 males and 78 females, with a mean age of 10.8 years. The total nasal symptoms score (TNSS), symptom medication score (SMS), rhinoconjunctivitis quality of life questionnaire (RQLQ) and visual analogue scale (VAS) before and after 2 to 3 years' treatment were recorded, and the differences before and after treatment were compared. Adverse reactions during SCIT were recorded to evaluate its safety. SPSS 22.0 software was used for statistical analysis. Results: The overall effectiveness rate during SCIT in 283 children with AR was 89.4% (253/283). Compared with baseline, all symptom scores, medication scores and quality of life scores were significantly lower after 2 to 3 years of SCIT (all P<0.05). Further group comparisons showed positive efficacy in patients with different clinical characteristics, including age, gender, smoking status, family history of AR, symptom severity, mono-or poly-allergy, and second immunization, with no statistically significant differences between groups (all P>0.05). A total of 12 735 injections were administered during the SCIT, and a total of 213 (1.67%) injections of local adverse reactions occurred, mainly in the initial treatment phase, and the diameter of the local air mass was mostly 5 to 20 mm; 71 (0.56%) injections of systemic adverse reactions occurred, mainly in the initial treatment phase, and most of them were grade 1 reactions with no serious systemic adverse reaction such as shock. Conclusion: Standardized dust mite SCIT has a good safety profile and definite efficacy in treating AR children with different clinical characteristics. It can significantly improve all symptoms, reduce the use of symptomatic drugs and improve their quality of life.

[Compliance and withdraw reason of sublingual immunotherapy in 245 patients with allergic rhinitis]

Objective:To investigate the compliance of patients with allergic rhinitis（AR） receiving sublingual immunotherapy and its influencing factors. Methods:The clinical data of 291 AR patients who received sublingual immunotherapy for dust mites at the First Hospital of Peking University from January 2016 to January 2018 were retrospectively analyzed, and their outpatient or telephone follow-up was conducted. For patients whose treatment time was less than 2 years, the time and reason for the loss were recorded, and the factors affecting their compliance were discussed from the aspects of gender, age, and education. Results:Among the 291 patients, 245 cases（84.2%） were successfully followed up, and 193 cases（78.8%） fell off midway（treatment time<2 years）. The overall compliance rate was 21.22%（52/245）. The compliance rate of children is higher than that of adults（χ²=21.306, P<0.05）, and gender and education level have no significant effect on the compliance rate. The time period for the largest number of shedding was 6-<12 months after treatment（68 cases, 27.8%）. The main cause of shedding was symptom relief, which was considered cured（16.7%）. Secondly, within 3 months after treatment, a total of 61 patients（24.9%） fell off, of which 34 cases（13.9%） fell off because of troublesome medication, often missed medication, and simply stopped taking the drug. Statistics on the overall reasons for shedding in 193 patients, the top three shedding reasons were: cured after symptom relief（59 cases, 30.6%）, troublesome medication, discontinuation after missed dose（44 cases, 22.8%）, slow onset or ineffectiveness（26 cases, 13.5%）. Conclusion:The overall compliance of sublingual immunotherapy in patients with allergic rhinitis is poor, and the compliance of children is better than that of adults. Clinicians should focus on the reasons for patients to fall off at various times, strengthen patient education, enhance patient confidence in treatment, and improve the compliance of patients.

Allergen immunotherapy for allergic asthma: The future seems bright

Allergen specific immunotherapy (AIT) is the only causal therapeutic option for allergic airway diseases including asthma and allergic rhinitis. AIT has been shown to restore the allergen immune tolerance, can modify both the early and late-onset allergen-specific airway hyperreactivity, helps to achieve disease control/remission and prevents new sensitisations. Recent real life data on long-term effectiveness of house dust mite (HDM) AIT in a large group of patients with HDM-driven asthma further underscored its unique therapeutic potential as well as confirmed previous data with pollen AIT. More widespread use of this causal treatment in select patient populations should further move this promising therapeutic field. In this mini-review, we discuss updates on new insights based on real world patient data.

The Effectiveness of Allergen Immunotherapy in Adult Patients with Atopic Dermatitis Allergic to House Dust Mites

Background and objectives: Allergen immunotherapy (AIT) is not a first-line therapy in atopic dermatitis (AD) and its effectiveness has been criticised. Objectives: The efficacy and safety of AIT in adult patients with AD and monosensitisation to house dust mites (HDMs) were investigated. Materials and Methods: A total of 37 patients were included in this double-blind, placebo-controlled study. Patients were eligible if they were diagnosed with AD; had moderate-to-severe AD according to the Eczema Area and Severity Index (EASI) with at least 7.1 points, the % BSA (body surface area) scale with at least 16 points, and the IsGA (investigator global assessment) scale with 3 points; had positive skin prick tests (SPTs); and were positive for the specific immunoglobulin E (sIgE) response to D. pteronyssinus and D. farinae extracts, as well as Der p 1 and Der f1. The patients received Purethal mites (20,000 AUeq/mL, HAL Allergy, Leiden, The Netherlands) with the extract allergens D. pteronyssinus and D. farinae (50/50%) or a placebo for 12 months. The primary outcomes included changes in EASI, % BSA, and IsGA due to SCIT between the start and after 12 months of therapy. Results: In the study group, significant improvement was observed in terms of the EASI score from 43 ± 8.2 to 21 ± 5.9 points, % BSA from 72 ± 18 to 28 ± 11 points, and IsGA from 4.5 ± 0.5 to 1.5 ± 0.5 points in comparison with the placebo after 1 year of AIT. Additionally, the proportion of patients who achieved success in the IsGA (IsGA < 2) was significantly better in comparison to the placebo with 13/20 (65%) vs. 4/14 (29%), respectively (p < 0.05). Conclusions: HDM-AIT effectively improved atopic dermatitis in patients that strictly qualified for desensitisation with a confirmed monovalent mite allergy.

[Efficacy comparison and safety analysis of subcutaneous specific immunotherapy with standardized house dust mite allergen in patients with single and multiple allergic rhinitis]

Objective: To investigate the efficacy and safety of house dust mite (HDM) allergen subcutaneous specific immunotherapy (SCIT) in patients with allergic rhinitis (AR) with single dust mite allergy and multiple allergen allergy. Methods: A retrospective study was conducted. A total of 372 patients with allergic rhinitis induced by house dust mite were diagnosed in the allergy clinic of General Hospital of North Theater Command from January 2013 to January 2018.They were treated with house dust mite allergen preparation for standardized SCIT for 3 years or more, and had complete follow-up data. The age ranged from 5 to 55 years, the median age was 13 years, and the average age was (19.4±14.7) years; 216 males and 156 females. According to their age, they were divided into the older group (age >14 years) and younger group (age ≤ 14 years). According to the number of allergens, they were divided into single group (only HDM group allergic to house dust mites) and multi recombination (including 2 or more allergens including house dust mites). The multi recombination was further divided into HDM+1 group, HDM+2 group, HDM+3 group, HDM+4 and above group. Before treatment (T0), 1 year (T1) and 3 years (T2) after SCIT treatment, the patients in each group established files, analyzed and compared the average total nasal symptoms score (TNSS), total non nasal symptoms score (TNNSS), visual analogue scale (VAS), total medicine score (TMS) and rhinoconjunctivitis quality of life questionnaire (RQLQ), and evaluated the clinical efficacy of the treatment and the comparison of various scores in the efficacy of SCIT with different allergens and ages. Record the occurrence of local and systemic adverse reactions of all patients during treatment, and evaluate the safety of SCIT. All scores are measurement data that do not conform to normal distribution. Mann-Whitney U and Kruskai-Wallis test of independent samples are used for inter group comparison, and Bonferroni correction is used for further pairwise comparison; Chi square test and continuity correction method were used for the comparison between count data groups such as the incidence of adverse reactions and the effective rate of TNSS, and a-division method was used for further pairwise comparison. Results: After SCIT treatment, the scores of TNSS, TNNSS, TMS, VAS and RQLQ in T1 and T2 were significantly lower than those in T0, and the scores in T2 were significantly lower than those in T1 (Z=-11.168, -4.786, -6.639, -13.012, -10.652 in T0 vs T1; Z=-13.527, -8.746, -13.397, -14.477, -11.833 in T0 vs T2; Z=-4.721, -4.607, -10.020, -7.180, -5.721 in T1 vs T2; P<0.05). In T1 and T2, compared with the older group, the scores of TNSS, TNNSS, TMS, VAS and RQLQ in younger group were lower, and the differences of various indexes were statistically significant(the median scores of T1: M_younger=3.0, 1.0, 2.0, 4.0, 2.6, M_older=5.0, 2.0, 3.0, 5.0, 3.2; the median scores of T2: M_younger=3.0, 1.0, 0, 2.0, 1.3, M_older=4.0, 1.0, 1.5, 3.0, 2.3; Z_T1=-4.525, -5.830, -4.061, -3.608, -2.785; Z_T2=-3.847, -4.055, -2.820, -2.998, -3.418; P<0.05). In T1 and T2, the scores of TNSS, VAS and RQLQ in a single group after SCIT treatment were lower than those in multiple recombination(the median scores of T1:M_single=4.0, 4.0, 2.6, M_multiple=5.0, 5.0, 3.2; the median scores of T2: M_single=3.0, 2.0, 1.4, M_multiple=4.0, 3.0, 2.1), and the difference was statistically significant (Z_T1=-3.002, -2.092, -1.977; Z_T2=-3.354, -2.469, -2.116; P<0.05). There was no significant difference in TMS (the median score during T1 period: M_single=2.0, M_multiple=3.0, Z_T1=-1.130; the median score during T2 period: M_single=1.0, M_multiple=1.0, Z_T2=-1.544; P>0.05). Further comparison within the group showed that there was no significant difference in the improvement rate of TNSS during T2 period among HDM group, HDM+1 group, HDM+2 group and HDM+3 group (HDM vs HDM+1 group χ²=0.277, HDM vs HDM+2 group χ²=0.78, HDM vs HDM+3 group χ²=0.075, HDM+1 vs HDM+2 group χ²=0.057, HDM+1 vs HDM+3 group χ²=0.019, HDM+2 vs HDM+3 group χ²=0.003; P>0.005), the improvement rates were 92.5%, 90.3%, 89.1% and 89.5%. Respectively in HDM group,HDM+1 group, HDM+2 group, HDM+3 group, compared with HDM+4 and above group, the difference was statistically significant (χ²=26.144, 13.254, 15.144, 8.808; P<0.005). The improvement rate of TNSS in HDM+4 and above group was 60.9%. 122 patients had local adverse reactions during the treatment of SCIT, accounting for 32.8%. The local adverse reactions were 759 injections (15 336 injections in total), accounting for 4.95%. Most of them were swelling, dizziness, induration and pruritus at the injection site, which could be relieved by oral antihistamines or within 2 hours. There were 2 cases of local urticaria, once for each case. The symptoms were relieved within 1 week after oral antihistamine. No serious systemic adverse reactions occurred. Conclusion: Standardized SCIT may be a safe and effective treatment for AR patients, and the type of allergen may be one of the important factors affecting the efficacy of SCIT. The efficacy of SCIT was significant in AR patients with three or less allergens other than house dust mite.

