Efficacy analysis of three-year subcutaneous SQ-standardized specific immunotherapy in house dust mite-allergic children with asthma

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Abstract

The present study aimed to evaluate the efficacy of three-year subcutaneous SQ-standardized specific immunotherapy (SCIT) in house dust mite (HDM)-allergic children with asthma. Ninety children with allergic asthma to HDMs, with or without allergic rhinitis, were randomly divided into two groups, the treatment group and the control group. The treatment group received SCIT combined with standardized glucocorticoid management and the control group received standardized glucocorticoid management alone for a period of three years. The mean daily dose of inhaled corticosteroids (ICSs), a four-week diary recording the symptom scores of asthma, peak expiratory flow (PEF) measurements, skin prick test results and serum immunoglobulin E (IgE) levels were assessed prior to treatment and following one, two and three years of treatment. The median dose of ICS was reduced in the treatment group after two and three years of treatment compared with that of the control group. After three years of treatment, the discontinuation percentage of ICS in the treatment group was higher than that in the control group. The treatment group demonstrated significantly reduced daytime and night-time asthmatic symptom scores, increased PEF values and reduced serum IgE levels after two and three years of treatment compared with those in the control group (P<0.05). In conclusion, three-year SCIT treatment combined with ICS is an effective immunotherapy for children with allergic asthma and resulted in a reduction of the required ICS dose.

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Mechanisms of allergen-specific immunotherapy.

Cezmi Akdis, Mubeccel Akdis (2010)

Allergen-specific immunotherapy has been used for 100 years as a desensitizing therapy for allergic diseases and represents the potentially curative and specific method of treatment. The mechanisms of action of allergen-specific immunotherapy include the very early desensitization effects, modulation of T-and B-cell responses and related antibody isotypes, and migration of eosinophils, basophils, and mast cells to tissues, as well as release of their mediators. Regulatory T (Treg) cells have been identified as key regulators of immunologic processes in peripheral tolerance to allergens. Skewing of allergen-specific effector T cells to a regulatory phenotype appears as a key event in the development of healthy immune response to allergens and successful outcome in patients undergoing allergen-specific immunotherapy. Naturally occurring forkhead box protein 3-positive CD4(+)CD25(+) Treg cells and inducible T(R)1 cells contribute to the control of allergen-specific immune responses in several major ways, which can be summarized as suppression of dendritic cells that support the generation of effector T cells; suppression of effector T(H)1, T(H)2, and T(H)17 cells; suppression of allergen-specific IgE and induction of IgG4; suppression of mast cells, basophils, and eosinophils; and suppression of effector T-cell migration to tissues. New strategies for immune intervention will likely include targeting of the molecular mechanisms of allergen tolerance and reciprocal regulation of effector and Treg cell subsets. Copyright Â© 2010 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

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Clinical efficacy and immunological mechanisms of sublingual and subcutaneous immunotherapy in asthmatic/rhinitis children sensitized to house dust mite: an open randomized controlled trial.

Nerin Bahceciler, S Keles, A. Yildiz … (2010)

In children, the clinical efficacy and immunological mechanisms of sublingual immunotherapy (SLIT) compared with subcutaneous immunotherapy (SCIT) is still to be elucidated. To compare SLIT, SCIT and pharmacotherapy in relation to clinical efficacy and immunological mechanisms that govern its effect in asthmatic/rhinitis children who were sensitized to house dust mite (HDM). In this single centre, prospective, randomized, controlled, open labelled, three parallel group trial, 48 patients mono-sensitized to HDM were randomized to receive either SLIT (n=16), SCIT (n=16) or pharmacotherapy alone (n=16). Symptom, medication and visual analogue score (VAS) were collected and bronchial-nasal hyper-reactivity, skin prick tests, total-specific IgE were performed at baseline and 12 months after treatment. In addition, peripheral blood mononuclear cells were cultured with recombinant Der p 1 and Bet v 1 extracts and allergen-specific IL-4, IL-5, IL-13, IFN-gamma, IL-10, and TGF-beta secretions were measured. SLIT and SCIT demonstrated a significant reduction of total rhinitis and asthma symptom score, total medication score, VAS and skin reactivity to HDM (P<0.05) when compared with pharmacotherapy. A significant reduction of serum-specific HDM-IgE in SCIT and SLIT were observed. Moreover, titrated nasal provocative dose significantly increased in both immunotherapy groups when compared with the pharmacotherapy group. No adverse effects were reported in SLIT, while two patients demonstrated serious adverse events in SCIT. After 1 year of treatment, Der p 1-driven IL-10 significantly increased in SLIT compared with pharmacotherapy, whereas Bet v 1-driven TGF-beta (negative control) increased significantly in SLIT only. No changes were observed for Th1-Th2 cytokines. Both SLIT and SCIT demonstrated clinical improvement compared with pharmacotherapy in asthma/rhinitis children sensitized to HDM.

