Sublingual Allergen-Specific Immunotherapy in Allergic Rhinitis and Related Pathologies: Efficacy in a Paediatric Population

The aim of this study was to demonstrate the efficacy and safety of the sublingual-swallow allergen-specific immunotherapy (SLIT) in a paediatric population suffering from allergic rhinitis and related pathologies. From March 1994 through March 2000, at our ENT Department 4000 children (1800 males and 2200 females), aged 3 to14 years, were examined for recurrent nasal obstruction and nasal polyps. 2400 (60%) of them were allergic and underwent the following investigations: Impedance test, Pure tone audiometry, rhinomanometry, Prick test, RAST, nasal provocation test and paranasal sinus TC without contrast media. Of the allergic group we admitted 288 patients(12%) to a 3 yr SLIT, meeting the following criteria: children aged 5 years or more, mono-sensitised to one allergen and with family cooperation support. After three years of SLIT, we observed complete symptom remission and a marked improvement in instrumental examinations in 80% of these children. The improvement was poor in 8% of patients, while in 12% of the subjects no changes in symptoms and instrumental results were detected. These results are in agreement with previously published studies and confirm that SLIT can be a valid tool for treating allergic upper respiratory tract diseases in children.

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Assessment of Allergen-Induced Respiratory Hyperresponsiveness before the Prescription of a Specific Immunotherapy

Allergy & Rhinology ◽

10.2500/ar.2015.6.0122 ◽

2015 ◽

Vol 6 (2) ◽

pp. ar.2015.6.0122 ◽

Cited By ~ 1

Author(s):

Celso Eduardo Olivier ◽

Daiana Guedes Pinto Argentão ◽

Regiane Patussi dos Santos Lima ◽

Mariana Dias da Silva ◽

Raquel Acácia Pereira Gonçalves dos Santos ◽

...

Keyword(s):

Allergic Rhinitis ◽

Specific Immunotherapy ◽

Bronchial Hyperresponsiveness ◽

Provocation Test ◽

Forced Expiratory Volume ◽

Allergen Specific Immunotherapy ◽

Nasal Provocation Test ◽

Nasal Provocation ◽

Before And After ◽

Spearman’S Correlation

Background Asymptomatic sensitization is a frequent condition that must be considered before the indication of allergic-specific immunotherapy. Objective The aim of this study was to appreciate and correlate the local and spirometric changes elicited by the allergen-specific nasal provocation test (NPT) to define practical and feasible guidelines for the allergist/immunologist to demonstrate specific respiratory hyperresponsiveness before the indication of allergic-specific immunotherapy. Methods A total of 172 subjects (children and adults) with a diagnosis of allergic rhinitis were submitted to flow-volume spirometry immediately before and after the NPT performed with Dermatophagoides antigens. The differences between the pre- and postspirometric estimated values of peak expiratory flow rate (PEFdif%), forced expiratory volume in 1 second (FEV1dif%), and forced vital capacity (FVCdif%) were correlated with the results of the nasal provocation test symptom score (NPT-SS). Results There were 119 subjects (69%) with NPT-SS > 2. Among these patients who were reactive, the mean NPT-SS was 6.3. The Spearman's correlation between PEFdif% and NPT-SS was r = −0.44 (p = 0.01); the Spearman's correlation between FEV1dif% and NPT-SS was r = −0.22 (p = 0.01), and the Spearman's correlation between FVCdif% and NPT-SS was r = −0.21 (p = 0.04). Conclusion The combined utilization of the allergen-specific NPT-SS with the spirometry (or PEF meter) is a safe methodology to evaluate allergen-specific nasal and bronchial hyperresponsiveness (which sometimes acts as a bronchial provocation test) in patients with allergic rhinitis and asthma due to hypersensitivity who are candidates for allergen-specific immunotherapy.

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The Importance of Nasal Provocation Testing in the Diagnosis of Dermatophagoides pteronyssinus-Induced Allergic Rhinitis

American Journal of Rhinology and Allergy ◽

10.1177/19458924211037913 ◽

2021 ◽

pp. 194589242110379

Author(s):

Hao Xiao ◽

Qiaoru Jia ◽

Hongting Zhang ◽

Li Zhang ◽

Guo Liu ◽

...