Efficacy and Safety of House Dust Mite Sublingual Immunotherapy Tablet in Allergic Asthma: A Systematic Review of Randomized Controlled Trials

BACKGROUND

House dust mite sublingual immunotherapy (HDM SLIT) effectively treats allergic rhinitis (AR). However, the evidence of HDM SLIT for allergic asthma remained limited.

OBJECTIVE

To systematically review the efficacy and safety of HDM SLIT tablets in patients with allergic asthma.

METHODS

We performed a systematic search through PubMed, Scopus, EMBASE, Web of Science, the Cochrane Center of Controlled Trials, and Google Scholar for randomized controlled trials (RCTs) that addressed the efficacy and safety of HDM SLIT tablets compared with placebo or no intervention in allergic asthma from their inception date until September 2021. The primary outcome was the reduction in inhaled corticosteroids (ICS) dose. Additional outcomes were asthma control, exacerbation, lung function, quality-of-life, and adverse events.

RESULTS

There were 7 RCTs, 5 studies in allergic asthma (4 in adults and 1 in children), and 2 in AR with or without asthma. The 6 standardized quality (SQ) HDM effectively reduced ICS dose in well- to partly controlled mild-to-moderate asthma in 1 RCT. Two RCTs evaluated the efficacy of 6 SQ and 12 SQ HDM in reducing asthma exacerbation in partly controlled moderate-to-severe asthma, and their results were inconsistent. One study in children with mild-to-moderate asthma found no benefit of HDM SLIT. Two RCTs in AR with or without mild-to-moderate asthma showed improvement of asthma symptoms. Adverse events were primarily local, and anaphylaxis treated with epinephrine was reported in 3 patients.

CONCLUSIONS

The HDM SLIT tablets tend to effectively reduce ICS use in adults and adolescents with well- to partly controlled mild-to-moderate allergic asthma with a favorable safety profile.

[Effect of sublingual immunotherapy with Dermatophagoides Farinae on the expression of specific IgG4 in patients with allergic rhinitis in Hainan area]

Objective:The aim of this study is to investigate the effect of sublingual immunotherapy with Dermatophagoides Farinae on the expression of specific IgG4（sIgG4） in patients with allergic rhinitis （AR） in Hainan area. Method:Seventy-two patients with dust-mite allergic rhinitis, all three generations of whom were local islanders in Hainan, were randomly divided into control group（36 cases） and SLIT group（36 cases）. sIgG4 and sIgE expression levels were detected before treatment, 6 months after treatment, 12 months after treatment, and 18 months after treatment. The patient's symptom score, medication score, VAS score and adverse reactions was also assessed. Finally, through statistical analysis of the relevant data collected at 4 time points in the two groups of patients, the efficacy, safety and changes of sIgG4 antibody expression level in patients with allergic rhinitis receiving sublingual specific immunotherapy in Hainan were observed. Result:Symptoms scores, medication scores and VAS scores were significantly improved in the SLIT group after treatment compared with before treatment（P<0.05）, and serum sIgG4 increased significantly（P<0.01）, serum sIgE showed no significant change（P>0.05）. In the control group, symptom scores, medication scores and VAS scores were also significantly improved compared with before treatment（P<0.05）, while serum sIgG4 and sIgE showed no significant change（P>0.05）. When comparing the two groups, Symptoms scores, medication scores and VAS scores of the SLIT group were significantly lower than those of the control group at 12 months and 18 months after treatment（P<0.05）. sIgG4 expression levels in the SLIT group were significantly higher than those in the control group after 6, 12 and 18 months of treatment（P<0.01）. There was no significant difference in sIgE expression level between the two groups（P>0.05）. No severe systemic adverse reactions occurred in the two groups, and 3 patients showed mild adverse reactions in the SLIT group. Conclusion:Sublingual immunotherapy of Dermatophagoides Farinae was effective and could increase the expression of sIgG4 in patients with Dermatophagoides farinae AR, sIgG4 is expected to be an immunological marker for the objective evaluation of the clinical efficacy of Hapten.

[Effect of sublingual immunotherapy on patients with allergic rhinitis]

Objective:Study the efficacy of sublingual immunotherapy （SLIT） for monosensitized and polysensitized allergic rhinitis patients of different severity. Method:According to the results of intradermal experiments, 186 patients with AR who were treated with standardized dust mites SLIT for 2 years. These patients have been divided into mild monosensitized group and mild polysensitized group, moderate monosensitized group and moderate polysensitized group, severe monosensitized group and severe polysensitized group. Statistics and analysis of total nasal symptom score （TNSS）, total medication score （TMS） , visual analog scale （VAS） about before and after SLIT treatment. Result:Before SLIT treatment and after 2 years, the TNSS: Mild monosensitized group （5. 58±1. 68）（0. 58±0. 75）, mild polysensitized group（5. 34±1. 49）（0. 93±0. 75）;moderate monosensitized group （4. 68±1. 55）（0. 32±0. 63）, moderate polysensitized group（6. 26±1. 46）（0. 61±0. 67）,which have showed a statistically significant difference（P<0.05）,between the two groups have no significant difference （P>0.05）. Severe monosensitized group（6. 26±0. 73）（1. 16±1. 13）, severe polysensitized group（6. 49±1. 04）（1. 89±1. 07）, which have showed a statistically significant difference（P<0.05）, between the two groups have a statistically significant difference（P<0.05）. The VAS:Mild monosensitized group （6. 09±1. 23）（1. 52±1. 25）, mild polysensitized group（6. 21±0. 90）（1. 97±1. 18）,moderate monosensitized group（6. 12±0. 53）（1. 16±1. 03）, moderate polysensitized group（6. 65±1. 08）（1. 65±0. 98）,which have showed a statistically significant difference（P<0.05）,between the two groups have no significant difference （P>0.05）. Severe monosensitized group（6. 26±0. 73）（1. 16±1. 13）, severe polysensitized group（6. 49±1. 04）（1. 89±1. 07）, which have showed a statistically significant difference（P<0.05）, between the two groups have a statistically significant difference（P<0.05）. The TMS:These have showed a statistically significant difference（P<0.05）with same group,between all groups have no significant difference （P>0.05）. Conclusion:Dust mites under the SLIT are effective for monosensitized and polysensitized allergic patients. For patients with severe polysensitized , it is necessary to extend the treatment time （>2 years）.