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Safety of allergen-specific immunotherapy. Relation between dosage regimen, allergen extract, disease and systemic side-effects during induction treatment.

Eckhart Hahn, Sara Poulsen, H-J Malling … (2000)

Allergen-specific immunotherapy is a well-documented treatment for allergic rhinitis, asthma, and allergy to Hymenoptera venoms. The drawbacks of injection immunotherapy are related to the risk of inducing systemic side-effects (especially during the induction phase), the time used to reach the maintenance dose, and the percentage of patients completing the induction phase). To investigate the practicability and safety of three different patient-friendly induction regimens of clustered immunotherapy (several injections administered during each visit). Since 1990, three different clustered induction regimens (regimen 1 = exclusively aqueous extracts; regimen 2 = a combination of aqueous and alum depot extracts; and regimen 3 = induction using exclusively alum depot extracts) have been investigated in 657 patients (10 369 injections). A total of 454 systemic (immediate and late) reactions were observed in 257 patients corresponding to 4.4% of the injections and 39.1% of the patients. Most of the systemic reactions were of little or no clinical importance (93% grade 1 and grade 2) and < 1% anaphylactic reactions. The 8-week induction regimen using exclusively alum depot extracts showed a statistical significant lower frequency and severity of systemic side-effects. Immunotherapy with cat and mite allergen extracts showed the highest frequency of severe side-effects, which may be related to these extracts being used predominantly in asthmatic patients. The lowest frequency of systemic side-effects was observed in patients allergic to Hymenoptera venoms and these patients furthermore showed the highest number of patients (97%) completing the induction phase. An 8-week clustered induction regimen using alum depot extract seems an acceptable compromise in relation to a reduction in the time used to reach maintenance dose and the risk of inducing clinically relevant systemic side-effects, and consequently imply a reduction in the costs of the treatment.

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Author and article information

Journal

Journal ID (nlm-ta): Exp Ther Med

Journal ID (iso-abbrev): Exp Ther Med

Journal ID (publisher-id): ETM

Title: Experimental and Therapeutic Medicine

Publisher: D.A. Spandidos

ISSN (Print): 1792-0981

ISSN (Electronic): 1792-1015

Publication date (Print): March 2014

Publication date (Electronic): 02 January 2014

Publication date PMC-release: 02 January 2014

Volume: 7

Issue: 3

Pages: 630-634

Affiliations

Department of Respiratory Medicine, Wuxi Children’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, P.R. China

Author notes

Correspondence to: Dr Ling Li, Department of Respiratory Medicine, Wuxi Children’s Hospital Affiliated to Nanjing Medical University, No 299 Qingyang Road, Wuxi, Jiangsu 214023, P.R. China, E-mail: linglicn@ 123456126.com

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Publisher ID: etm-07-03-0630

DOI: 10.3892/etm.2014.1469

PMC ID: 3919950

PubMed ID: 24520258

SO-VID: ad4a7b15-fb44-4f3f-8aba-ed0d3ef68a8d

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This is an open-access article licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License. The article may be redistributed, reproduced, and reused for non-commercial purposes, provided the original source is properly cited.

Efficacy analysis of three-year subcutaneous SQ-standardized specific immunotherapy in house dust mite-allergic children with asthma

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Most cited references 22

Mechanisms of allergen-specific immunotherapy.

Clinical efficacy and immunological mechanisms of sublingual and subcutaneous immunotherapy in asthmatic/rhinitis children sensitized to house dust mite: an open randomized controlled trial.

Safety of allergen-specific immunotherapy. Relation between dosage regimen, allergen extract, disease and systemic side-effects during induction treatment.

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