Keyword(s):

Allergic Rhinitis ◽

Immunoglobulin E ◽

Area Under The Curve ◽

Roc Curves ◽

Dermatophagoides Pteronyssinus ◽

Allergen Specific Immunotherapy ◽

Prick Test ◽

Nasal Provocation ◽

Provocation Testing ◽

Nasal Provocation Testing

Background Allergen identification is the first step for allergen-specific immunotherapy (AIT) of allergic rhinitis (AR). Currently, the diagnosis of AR is based mainly on the positive results of the skin prick test (SPT) and/or serum specific immunoglobulin E (sIgE) measurement. However, the results of these two tests may not always directly correlate with AR. Objective To investigate the importance of nasal provocation testing (NPT) in the diagnosis of Dermatophagoides pteronyssinus (Der p)-induced AR. Methods Rhinitis patients willing to undergo AIT (n = 171) were enrolled. The correlations of Der p SPT, sIgE, NPT, and clinical symptom severity were assessed. Results NPT-positive responses were more common in patients with higher SPT and sIgE levels. The optimal cut-off value for a NPT-positive response for SPT was 5.5 mm and for sIgE was 2.77 kUA/L, based on the respective receiver operating characteristic (ROC) curves. The area under the curve (AUC) of the ROCs was 0.814 (SPT only) and 0.794 (sIgE only) and increased to 0.828 with the combination of SPT and sIgE. The Der p-NPT concentration was inversely correlated with SPT and sIgE levels ( r = −0.477, P < .001, and r = −0.461, P < .001, respectively), but none was correlated with the total nasal symptom score. Conclusion For patients who are willing to receive Der p AIT, NPT is a useful and safe test to confirm diagnosis prior to treatment initiation, especially in patients with lower levels of Der p SPT (< 5.5 mm) or sIgE (< 2.77 kUA/L).

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A study on allergen sensitivity in patients with allergic rhinitis in Bangalore, India

The Journal of Laryngology & Otology ◽

10.1017/s0022215114001984 ◽

2014 ◽

Vol 128 (10) ◽

pp. 892-896 ◽

Cited By ~ 1

Author(s):

G Gowda ◽

S Lakshmi ◽

B G Parasuramalu ◽

C Nagaraj ◽

B V C Gowda ◽

...

Keyword(s):

Allergic Rhinitis ◽

Patient Education ◽

Skin Prick Test ◽

Specific Immunotherapy ◽

Indian Subcontinent ◽

Geographical Area ◽

Allergen Specific Immunotherapy ◽

Prick Test ◽

Dust Mite ◽

Positive Results

AbstractBackground:Allergic rhinitis is the most common form of non-infectious rhinitis, affecting 500 million people worldwide, with one-fifth of those affected living in the Indian subcontinent. The skin prick test is the most valuable test for detecting offending allergens, and can be helpful for patient education, allergen avoidance and immunotherapy planning.Method:The skin prick test was performed with 49 allergens in 486 patients who presented with symptoms of allergic rhinitis, and the allergen profile was studied.Results:Of the 486 allergic rhinitis patients, 335 (68.93 per cent) showed allergen positivity to the skin prick test. Dust mite was the most common allergen, with positive results in 44.65 per cent of cases.Conclusion:The most common offending allergen in our study was the dust mite. Identification of specific allergens for a particular geographical area aids patient education and enables allergen-specific immunotherapy.

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Dynamics of class E and G immunoglobulins under the influence of combined allergen-specific immunotherapy in patients with allergic rhinitis with combined sensitization to pollen and household allergens

OTORHINOLARYNGOLOGY 2-3(2) 2019 - OTORHINOLARYNGOLOGY ◽

10.37219/2528-8253-2020-6-42 ◽

2020 ◽

pp. 42-48

Author(s):

E.М Dityatkovska ◽

S.V. Biletska

Keyword(s):

Allergic Rhinitis ◽

Specific Immunotherapy ◽

Immunoglobulin E ◽

Skin Tests ◽

Total Serum ◽

Combination Immunotherapy ◽

Pollen Allergens ◽

Allergen Specific Immunotherapy ◽

Prick Test ◽

Specific Combination

The aim of this study is to assess the dynamics of immunoglobulin E and G under the influence of combined allergen-specific immunotherapy (ASIT) in patients with allergic rhinitis with combined sensitization to pollen and household allergens. Materials and methods: The study involved 49 patients, residents of Dnipro city, of working age (35,5±1,5 years), of whom 24 (49,0%) - women and 25 (51,0%) - men. All patients were diagnosed with allergic rhinitis with average disease duration of 9,2 ±1,1 year, who underwent allergy examination - skin tests - prick test with pollen and household allergens and/or methods of allergy component diagnosis ALEX. The number of pollen allergens in one patient was 4,6±0,4 on average. All patients received one course of pre-season ASIT allergen according to the express scheme. Patients in the main group (31 patients) received a combined ASIT with solutions of pollen and household allergens. 18 patients in the comparison group received ASIT only with pollen allergens. Clinical groups were homogeneous in age, sex, duration of the disease, as well as the average number of pollen allergens. Results: The obtained results and their analysis show that the use of allergen-specific combination immunotherapy in patients with allergic rhinitis with combined sensitization to pollen allergens causes a more significant effect on the activation of the immune response, which was revealed by reduced relative to baseline lgE production by 41,9% (p<0,001) and an increase in lgG by 7,5% (p<0,05). The production of total serum in patients with allergic rhinitis before treatment and under the influence of ASIT was the opposite to the dynamics of lgG production. The positive results of immunological studies convincingly prove the benefits and effectiveness of allergen-specific combination immunotherapy in the treatment of patients with allergic rhinitis with combined sensitization to pollen and household allergens.