An Engineered Hybrid Protein from Dermatophagoides pteronyssinus Allergens Shows Hypoallergenicity

The house dust mite (HDM) Dermatophagoides pteronyssinus is an important risk factor for asthma and rhinitis. Allergen specific immunotherapy that is based on recombinant proteins has been proposed for the safer and more efficient treatment of allergic diseases. The aim of this study was to design and obtain a hybrid protein (DPx4) containing antigenic regions of allergens Der p 1, Der p 2, Der p 7, and Der p 10 from this mite. DPx4 was produced in Escherichia coli and its folding was determined by circular dichroism. Non-denaturing dot-blot, ELISA, basophil activation test, dot blot with monoclonal antibodies, ELISA inhibition, and cysteine protease activity assays were performed. Mice that were immunized with DPx4 were also analyzed. We found that DPx4 had no cysteine protease activity and it showed significantly lower IgE reactivity than Der p 1, Der p 2, and D. pteronyssinus extract. DPx4 induced lower basophil activation than Der p 2 and the allergen extract. Immunized mice produced IgG antibodies that inhibited the binding of allergic patient’s IgE to the allergen extract and induced comparatively higher levels of IL-10 than the extract in peripheral blood mononuclear cells (PBMC) culture. These results suggest that DPx4 has immunological properties that are useful for the development of a mite allergy vaccine.

Salivary Immunoglobulin A, E, and G4 Levels Specific to Dermatophagoides pteronyssinus in Allergic Rhinitis Patients Treated With Subcutaneous Immunotherapy

BACKGROUND

Allergen-specific immunotherapy (AIT) is an effective treatment for allergic rhinitis (AR). During the course of AIT, many biomarkers in body fluids change. It is necessary to find effective indicators of AIT.

OBJECTIVE

To examine levels of salivary immunoglobulin A, E, and G4 (IgA, IgE, and IgG4, respectively) specific to Dermatophagoides pteronyssinus (Dp-IgA, Dp-IgE, and Dp-IgG4, respectively) and their changes in AR patients undergoing subcutaneous immunotherapy (SCIT).

METHODS

This study included 82 patients with AR sensitized only to Dp and 14 healthy controls. Among patients with AR, 30 patients were not treated with specific immunotherapy (group A), while the remainder (n = 52) received house dust mite SCIT in the up-dosing phase (n = 27; group B) or the maintenance treatment phase (n = 25; group C). Dp-IgA, Dp-IgE, and Dp-IgG4 levels in the saliva were measured using the enzyme-linked immunosorbent assay. Clinical symptoms, concomitant medication, and the Rhinoconjunctivitis Quality of Life Questionnaire score were recorded and correlated with immunoglobulin levels.

RESULTS

Salivary Dp-IgG4 and Dp-IgA levels were significantly lower in AR patients than in healthy controls ( P < .001 for both), while Dp-IgE levels were significantly higher ( P < .001). SCIT resulted in sustained increases in Dp-IgG4 and Dp-IgA in the maintenance phase compared to the up-dosing phase ( P < .001 for both), whereas Dp-IgE only increased in the up-dosing phase ( P = .004, P < .0125). There was no correlation between the different salivary immunoglobulins and clinical scores during SCIT.

CONCLUSIONS

This study shows that allergen-specific IgE levels are increased in the saliva of sensitized patients, suggesting that measuring salivary IgE testing should be further considered for the diagnosis of AR. Moreover, allergen-specific IgA and IgG4 in the saliva, which may play protective roles against allergy, may serve as objective indicators for evaluating treatment response to SCIT. However, none of the immunoglobulin reflects subjective symptoms.

[Efficacy of sublingual immunotherapy with Dermatophagoides farina drops in monosensitized and polysensitized patients with allergic rhinitis]

OBJECTIVE

To evaluate the efficacy of sublingual immunotherapy (SLIT) with standardized Dermatophagoides farina drops in monosensitized and polysensitized patients with allergic rhinitis.

METHOD

The clinical data of 162 patients treated with standardized Dermatophagoides farina drops were analyzed retrospectively. These patients were divided into the monoallergen sensitized group and polyallergen sensitized group according to the results of skin prick tests. The total nasal symptoms score (TNSS), the total medication score (TMS) and adverse effects (AEs) were evaluated before treatment, 2 year after SLIT treatment and 3 year after drug discontinuance. Result:After SLIT treatment for 2 years and drug discontinuance for 3 years, the TNSS (3. 14[2. 47; 3. 65], 3. 45 [2. 76; 3. 92], respectively) and TMS (0. 42[0. 36; 0. 57],0. 35[0. 26; 0. 44], respectively) in the monoallergen sensitized group were lower than that before the treatment (TNSS: 9. 00 [8. 00; 10. 00], TMS: 2. 16 [1. 88; 2. 37]), which have showed a statistically significant difference(P<0. 05). Similarly, after SLIT treatment for 2 years and drug discontinuance for 3 years, the TNSS (3. 14[2. 46; 3. 63], 4. 23[3. 65; 4. 96], respectively) and TMS (0. 42[0. 36; 0. 58], 0. 50[0. 34; 0. 72], respectively) in the polyallergen sensitized group were lower than that before the treatment (TNSS: 9. 00[8. 00; 10. 00], TMS: 2. 18[1. 95; 2. 37]), which have showed a statistically significant difference(P<0. 05). No statistically significant finding could be observed in monoallergen and polyallergen sensitized group before the treatment and 2 years after treatment, respectively. However, a statistically significant finding could be observed between two groups in the drug discontinuance for 3 years (P<0. 05). Eleven patients suffered local adverse effects, and the incidence of adverse effects showed no significantly difference (P>0. 05).

CONCLUSION

SLIT with standardized Dermatophagoides farina drops has a long-term efficacy in monosensitized and polysensitized patients with allergic rhinitis. Moreover, a longer SLIT treatment (>2 years) may be necessary to consolidate its efficacy.

SQ house dust mite sublingually administered immunotherapy tablet (ALK) improves allergic rhinitis in patients with house dust mite allergic asthma and rhinitis symptoms

BACKGROUND

House dust mite (HDM) allergy is associated with persistent allergic rhinitis (AR) and allergic asthma.

OBJECTIVE

To investigate the efficacy and safety of a SQ HDM sublingually administered immunotherapy tablet (ALK, Hørsholm, Denmark) in adults and adolescents with HDM respiratory allergic disease and report the AR results.

METHODS

Six hundred four subjects at least 14 years old with HDM AR and mild to moderate HDM allergic asthma were randomized 1:1:1:1 to double-blinded daily treatment with 1, 3, 6 SQ-HDM or placebo. End-of-treatment rhinoconjunctivitis symptoms and medication score were predefined extrapulmonary end points. A subgroup analysis was conducted post hoc in subjects with a total combined rhinitis score (TCRS) > 0 (ie, with AR symptoms and/or AR medication use during the 4-week baseline period). The subgroup was comprised of 498 subjects (82%).

RESULTS

In the subgroup, the absolute difference in end-of-treatment TCRS between 6 SQ-HDM and placebo was -0.78 (95% confidence interval -1.47 to -0.07, relative difference 28.8%, P = .0357). Furthermore, a significant difference was found for the total score of the Rhinitis Quality of Life Questionnaire with Standardized Activities RQLQ(S) and for the individual domains: activities, sleep, non-nose and non-eye symptoms, and nasal symptoms. For the TCRS and Rhinitis Quality of Life Questionnaire score, a dose response was seen, with numerically lower, nonsignificant differences for 1 and 3 SQ-HDM. The predefined analysis for the entire trial population showed no statistically significant difference between the placebo and actively treated groups. No safety concerns were observed.

CONCLUSION

Efficacy in mild to severe AR of 6 SQ-HDM compared with placebo was demonstrated by statistically significant improvements in TCRS and Rhinitis Quality of Life Questionnaire score in subjects with AR present at baseline. The treatment was well tolerated.

TRIAL REGISTRATION

EudraCT, no 2006-001795-20; ClinicalTrials.gov, identifier NCT00389363.

[Clinical observation of the adverse effects of standardized dust mite allergen preparation in the treatment of allergic rhinitis]

OBJECTIVE

To observe the adverse effects of specific immunotherapy (SIT) with standardized dust mite allergen preparation in the treatment of allergic rhinitis.

METHOD

Three hundred and eighty-six patients with allergic rhinitis who received subcutaneous SIT with a standardized dust mite allergen preparation were enrolled in this study. The patients were treated for at least 15 weeks,adverse effects after each injection from dosing phase to maintenance phase were recorded and incidence of adverse effects were analyzed.

RESULT

Of all the patients,adverse reactions occurred in 42 patients (10. 9%),10 local reactions (2. 6%) and 36 systemic side effects (9. 3%) which included 34 mild ,1 moderate and 1 severe side effects (no fatal) were reported respectively. None had anaphylactic shock. Among three treatment options, incidence of routine program was the highest (21.1%),followed by adult cluster program (11. 9%), adverse effects of children cluster program was the least (1. 5%). The adverse effects often happened in the middle and late phase of does addition period and early phase of maintenance period.

CONCLUSION

SIT with standardized dust mite allergen preparation in the treatment of allergic rhinitis is a safe and effective treatment by complying with the guidelines and taking specific interventions.

[Experimental study on the Der f 1 mRNA molecules derived from dermatophagoides farinae for specific immunotherapy on murine model of asthma]

OBJECTIVE

To investigate the effect of Der f 1 mRNA molecules for specific immunotherapy on murine model of asthma.

METHODS

Fifty BALB/c mice were randomly divided into 5 groups: PBS group, Der f 1 sensitization group, Der f 1 specific immunotherapy (SIT) group, beta-actin mRNA SIT group, and Derf 1 mRNA SIT group. On days 0, 7 and 14, mice in PBS group received PBS injection; mice in the other groups were intraperitoneally injected with 10 microg Derf 1. At day 21, the mice in the 4 experimental groups were challenged with a 30-min inhaled dose of Der f 1 (100 microg/ml) for 7 successive days. Two weeks after the final sensitization, the mice in the above five groups were im- munized by intradermal injection with PBS, 1 microg Der f 1, 10 microg Der f 1, 2 microg beta-actin mRNA, and 2 microg Der f 1 mRNA, respectively for 3 times at one-week intervals. Two weeks after the last intradermal injection, all mice were sacrificed and bronchoalveolar lavage fluid (BALF) was collected. ELISA was performed to detect the levels of IFN-gamma and IL-13 in BALF, the number of eosinophils in the BALF was recorded. Splenocytes were prepared, and cultured with Der f 1 al- lergen (10 Jg/ml) for 72 h. Splenocytes of PBS group was cultured without Derf 1 allergen. The levels of IFN-gamma and IL-13 in splenocyte culture supernatant were measured by ELISA, as well as serum antibody levels of total IgE, allergen- specific IgE (sIgE), sIgG1, and sIgG2a. Lung sections were stained in hematoxylin and eosin, and observed under the microsope.

RESULTS

Except for PBS group, mice in the other 4 group showed symptoms of acute asthma attack. Com- pared with Derf 1 sensitization group [(897.56 +/- 105.73) pg/ml] and beta-actin mRNA SIT group [(219.47 +/- 64.72) pg/ml], the level of IFN-gamma in BALF from Der f 1 mRNA SIT group [(897.56 +/- 105.73) pg/ml] and Derfl SIT group [(864.48 +/- 70.62)pg/ml] significantly increased (P<0.01). However, the level of IL-13 in BALF from Derf 1 mRNA SIT group [(241.64 +/- 31.41) pg/ml] and Derf 1 SIT group [(321.94 +/- 41.07)pg/ml] was significantly lower than that of Der f 1 sensitization group [(520.62 +/- 43.77) pg/ml] and beta-actin mRNA SIT group [(507.22 +/- 42.26) pg/ml](P<0.01). The number of eosinophils in Der f 1 mRNA SIT group [(1.33 +/- 0.44) x 10(5)/ml] and Der f 1 SIT group [(1.48 +/- 0.39) x 10(5)/ml] was also lower than that of Der f 1 sensitization group [(3.54 +/- 0.52)x10(5)/ml] and beta-actin mRNA SIT group [(2.98-0.53) x 10(5)/ml] (P<0.01). The levels of IFN-GAMMA and IL-13 in splenocyte culture supernatant showed that IFN-gamma level in Der f 1 mRNA SIT group [(420.91+69.92) pg/ml] and Der f 1 SIT group [(334.92 +/- 43.72) pg/ml] was significantly higher than that of Der f 1 sensitization group[(123.75 +/- 5.48) pg/ml] and beta-actin mRNA SIT group[(128.84 +/- 59.00) pg/ml] (P<0.01). However, IL-13 level of Der f 1 mRNA SIT group [(268.51 +/- 40.42) pg/ml] and Der f 1 SIT group [(285.26 +/- 62.21) pg/ml] was significantly lower than that of Derf 1 sensitization group [(613.89 +/- 51.54) pg/ml] and beta-actin mRNA SIT group [(524.05 +/- 39.12) pg/ml] (P<0.01). Compared with Der f 1 sensitization group [total IgE: (94.34 +/- 11.66) ng/ml, sIgE: (65.67 +/- 9.47) ng/ml, sIgG1: (75.18 +/- 9.52) ng/ml, sIgG2a: (2.81 +/- 1.17) ng/ml] and beta-actin mRNA SIT group[total IgE: (86.48 +/- 10.26) ng/ml, sIgE: (62.36 +/- 8.35) ng/ml, sIgG1: (69.51 +/- 8.98) ng/ml, IgG2a: (1.06 +/- 0.11) ng/ml], the serum antibody levels of total IgE [(33.72 +/- 9.78) ng/ml], sIgE [(22.76 +/- 8.09) ng/ml], sIgG1 [(17.87 +/- 7.59) ng/ml] of Der f 1 mRNA SIT group decreased significantly (P<0.01), whereas the level of IgG% [(7.74 +/- 0.88) ng/ml] increased (P<0.01). Compared with Der f 1 sensitization group, the asthmatic symptoms were relieved after immunization with Der f 1 mRNA for specific immunotherapy, including intact structure of respiratory and alveolar epithelial cells, decreased inflammatory cell infiltration, and similar to those in Der f 1 SIT group. However, the breakage and detachment of bronchial epithelial cells occurred in beta-actin mRNA SIT group.

CONCLUSION

Derf 1 mRNA vaccine can correct Th1 and Th2 imbalance.

Design of a ProDer f 1 vaccine delivered by the MHC class II pathway of antigen presentation and analysis of the effectiveness for specific immunotherapy

Dermatophagoides farinae (Der f 1) is one of leading cause for allergic asthma, and allergen-specific immunotherapy (SIT) is currently recognized as the only etiological therapy to ameliorate asthmatic symptom. The current study was designed on the major histocompatibility complex (MHC) class II pathway, invariant chain (Ii)-segment hybrids as vaccine basis to explore the efficacy of Der f 1 hybrid vaccine by virtue of Ii as carrier in enhancing the protective immune response to asthma. Initially, we engineered a fused molecule, DCP-IhC-ProDer f 1, to deliver ProDer f 1 antigen via specific dendritic cell-targeting peptides to dendritic cells (DCs). Then the DCP-IhC-ProDer f 1 was immunized to the asthmatic models of murine induced by ProDer f 1 allergen. The findings showed that the cytokine repertoire in the murine model was shifted after SIT, including stronger secretion of IFN-γ and IL-10, and a decreased production of IL-4 and IL-17. ELISA determination revealed that the hybrid displayed weak IgE and IgG1 reactivities, and IgG2a levels were elevated. Furthermore, DCP-IhC-ProDer f 1 treatment inhibited inflammatory cell infiltration in the lung tissues. Our results suggest that the DCP-Ihc-ProDer f 1 may be used as a candidate SIT against asthma.

[[Expression of house dust mite allergens Der f1 and Der f2 in Nicotiana benthamiana leaves]

The class E immunoglobulins (IgE) is known to recognize conformational epitopes and therefore the native conformation of recombinant allergens is essential for their using in test-systems. Recombinant Dermatophagoides farinae house dust mite (HDM) allergens Der f1 and Der f2 were expressed in bacteria Escherichia coli and Nicotiana benthamiana plants. It has been shown that IgE in sera from children allergic to HDM recognizes Der f2 expressed both in E. coli and N. benthamiana. Mature form of Der f1 expressed in E. coli does not interact with IgE while the protein purified from N. benthamiana is able to recognize IgE as a native allergen.

[Evaluation of the efficacy and safety of standardized dust mite allergen specific immunotherapy to children with allergic asthma]

OBJECTIVE

To evaluate the efficacy and safety of mite allergen specific immunotherapy (SIT) in treating children with allergic asthma.

METHOD

A total of 136 patients with mite allergy were recruited into the study. They were randomly divided into two groups: SIT group (n = 66) and ST (symptomatic therapy) group (n = 70). They were investigated of SIT with standardized allergen vaccine or no SIT only symptomatic therapy respectively. Therapeutic evaluation index includes: asthma symptoms score, drug score, skin prick test, pulmonary function, serum specificity IgE (sIgE) and the new sensitization was also assessed. Local and systemic adverse reactions were used to evaluate the clinical safety.

RESULT

Clinical symptom scores, drug scores, Lung function, and skin test result all improved significantly after the treatment with SIT compared to ST group (P < 0.01). SIT groups do not have new sensitization and no fatal systemic reactions occurred.

CONCLUSION

The standardized dust mite allergen specific immunotherapy is efficacious and safe to Children with allergic asthma . SIT can reduce house dust mites skin sensitivity and prevent new allergen appeared.