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Correlation of Nasal Eosinophilia and Response after Nasal Provocation Test in Patients with Nonallergic Rhinitis

Otolaryngology ◽

10.1177/0194599818768806 ◽

2018 ◽

Vol 159 (2) ◽

pp. 231-237 ◽

Cited By ~ 2

Author(s):

Ki-Ik Park ◽

Tae Young Jang ◽

Seung-Chan Yang ◽

Hyung Sun Hong ◽

Young Hyo Kim

Keyword(s):

Allergic Rhinitis ◽

Nasal Obstruction ◽

Provocation Test ◽

Retrospective Chart Review ◽

Nonallergic Rhinitis ◽

Cross Sectional ◽

Nasal Provocation Test ◽

Prick Test ◽

Nasal Provocation ◽

Group D

Objectives We aimed to evaluate the relationship between nasal eosinophilia and nasal hyperresponsiveness to allergen extract. Study Design Retrospective chart review. Setting Academic tertiary rhinologic practice. Subjects and Methods We performed allergy tests (skin prick test and multiple allergosorbent test) and nasal cytology for 194 patients with rhinitis symptoms (76 males and 118 females; age, 11-69 years). According to the results, they were classified into 4 groups: group A (allergic rhinitis with eosinophilia, n = 26), group B (allergic rhinitis without eosinophilia, n = 77), group C (nonallergic rhinitis with eosinophilia syndrome, n = 20), and group D (nonallergic rhinitis without eosinophilia, n = 71). We performed a nasal provocation test (NPT) using house dust mite extract and assessed the changes in symptoms and the decrease in acoustic parameters (total nasal volume and minimal cross-sectional area [MCA]). Results Patients in group C were more likely to have severe rhinorrhea and sneezing than those in group D ( P < .001). After NPT, group C had greater aggravation of nasal obstruction than group D ( P < .001). Group C also showed markedly greater MCA changes as compared with group D 15 minutes after the antigen challenge ( P = .002). There was significant correlation between the number of eosinophils and an increase in nasal obstruction ( r = 0.319, P = .0009), rhinorrhea ( r = 0.302, P = .0017), sneezing ( r = 0.219, P = .0241), change in the total nasal volume 15 minutes after NPT ( r = 0.287, P = .0028), and change in the MCA 15 minutes ( r = 0.322, P = .0008) and 30 minutes ( r = 0.250, P = .0098) after NPT. Conclusion In patients with NAR, nasal eosinophilia is associated with provocative response after NPT. Further research should be performed to elucidate the mechanisms that underlie this phenomenon.

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The effect of probiotics on prevention of upper respiratory tract infections in the paediatric community – a systematic review

Beneficial Microbes ◽

10.3920/bm2019.0119 ◽

2020 ◽

Vol 11 (3) ◽

pp. 201-211

Author(s):

İ.E. Emre ◽

Y. Eroğlu ◽

A. Kara ◽

E.C. Dinleyici ◽

M. Özen

Keyword(s):

Respiratory Tract ◽

Respiratory Tract Infections ◽

Data Extraction ◽

Antibiotic Use ◽

Paediatric Population ◽

Upper Respiratory Tract Infections ◽

Upper Respiratory Tract ◽

Upper Respiratory ◽

Randomised Controlled ◽

Tract Infections

Prevention of acute upper respiratory tract infections (URTIs) is becoming an increasingly important concept in public health application due to the increase in antibiotic resistance. Probiotics have been shown to have some effect on prevention in various reviews. In this study we aimed to re-asses the effect of probiotics as there has been a substantial increase in literature regarding the effects and safety of probiotics in the paediatric population. Two major databases were systematically searched to identify clinical trials eligible for inclusion. Study selection, data extraction and quality assessment were carried out by two reviewers. This review comprises 33 randomised controlled trials (RCTs) applied to a paediatric population with high-quality methodology. The primary outcome for this review was the incidence of respiratory tract infections. Secondary outcomes were severity of symptoms, missed days of school, incidence of antibiotic use and safety of prebiotic use. This review showed that probiotics have an impact on decreasing the incidence of URTIs and the severity of symptoms. The use of probiotics is extremely safe and as studies increase in evaluation of the effect of probiotics more and more show a significant beneficiary effect. Although still a long way from becoming a unanimous treatment modality, the small positive changes that probiotics have on URTIs is important to consider and the use of probiotics should be encouraged more.