[Efficacy of sublingual immunotherapy with dermatophagoides farinae drops in monosensitized and polysensitized patients with allergic rhinitis]

OBJECTIVE

To compare the efficacy of sublingual immunotherapy (SLIT) with standardized Dermatophagoides farinae drops in monosensitized and polysensitized patients with allergic rhinitis.

METHODS

The efficacy of SLIT in 69 patients who were sensitized to house dust mites and treated with Dermatophagoides farinae drops for 1.5-2.0 year with complete clinical data were analyzed retrospectively. These patients had been divided into the monoallergen sensitized group and polyallergen sensitized group according to the results of skin prick tests. The total medication score (TMS) and the total nasal symptoms score (TNSS) were evaluated before and half an year, 1.0 year and 1.5-2.0 years after SLIT treatment.

RESULTS

After SLIT treatment for half an year, the TNSS in the monoallergen sensitized group (2.00 [1.00; 3.00]) was significantly lower than that in the polyallergen sensitized group (3.00 [2.00; 4.00], Z = -2.851, P < 0.05), this significant difference of TNSS between the two groups was also found after SLIT treatment for 1.0 year (0.00 [0.00; 1.00], 2.00 [0.00; 3.00], Z = -2.590, P < 0.05). Whereas, there was no significant difference between the two groups after 1.5-2.0 years treatment refer to the TNSS (0.00 [0.00; 1.00], 0.00 [0. 00; 2.00], Z = -1.461, P > 0.05). Half an year, 1.0 year and 1.5-2.0 years after SLIT treatment, the TMS in both groups reduced significantly, with no significant difference between two groups (Z value was - 0.777, -0.944, -0.907, all P > 0. 05).

CONCLUSIONS

SLIT with Dermatophagoides farinae drops is effective in monosensitized and polysensitized patients with allergic rhinitis. And equivalent efficacy could be achieved after 1.5-2.years.

Localized interstitial granuloma annulare induced by subcutaneous injections for desensitization

We describe a patient with interstitial granuloma annulare associated with subcutaneous injection therapy (SIT) for desensitization to a type I allergy. Asymptomatic, erythematous, violaceous annular patches were located at the injection sites on both her arms. Medical history revealed perennial rhinoconjonctivitis treated with SIT (Phostal Stallergen® cat 100% and D. pteronyssinus/D.farinae 50%:50%).

[Efficacy and safety of sublingual immunotherapy with house dust mite extract in poly allergen sensitized children with allergic rhinitis]

OBJECTIVE

To compare the efficacy of sublingual immunotherapy (SLIT) with standardized house dust mite extract in mono sensitized and polysensitized children with allergic rhinitis.

METHOD

One hundred and fifty-seven children who were sensitized to house dust mites and treated with SLIT for house dust mites for at least 1 year were studied. The monoallergen sensitized group included patients who were sensitized to Dermatophagoides pteronyssinus and/or Dermatophagoides farinae (n=92). The polyallergen sensitized group included patients who were simultaneously sensitized to house dust mites and other allergens (n = 65). A standardized extract of house dust mites was used for immunotherapy. Antiallergic medication and the total nasal symptom score (TNSS) were evaluated before and 1 year after SLIT.

RESULT

One hundred and twenty-five children completed 1-year SLIT. The TNSS improved significantly after SLIT in both groups, with monoallergen sensitized group 11.42 +/- 1.60 vs 3.55 +/- 1.57 (t=30.03, P<0.01), and polyallergen sensitized group 11.54 +/- 1.55 vs 3.23 +/- 1.56 (t=27.76, P< 0.01). But the change in the TNSS did not differ significantly between the groups (TNSS change, 7.94 +/- 2.24 vs 8.32 +/- 2.18, P>0.05). The AMSs were decreased significantly after SLIT in both groups, with monoallergen sensitized group 1.62 +/- 0.44 vs 0.56 +/- 0.37 (t=15.01, P<0.01), and polyallergen sensitized group 1.63 +/- 0.43 vs 0.50 +/- 0.40 (t=13.49, P<0.01). But the AMSs improvement did not differ significantly between the two groups(AMSs change 1.03 +/- 0.58 vs 1.13 +/- 0.61, P>0.05).

CONCLUSION

In polysensitized allergic rhinitis patients, SLIT for D pteronyssinus and/or D farinae produced improvements in both nasal symptoms and rescue medication scores comparable to those in mono sensitized patients. SLIT for D pteronyssinus and/or D farinae should be considered in polysensitized allergic rhinitis patients.

[Efficacy evaluation of specific immunotherapy with standardized house dust mite allergen preparation for allergic rhinitis]

OBJECTIVE

To evaluate the efficacy of specific immunotherapy (SIT) with standardized house dust mite allergen preparation for allergic rhinitis (AR).

METHOD

Fifty-five patients with allergic rhinitis caused by house dust mites were selected in this self-control study. Clinical efficacy was evaluated by symptom and sign score after two years of specific immunotherapy and compared with pre-treatment scores.

RESULT

After completing the study, a clinically significant reduction in symptom and sign score in these patients was noted, compared with that of pretreatment. And the difference was statistically significant (P < 0.01).

CONCLUSION

Standardized house dust mite allergen preparation is an effective treatment in patients suffering from allergic rhinitis due to house dust mites.

Geography of house dust mite allergens

OBJECTIVE

To consider how the different distribution of house dust mites and their species in different geographical locations affects the allergens in the environment and their use.

DATA SOURCES

Data were obtained from Medline, Genbank and library and web searches.

STUDY SELECTIONS

A comprehensive description of the genetic variations of allergens is given. The distribution of house dust mites is illustrated with publications that either make pertinent observations or would be useful for a broad appreciation of their geographical distribution.

RESULTS

The review identifies regions where glycyphagid house dust mites have been found and the distribution of the pyroglyphid Dermatophagoides spp. The antigenic differences the allergens of D. pteronyssinus and D. farinae are outlined and how this should affect optimal allergen usage in different regions. The allelic variations within the major allergens of Dermatophagoides sp. are similarly presented.

CONCLUSIONS

While there is a broad knowledge of the distribution of different species of house dust mites, regions that require further examination have been identified and there are examples of incorrect use of allergens for different regions. The extension of allergy research and practice into new regions will benefit from allergen formulations designed for regional use. Specific knowledge of the allergens in the environments will be required to optimally implement some of the new molecularly-defined medicaments currently being developed for effective allergy vaccination and immunotherapy.

[Clinical efficacy of a standardized specific immunotherapy against house dust mite in 85 asthmatic children]

OBJECTIVE

The scientific basis and the clinical effectiveness of allergen specific immunotherapy (SIT) administered by subcutaneous injection are well established. This study aimed to observe the changes in amount of inhaled corticosteroids, total IgE, specific IgE, peak expiratory flow rate (PEF), etc. during a standardized SIT against house dust mite in allergic asthmatic children.

METHOD

Children (5 - 13 years old) with mild to moderate allergic asthma seen from February 2005 to June 2008 were enrolled into this study. A non- randomized retrospective study was performed. All children were diagnosed sensitive to dust mites, the treatment group accepted standardized dust mite allergen specific immunotherapy. Each fourth injections were defined as observation points, the study took 3.4 years. The investigators recorded the treatment, the cumulative allergen extract, changes of daily doses of inhaled corticosteroid, peak expiratory flow (PEF), total IgE (TIgE), specific IgE (SIgE). The control group only received inhaled corticosteroids. The daily doses of inhaled corticosteroid and the number of asthma attacks, and the control rate were compared between the 2 groups.

RESULT

Totally 85 children were treated with SIT [(7.6 ± 1.4) years], 45 males and 40 females; 50 children received only drug treatment [(7.7 ± 1.5) years], 28 males and 22 females. The cumulative dose of allergen was up to (69.7 ± 4.8) µg after the 20 times injection, the dose of inhaled corticosteroids was significantly less than that in the control group (t = 2.359, P < 0.05). PEF was significantly higher than that of pre-treatment level (F = 7.874, P < 0.05). TIgE and SIgE had no significant change (t = 0.313, P > 0.05, t(Derp) = 0.517, t(Derf) = 0.717, P > 0.05). After the treatment, the control rate of the SIT group was 85.5%, that of the control group was 62.0% (χ(2) = 10.150, P < 0.01).

CONCLUSION

The standardized SIT against house dust mite could reduce steroid use in mild to moderate allergic asthmatic children. After (38.7 ± 2.3) weeks, the cumulative dose of allergen was up to (69.7 ± 4.8) µg, inhaled corticosteroid was significantly reduced. At the end of SIT, 85% of patients obtained complete control of asthma. Total IgE and mite-specific IgE had no significant changes.

Sublingual immunotherapy in polysensitized patients: effect on quality of life

BACKGROUND

Quality of life (QOL) is an important issue in allergic rhinitis and has been evaluated in a number of studies that have shown how it is impaired in untreated patients and improved by effective treatment. However, there are no data concerning QOL after sublingual immunotherapy (SLIT) in polysensitized patients.

OBJECTIVE

To evaluate the effect, in real-life clinical practice, of SLIT on QOL in a population of polysensitized patients with allergic rhinitis.

METHODS

We prospectively evaluated 167 consecutively enrolled polysensitized patients with allergic rhinitis. QOL was measured in all cases with the Rhinoconjunctivitis Quality of Life Questionnaire at baseline and after 1 year of SLIT (performed in approximately 70% of cases using single allergen extracts provided by the same manufacturer).

RESULTS

The most frequent causes of sensitization were grass pollen, Parietaria, and house dust mites. The mean number of sensitizations per patient was 3.65. SLIT was performed with 1 extract in 123 patients (73.6%), with 2 extracts in 31 patients (18.6%), and with more than 2 extracts in 13 patients (7.8%). The mean values of all the QOL items improved significantly (P < .01 in all cases), with the following reductions noted: activities, 3.96 to 2.89; sleep, 2.07 to 1.56; general problems, 2.16 to 1.5; practical problems, 3.69 to 2.58; nasal symptoms, 3.57 to 2.50; eye symptoms, 2.92 to 1.83; and emotional aspects, 2.2 to 1.44.

CONCLUSIONS

This study provides evidence that QOL can be improved in polysensitized patients treated with SLIT, and that the use of just 1 or 2 allergen extracts seems to be sufficient and effective in terms of improving QOL.

Epidemiology and current status of allergic rhinitis, asthma, and associated allergic diseases in Korea: ARIA Asia-Pacific workshop report

The prevalence of allergic rhinitis and asthma has recently increased in Korea, and both conditions are recognized as major chronic respiratory diseases requiring active intervention. The prevalence of rhinitis among asthmatic patients is high, ranging from 60 to 80%, and could seriously affect asthma severity and outcome. We suggest that allergic rhinitis should be properly evaluated in asthmatic patients to achieve better asthma control.

[Sublingual immunotherapy in allergic rhinitis and asthma in 2-5 year-old children sensitized to mites]

BACKGROUND

More than 10 years ago prick tests have been applied to children from the age of 12 months and a lot of them were given sublingual immunotherapy with significant acceptance from family and without undesirable reactions.

OBJECTIVE

To assess the efficacy and safety of sublingual immunotherapy in children.

PATIENTS AND METHODS

A clinical trial was done in 138 children with asthma or rhinitis and positive prick test to Dermatophagoides pteronyssinus, D. siboney and Blomia tropicalis. Randomly 69 received sublingual immunotherapy, applying two drops in growing concentrations of 500, 1,000, 2,000, 10,000 and 20,000 biological units. The concentration of 20,000 was left as maintenance till completes the scheme.

RESULTS

Out of the 138 children included in the study 69, who received sublingual immunotherapy, showed a difference in variables in relation to control group, and the attendance to emergency services was lower in the study group than in the control one for a relative risk of 0.39 with a 95% confidence interval of 0.19, 0.81. Corticosteroid consumption was lower in patients treated for a relative risk of 0.37 and 95% confidence interval of 0.14, 0.79. Out of the 69 patients, 11 had mild (8.6%) and moderate (7.2%) adverse reactions.

CONCLUSIONS

84% did not have any reaction, thus, sublingual immunotherapy with allergenic extracts of acarus is effective and safe in the treatment of asthma and allergic rhinitis.

Mite-specific immunotherapy using allergen and/or bacterial extracts in atopic patients in Brazil

OBJECTIVE

This study aimed to evaluate the clinical efficacy and antibody response changes after specific immunotherapy (SIT) using Dermatophagoides pteronyssinus (Dpt) allergens with or without bacterial extracts in Brazilian mite-atopic patients.

METHODS

One-hundred patients with allergic rhinitis were selected for a randomized double-blind, placebo-controlled trial and distributed into 4 groups: Dpt (Dpt allergen extract), Dpt+MRB (Dpt allergen plus mixed respiratory bacterial extracts), MRB (MRB extract only) and placebo. Rhinitis symptom and medication scores; skin prick test (SPT) to Dpt extract; and serum immunoglobulin (Ig) E, IgG4, and IgG1 levels to Dpt, Der p 1, and Der p 2 allergens were evaluated before and after a year of treatment.

RESULTS

After 1 year, the SPT response was reduced in the Dpt group (P=.03), whereas IgE levels to Der p 2 decreased only in the Dpt (P = .048) and Dpt+MRB (P = .005) groups. IgG4 and IgG1 levels to Dpt and Der p 1 increased in the Dpt group (P < .05), whereas in the Dpt + MRB group the IgG1 level only increased to Dpt (P=.001) and the IgG4 only increased to Der p 1 (P=.049). IgE levels to Dpt decreased only in the MRB (P= .005) and Dpt + MRB (P= .001) groups. Rhinitis symptom and medication scores fell in all groups, including the placebo group (P<.001).

CONCLUSIONS

SIT using Dpt extract alone was effective in reducing SPT response and IgE levels to Der p 2 allergen, while bacterial extracts induced decreases in IgE levels to whole Dpt extract. However, only groups receiving Dpt allergen had higher levels of IgG1 and IgG4 to Dpt and Der p 1 after a year of treatment.

Sublingual immunotherapy in mite-sensitized children with atopic dermatitis: a randomized, double-blind, placebo-controlled study

BACKGROUND

Atopic dermatitis often has an allergic component, and immunotherapy may therefore prove beneficial.

OBJECTIVE

To assess the effect of sublingual immunotherapy (SLIT) in children with atopic dermatitis.

METHODS

Children age 5 to 16 years with atopic dermatitis (Scoring Atopic Dermatitis [SCORAD] > 7) and sensitization to dust mites alone, without food allergy or chronic asthma, were enrolled in a randomized, double-blind, placebo-controlled study and stratified according to disease severity. SLIT or placebo was given for 18 months in addition to standard therapy. SCORAD, visual analog scale, and rescue medication consumption were recorded at 3-month intervals.

RESULTS

Fifty-six children were enrolled, and 28 were allocated to SLIT. Forty-eight completed the study, with 2 dropouts in the active and 6 in the placebo group. The difference from baseline in the SCORAD was significant (P = .025) between the 2 groups starting from month 9. Similarly, there was a significant reduction in the use of medications only in the active group. A trend toward significance was seen for the visual analog score only in the active group versus baseline (P = .07). A significant difference in the considered parameters was found only in patients with a mild-moderate disease, whereas severe patients had only a marginal benefit. SLIT had to be discontinued in 2 patients because of exacerbation of dermatitis.

CONCLUSION

Sublingual immunotherapy to dust mite improves mild-moderate atopic dermatitis.

CLINICAL IMPLICATIONS

Sublingual immunotherapy may represent an additional therapeutic tool for the treatment of extrinsic atopic dermatitis in properly selected children.

Specific immunotherapy is effective in the prevention of new sensitivities

BACKGROUND

Allergen specific immunotherapy is the only specific and curative approach in the treatment of IgE-mediated allergic diseases such as bronchial asthma and allergic rhinitis. The safety and clinical efficacy of this treatment are well documented but data on the prevention of new sensitizations remain scarce.

OBJECTIVE

To demonstrate the efficacy of specific immunotherapy in allergic respiratory diseases in childhood and to determine whether this treatment prevents the development of new sensitizations in children sensitized to house dust mite or pollen species.

METHODS

Fifty-six patients received specific immunotherapy (43 sensitive to house dust mite and 13 sensitive to pollen). Fifty-one patients not receiving immunotherapy but treated with pharmacotherapy were enrolled in the control group. The patients were followed-up for at least 4 years and treatment efficacy and the development of new sensitizations were compared between the two groups.

RESULTS

The number of patients with symptoms was significantly decreased in both groups at the end of the treatment period. No new sensitizations were found in 35 of the 43 (81.39 %) patients in the house dust mite immunotherapy group and in 10 of 13 (76.92 %) patients in the pollen immunotherapy group. In contrast, 20 of 51 (39.21 %) patients in the control group showed new sensitizations. The difference between the house dust mite and pollen immunotherapy groups and the control group in this parameter was statistically significant (p = 0.033).

CONCLUSION

Our data demonstrate that administration of specific immunotherapy in allergic patients significantly reduced symptoms and the development of new sensitivities.

Sarcoidosis following specific immunotherapy: more than just coincidence?