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Intralymphatic allergen administration renders specific immunotherapy faster and safer: A randomized controlled trial

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.0803725105 ◽

2008 ◽

Vol 105 (46) ◽

pp. 17908-17912 ◽

Cited By ~ 206

Author(s):

Gabriela Senti ◽

Bettina M. Prinz Vavricka ◽

Iris Erdmann ◽

Mella I. Diaz ◽

Richard Markus ◽

...

Keyword(s):

Specific Immunotherapy ◽

Treatment Time ◽

Controlled Trial ◽

Skin Prick Testing ◽

Pollen Extract ◽

Open Label ◽

Allergen Specific Immunotherapy ◽

Safety And Efficacy ◽

Nasal Provocation ◽

Intralymphatic Immunotherapy

The only causative treatment for IgE-mediated allergies is allergen-specific immunotherapy. However, fewer than 5% of allergy patients receive immunotherapy because of its long duration and risk of allergic side effects. We aimed at enhancing s.c. immunotherapy by direct administration of allergen into s.c. lymph nodes. The objective was to evaluate safety and efficacy compared with conventional s.c. immunotherapy. In a monocentric open-label trial, 165 patients with grass pollen-induced rhinoconjunctivitis were randomized to receive either 54 s.c. injections with pollen extract over 3 years [cumulative allergen dose 4,031,540 standardized quality units (SQ-U)] or 3 intralymphatic injections over 2 months (cumulative allergen dose 3,000 SQ-U). Patients were evaluated after 4 months, 1 year, and 3 years by nasal provocation, skin prick testing, IgE measurements, and symptom scores. Three low-dose intralymphatic allergen administrations increased tolerance to nasal provocation with pollen already within 4 months (P < 0.001). Tolerance was long lasting and equivalent to that achievable after standard s.c. immunotherapy (P = 0.291 after 3 years). Intralymphatic immunotherapy ameliorated hay fever symptoms (P < 0.001), reduced skin prick test reactivity (P < 0.001), decreased specific serum IgE (P < 0.001), caused fewer adverse events than s.c. immunotherapy (P = 0.001), enhanced compliance (P < 0.001), and was less painful than venous puncture (P = 0.018). In conclusion, intralymphatic allergen administration enhanced safety and efficacy of immunotherapy and reduced treatment time from 3 years to 8 weeks.

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Effects of allergen-specific immunotherapy on functions of helper and regulatory T cells in patients with seasonal allergic rhinitis

European Cytokine Network ◽

10.1684/ecn.2011.0277 ◽

2011 ◽

Vol 22 (1) ◽

pp. 15-23 ◽

Cited By ~ 10

Author(s):

Cengiz Kirmaz ◽

Ozlem Ozenturk Kirgiz ◽

Papatya Bayrak ◽

Ozge Yilmaz ◽

Seda Vatansever ◽

...

Keyword(s):

T Cells ◽

Allergic Rhinitis ◽

Regulatory T Cells ◽

Seasonal Allergic Rhinitis ◽

Specific Immunotherapy ◽

Allergen Specific Immunotherapy

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Local allergic rhinitis

Medicinski pregled ◽

10.2298/mpns14s1049b ◽

2014 ◽

Vol 67 (suppl. 1) ◽

pp. 49-56

Author(s):

Maja Buljcik-Cupic ◽

Dragana Lemez ◽

Slobodan Savovic ◽

Ljiljana Jovancevic ◽

Danijela Dragicevic

Keyword(s):

Allergic Rhinitis ◽

Nasal Mucosa ◽

Immunoglobulin E ◽

Provocation Test ◽

Allergic Response ◽

Prick Test ◽

Local Allergic Rhinitis ◽

Provocation Tests ◽

Number Of Patients ◽

The Impact

Local allergic rhinitis is a localized allergic response of the nasal mucosa to aeroallergens in the absence of atopy with characteristic production of specific local immunoglobulin E antibodies in the nasal mucosa, T helper type 2 cellular infiltration response during the exposure to aeroallergens and positive results via the nasal allergic provocation test with the release of inflammatory mediators (triptase and eosinophil cationic proteins). Even though the prevalence of local allergic rhinitis has been and is still being investigated, a large number of patients with diagnosed non-allergic rhinitis or idiopathic rhinitis are currently classified as having local allergic rhinitis. The causes of local allergic rhinitis are most commonly house dust, dust mites, pollens and many others. Diagnosis of local allergic rhinitis is made using nasal allergen provocation tests when the prick test for standard inhalation allergens and the serum specific immunoglobulin analysis for aeroallergens are negative. The increasing amount of data on localized allergic response in non-atopic patients asks for many answers regarding local allergic rhinitis. These answers can be obtained by a study on the prevalence and incidence in children and adults, the impact of positive family atopy in the development of disease, the impact of associated diseases of the lower respiratory tract and conjunctiva, the effectiveness of drug treatment and the issue of administration of specific immunotherapy.

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