Although not yet clear, the etiology of sarcoidosis may be linked to seasonal, environmental and genetic factors; mycobacterial or other infections. To the best of our knowledge there is no data suggesting any connection between the onset of sarcoidosis and specific allergen immunotherapy in the medical literature. During the 11-year period between 1993 and 2005, a total of 91 sarcoidosis cases have been diagnosed at our institution. Out of these, here we present 3 cases of de novo sarcoidosis occurring after receiving specific immunotherapy (SIT) at the same institution (two of which had acquired the disease in Sweden where they had resided for a short time). We suggest that sarcoidosis may occur in patients following (SIT) probably via an abnormal immunological host response to an unknown antigenic trigger.

Mite immunotherapy

Dermatophagoides pteronyssinus and D. farinae are the most common house dust mites and are among the most common sources of indoor allergens worldwide. These species are very common in humid regions, where most allergic individuals are sensitized to house dust mites. Specific immunotherapy with mite extracts has demonstrated clinical benefits in several double-blind, placebo-controlled trials that are included in recent reviews of subcutaneous immunotherapy, including pediatric and adult patients with rhinoconjunctivitis and or asthma. Most successful studies of mite immunotherapy have used native allergen extracts adsorbed onto aluminum hydroxide, or chemically modified mite-allergen extracts. Several studies have also shown efficacy using sublingual immunotherapy in pediatric and adult patients with asthma and/or rhinitis. Additionally, the efficacy of subcutaneous immunotherapy has been demonstrated in patients with atopic dermatitis, although more double-blind, placebo-controlled studies are needed. Based on several studies, it cannot be concluded that mite immunotherapy is more dangerous or safer than immunotherapy with grasses, epithelia, or animal epithelia. Because the delivery of high doses of allergen carries with it the risk for immunoglobulin E (IgE)-mediated events, several methods have been developed to reduce specific IgE binding to mite-allergen extracts. An important challenge for future mite immunotherapy modalities is the delivery of relatively high doses without a significant risk for severe reactions.

Safety, tolerability and efficacy of sublingual allergoid immunotherapy with a 4-day shortened build-up phase

BACKGROUND

Sublingual specific immunotherapy (SLIT) with monomeric allergoid has shown to be safe and effective the studies performed so far. The build-up phase, however, is rather time consuming mainly if performed with the conventional schedule of 14 weeks.

AIMS OF STUDY

We evaluated the possibility of shortening and simplifying this phase, through a new build-up scheme of only 4 days, as well as the persistence of the allergoid SLIT efficacy after 12 months.

METHODS

Thirty-nine patients (26 M, 13 F, mean age 20.5 years, range 6-49) with a history of moderate/severe rhinitis with or without mild asthma due to perennial and/or seasonal allergens entered the study. The posological schedule, adopting only 1,000 AU tablets, was the following: 1/2 tablet the 1st day; 1/2 table twice the second day; 1/2 table plus 1 table the 3rd day, 1 tablet twice the 4th day; 1 tablet twice weekly from the 5th to the 365th day (maintenance therapy).

RESULTS

Only two mild adverse reactions occurred during the initial phase which disappeared with the prosecution of the treatment. During the maintenance therapy no adverse event was observed. Symptoms improved consistently and drug consumption was reduced in most of the patients.

CONCLUSIONS

The 4-day shortened build-up phase resulted to be safe, well tolerated and effective, already after one year of treatment.

Successful management of mite-allergic asthma with modified extracts of Dermatophagoides pteronyssinus and Dermatophagoides farinae in a double-blind, placebo-controlled study

BACKGROUND

Mite sensitivity is highly prevalent in tropical and subtropical regions, such as the Canary Islands.

OBJECTIVES

To evaluate the clinical efficacy and safety of a depigmented polymerized allergen vaccine containing a 50% mixture of Dermatophagoides pteronyssinus and Dermatophagoides farinae.

METHODS

Sixty-four patients participated in the study. It was prospective, double-blind, and placebo-controlled, with random allocation of patients to receive active treatment or placebo. The active group received a mixture of modified allergen extracts containing 50% D pteronyssinus and 50% D farinae; the control group received placebo. All individuals were diagnosed with mild/moderate asthma and rhinoconjunctivitis caused by sensitization to D pteronyssinus and D farinae. Bronchial provocation test (BPT) was considered the main outcome to document clinical efficacy.

RESULTS

Fifty-four patients completed the study. The active group experienced a significant improvement in BPT (P < .001), whereas the placebo group did not (P = .648). At the end of the study, 20 patients in the active versus 9 in the placebo group (P = .013; odds ratio, 5.71 [1.76, 18.51]) needed more than twice the amount of allergen to obtain a positive BPT. The median improvement in the active group over placebo was 53.76% in total symptom and 58.09% in medication scores.

CONCLUSION

Immunotherapy with a mixture of modified allergen extracts of D pteronyssinus and D farinae is safe and efficacious to treat mite-allergic asthma.

CLINICAL IMPLICATIONS

This immunotherapy modifies the natural course of the illness because it improves all clinical outcomes measured and prevents the worsening of specific bronchial hyperreactivity.

Pharmacological stimuli in asthma/urticaria

BACKGROUND

The use of opioids as analgesics is becoming increasingly widespread, which may have repercussions in patients with urticaria or asthma, as these agents frequently cause adverse reactions.

MATERIAL AND METHODS

We present three patients who developed allergic reactions after receiving codeine: two patients who developed acute urticaria, and a third asthmatic patient receiving specific immunotherapy who developed bronchospasm. Skin prick-testing (SPT) and intradermal reaction (IDR) tests with various opioids were performed, followed by controlled oral challenge. Prick tests and IDR were also carried out in 20 controls.

RESULTS

Similar SPT and IDR results were recorded in the three patients and in the controls. In the case of controlled oral challenge with codeine, patient 1 suffered bronchospasm, while patient 2 developed generalized urticaria. The test was not performed in the third patient. All of the patients tolerated tramadol 50 mg without problems. We advised the use of tramadol as analgesic and fentanyl or remifentanil as anesthetics.

DISCUSSION

In these types of manifestation, the pharmacological properties of the opioids used are highly important, particularly as regards their histamine-releasing potential. Codeine, morphine and pethidine present the greatest histamine-releasing capacity, while tramadol, fentanyl and remifentanil do not release histamine and their use is thus recommended in pulmonary disease requiring opioid administration. Cutaneous symptoms are more frequently caused by opioids than by respiratory symptoms, since these drugs act on the MTC mast cell population, which is more prevalent in the skin than in the lungs. Some of this action is inhibited by naloxone.

CONCLUSIONS

In most patients, these reactions are not IgE-mediated. Consequently, SPT and IDR are of little diagnostic value, and controlled oral challenging with the suspect drug or with one of the non-histamine releasing agents should be used. The patch test is useful in occupational contact dermatitis.

Randomized double-blind controlled study with sublingual carbamylated allergoid immunotherapy in mild rhinitis due to mites

BACKGROUND

The clinical efficacy of sublingual immunotherapy (SLIT) in mite allergy and in mild disease is still a matter of debate, thus we performed a long-term clinical trial.

METHODS

The study was randomized, double-blind and placebo-controlled. After a 1-year assessment, 68 patients with mild rhinitis with/without asthma due to mites were randomized to drugs + placebo or drugs + SLIT for 2 years. Sublingual immunotherapy was given as soluble tablets of monomeric carbamylated allergoid. Clinical scores for asthma and rhinitis (0, absent to 3, severe) and drug consumption were assessed by diary card in the period November-February. Quality of life was assessed before and after each observation period and pharmaco-economy data were evaluated as well.

RESULTS

Fifty-six patients completed the study. The rate of dropouts was similar in the two groups. No relevant side effect was reported. There was a significant reduction of total clinical scores (P < 0.05) in the active group vs placebo at the first year, but not at the second whereas nasal obstruction significantly improved in both years (P < 0.05). The reduction of drug intake score was significant only at the first year. No change was observed concerning most of the Short Form-36 items, because at baseline all patients displayed a normal profile. A significant change in SLIT group was seen for the item 'change in health status'. The need for extra visits was significantly lower in the active group (25%vs 43%).

CONCLUSIONS

Sublingual immunotherapy was clinically effective and safe in mite-induced mild disease.

Steroid-sparing effect of subcutaneous SQ-standardised specific immunotherapy in moderate and severe house dust mite allergic asthmatics

BACKGROUND

The present study evaluated the steroid-sparing effect of subcutaneous SQ-standardized specific immunotherapy (SIT) in moderate and severe house dust mite (HDM) allergic asthmatics.

METHODS

Fifty-four adult asthmatics allergic to HDM requiring at least inhaled corticosteroids (ICS) doses equivalent to 500 microg fluticasone propionate daily were randomized to subcutaneous SIT or placebo injections for a period of 3 years. The minimum required ICS dose, 4 week diary of asthma symptom score, use of rescue medication, peak expiratory flow (PEF) measurements and visual analog scale for asthma symptoms were assessed before start of treatment and after 1, 2 and 3 years of treatment.

RESULTS

In patients with moderate and severe asthma, the reduction in ICS was statistical significant after 2 years of treatment (P = 0.03) but not after 3 years. The median reductions were 82% and 42% after the third year for active and placebo respectively. In patients with moderate persistent asthma the reduction was statistical significant larger for those treated with SIT compared with placebo after year 2 and year 3. The median reductions after 3 years were 90% for SIT and 42% for placebo (P = 0.04). Despite significant steroid reduction, there was no difference in asthma assessments between the two groups. No serious reactions related to SIT injections were seen.

CONCLUSION

This study shows that SIT with a SQ-standardized HDM extract is safe. An ICS sparing effect was evident in patients with moderate persistent asthma.

[Desensitization of dust mite drops on antigen-specific asthmatic reaction in guinea pigs]

AIM

To establish an antigen-specific asthmatic model of guinea pig induced by protein antigen extracted from Dermatophagoides farinae (Der f), and study the desensitization of dust mite drops (DMD, extracted from Der f) in a dose progressive manner and long-term sublingual administration.

METHODS

To sensitize the guinea pigs, the protein antigen emulsified in aluminium hydroxide gel was subcutaneously and intraperitoneally injected. To observe early-phase reaction of asthma, lung resistance (R(L)) and lung dynamic compliance (Cdyn) in the sensitized guinea pigs were determined by intravenously injecting antigen. To observe late-phase reaction of asthma, the sensitized guinea pigs were challenged with aerosolized antigen for 7 days. Subsequently, methacholine (Mch) in a cumulative dose-manner induced-airway hyperreactivity (AHR), inflammatory cells numbers in bronchoalveolar lavage fluid (BALF) and pathological changes of lung tissue were measured in the model. From the first day of sensitization, the guinea pigs in treatment group sublingually received DMD in a dose progressive manner. The model group sublingually received equivalent saline. The normal control group did not receive any treatment.

RESULTS

The guinea pigs in model group showed a significant increase in R(L) and decrease in Cdyn, and developed a marked AHR to Mch. The number of total leukocytes and eosinophils increased significantly in BALF. Serious infiltration of eosinophils was observed in pathological section of lung tissue. Compared with model group, DMD treatment group exhibited a significant amelioration for early-phase and late-phase reaction of asthma.

CONCLUSION

DMD in a dose progressive manner and long-term sublingual administration displays a significant desensitization on Der f antigen-specific asthmatic reaction. The results provided experimental evidence for clinical therapy.

Once daily sublingual immunotherapy without updosing--A new treatment schedule

BACKGROUND

Treatment regimens with specific immunotherapy include updosing. Due to excellent tolerance of sublingual immunotherapy (SLIT), it was hypothesized that administration of once-daily SLIT could be initiated safely without updosing. The objective was to evaluate tolerability of SLIT administered once daily without updosing.

METHODS

135 patients suffering from allergic rhinitis with/without asthma were included in a double-blind, placebo-controlled, parallel-group study. Patients were randomized into two groups. Group 1 (n = 69) received active treatment throughout the study, including 10 days updosing (T1), 20 days maintenance treatment (T2), and 2 consecutive months on maintenance treatment (T3 and T4). Group 2 (n = 66) obtained placebo updosing (T1), placebo maintenance (T2), initiated active treatment (maintenance) at T3, and continued active treatment until the end of the study (T4). Adverse events (AEs) were assessed at T1-T4. 66 grass- and 69 mite-allergic patients were evenly distributed between groups.

RESULTS

229 AEs were reported, 157 AEs were related to treatment. The most frequently reported AEs (>5% of patients in any group) related to treatment were oral itching, ocular itching, rhinitis, and sublingual edema. For group 1 at T2, the rate of all AEs related to treatment per dose administered was 1.79%, and for group 2 at T3 the rate was 1.33% (p = 0.37). For the most frequently reported AE, oral itching, the rate per dose administered was 1.01% for group 1 at T2, and 0.74% for group 2 at T3 (p = 0.53).

CONCLUSIONS

Once daily SLIT was well tolerated and can be safely initiated without updosing.

Immunotherapy for patients with persistent allergic rhinitis unsatisfied with free chronic pharmacotherapy

BACKGROUND

Chronic pharmacotherapy is recommended to patients with persistent moderate-severe (PM-S) allergic rhinitis (AR). The cost of pharmacotherapy is the main barrier to achieve symptoms control.

AIMS OF THE STUDY

To determine the benefits of mite subcutaneous immunotherapy (SIT) in patients with PM-S AR not satisfied with chronic pharmacotherapy received free of charge.

METHODS

Open study with seven (7) patients with PM-S AR not satisfied with chronic pharmacotherapy. Prior to enrollment patients had received monthly for more than five months and free of charge, optimal pharmacotherapy. We compared, off pharmacotherapy, symptoms and quality of life (QOL) before and during SIT.

RESULTS

Mite SIT improved nasal symptoms, non nasal symptoms and QOL. Off pharmacotherapy patients reported adequate control of symptoms and were satisfied.

CONCLUSIONS

Not all patients with PM-S AR are satisfied with chronic pharmacotherapy, even if medication is received free of charge. SIT control symptoms and satisfies patients with PM-S AR unsatisfied with free chronic pharmacotherapy.

The safety of allergen immunotherapy (IT) in Turkey

Allergen immunotherapy (IT) has encouraging therapeutic outcomes but its safety is still being questioned because of possible severe systemic reactions. The aim of this study was to determine the frequency of systemic reactions (SR), and to identify their correlation with the characteristics of therapy, such as allergen composition and IT schedule, and diagnosis. We analyzed the data of 126 patients who received IT between 2000-2003, and suffered from respiratory allergy or hymenoptera venom anaphylaxis. IT was given by rush, clustered or conventional schedules. The standardized allergen extracts used were grass pollen, house dust mite and hymenoptera venom in 88, 18 and 20 patients, respectively. None of the patients received premedication. A total 4705 injections were administered. One hundred and twenty-three adverse events (AE) (2.6% per injection) were documented in 46 patients. Sixty-one of them were SRs (1.3% SRs per injection) and they were seen in 28 patients. Asthmatics had more tendency to SRs (p=0.05). Rush (1.8%) and clustered (2.8%) IT protocols were associated with a higher rate of SRs (per injection) when compared to conventional schedule (0.9%) (rush vs conventional; p=0.013, clustered vs conventional; p=0.001). The majority of SRs corresponded to grade 3 (49%). Forty-nine (80%) of the 61 SRs were observed during the build-up phase, and mostly with pollen extracts (75.5%). Patients showed more severe SRs during the build-up phase (p<0.05). Twenty-six (42.6%) of the SRs were immediate, whereas 35 (57.4%) SRs appeared within 2 hours. Delayed SRs were significantly more frequent in polysensitized patients when compared to monosensitized subjects (p=0.018). Our data indicate that rapid IT regimens and the presence of asthma represent a greater risk for SR development. Since the late SRs occur as frequently as the early ones, we suggest a longer waiting period beyond 30 minutes, especially in polysensitized and asthmatic patients.

Significant improvement of specific bronchial hyperreactivity in asthmatic children after 4 months of treatment with a modified extract of dermatophagoides pteronyssinus

BACKGROUND

The clinical efficacy of allergen immunotherapy using therapeutic vaccines containing modified allergen extracts has been previously shown.

OBJECTIVE

To evaluate the clinical efficacy of a vaccine containing depigmented, polymerized extract of Dermatophagoides pteronyssinus in asthmatic children, monosensitized to mites, after 4 months of treatment.

MATERIAL AND METHODS

A total of 30 mite-allergic, asthmatic children (age range, 8-16 years) were entered in the study; 15 were treated with the modified allergen extract (active group) and 15 received only pharmacologic treatment (control group). The study was open, controlled and parallel with random allocation of the patients to each of the groups. Efficacy was evaluated using allergen-specific bronchial challenge tests, dose-response skin-prick tests, and symptom and medication scores. The results of the bronchial challenges and dose-response skin-prick tests were compared at baseline and after 4 months of treatment. The build up phase consisted of 4 injections in 2 days, followed by 4 injections of the maintenance dose.

RESULTS

All patients of the active group concluded the study, whereas 2 of the control group did not. In the active group, there was a significant difference in the PC20FEV1 (P <.01) after 4 months. The mean allergen quantity needed was 26 microg at baseline vs. 309 microg after 4 months (a 12.8-fold increase). There was no difference in the control group (5 tg at baseline vs 8 microg at the end). A significant reduction in the number of cases with dual bronchial response was observed in the treated group (P < .05). Two treated patients of this group experienced a negative bronchial challenge after 4 months of treatment. The group of active patients also experienced significant improvement in skin reactivity and symptom and medication scores.

CONCLUSIONS

Vaccines containing depigmented polymerized extracts of D pteronyssinus are safe and effective in the treatment of mite allergic asthmatic children, and provide clinical benefit after 4 months of treatment.