scholarly journals A comparison of different methods of the allergen-specific immunotherapy in patients with pollinosis: the results of open randomized study

2019 ◽  
Vol 16 (3) ◽  
pp. 35-45
Author(s):  
A Y Nasunova ◽  
N M Nenasheva
Keyword(s):  
Pollen Season ◽  
Specific Immunotherapy ◽  
Allergic Rhinoconjunctivitis ◽  
Nasal Lavage ◽  
Subcutaneous Immunotherapy ◽  
Immune Reactivity ◽  
Allergen Specific Immunotherapy ◽  
New Findings ◽  
Study Results ◽  
Specific Igg4

Background. Allergen-specific immunotherapy (ASIT) is viewed as the only treatment that influences all patho-genetically significant parts of the allergic process in the initial and late phases of the IgE-mediated allergic reaction and modifies the abnormal immune reactivity to a specific allergen. Currently, sublingual (SLIT) and subcutaneous (SCIT) immunotherapy are most commonly used in clinical practice. Despite long experience of sublingual and subcutaneous immunotherapy application, questions remain about the preferred ASIT method and comparative effectiveness of different ASIT methods. This article evaluates the efficacy, benefits of SCIT and SLIT and highlights new findings related mechanisms and potential biomarkers. The aim of the study. To evaluate the comparative efficacy of different methods of ASIT (subcutaneous and sublingual) based on clinical data and biomarkers in the blood serum and other biological fluids in adult patients with allergic rhinoconjunctivitis (with/without asthma). Materials and methods. 60 patients with allergic rhinoconjunctivitis (with/without asthma) aged 18 to 50 were randomly assigned to 3 groups treated by sublingual immunotherapy with extracts of allergens, subcutaneous immunotherapy with extracts of allergens and subcutaneous with modified allergens (allergoids) respectively. Results. The efficiency of the first course of preseason ASIT (SCIT and SLIT) with extracts of allergens and aller-goids in the control of symptoms of allergic rhinoconjunctivitis (with/without asthma) was demonstrated. After the end of the first year pre-season ASIT data analysis scales (Total Symptom Score -TSS, Medircation Score -MS) revealed the best performance in the group of patients receiving SCIT with allergoids compared with patients receiving the SLIT with extracts of allergens: the scales of the TSS (p=0.023), MS (p=0.002). In addition, at the end of the maintenance phase of ASIT in patients treated with SCIT with allergoids the level of eosinophilic cationic protein (ECP) in the nasal lavage decreased by 22% (p=0.012), secretory immunoglobulin A (sIgA) in the nasal lavage increased by 70% (p=0.001), interleukin-10 (IL-10) in serum increased by 126% (p=0.006), allergen-specific IgG4 increased by 42% (p=0.01) from the initial values, that correlates with a decrease in the severity of clinical manifestations. In pollen season ECP level in nasal lavage was significantly (p=0.007) lower in a group of patients who received SCIT with allergoids compared with patients who received the SLIT with extracts of allergens. The most significant changes of serum level of IL-10 in the pollen season occurred in a group of patients receiving SCIT with allergoids compared with patients who received SLIT (p=0.013) and SCIT (p=0.001) with extracts of allergens. Conclusion. The study results deepen the existing understanding of the mechanisms of SCIT and SLIT. They allow to develop a comprehensive assessment of the therapy efficacy scheme based on clinical parameters and on monitoring of local (ECP, sIgA) and systemic biomarkers (IL-10, allergen-specific IgG4) as well.

СРАВНИТЕЛЬНАЯ ЭФФЕКТИВНОСТЬ РАЗНЫХ МЕТОДОВ АЛЛЕРГЕН-СПЕЦИФИЧЕСКОЙ ИММУНОТЕРАПИИ У ПАЦИЕНТОВ С ПОЛЛИНОЗОМ: ОТКРЫТОЕ РАНДОМИЗИРОВАННОЕ ИСПЫТАНИЕ

2019 ◽  
pp. 35-45
Author(s):  
A.Y. Nasunova ◽  
N.M. Nenasheva
Keyword(s):  
Pollen Season ◽  
Biological Fluids ◽  
Clinical Manifestations ◽  
Allergic Rhinoconjunctivitis ◽  
Nasal Lavage ◽  
Subcutaneous Immunotherapy ◽  
Immune Reactivity ◽  
Cationic Protein ◽  
New Findings ◽  
Study Results

Аллергенспецифическая иммунотерапия (АСИТ) является единственным методом, способным влиять на все патогенетически значимые звенья аллергического процесса, на раннюю и позднюю фазы IgEопосредованной аллергической реакции и тем самым видоизменять характер иммунного ответа организма на аллерген. В настоящее время в клинической практике наиболее часто используют подкожный (ПКИТ) и сублингвальный методы (СЛИТ) АСИТ. Несмотря на доказанную эффективность подкожной и сублингвальной аллергенспецифической иммунотерапии, остаются нерешенными вопросы предпочтительного метода сравнительной эффективности АСИТ посредством измерения биомаркеров в сыворотке крови и в других биологических жидкостях у пациентов с аллергическим ринитом (с/без астмы). Цель. Провести сравнительный анализ эффективности разных методов АСИТ (ПКИТ и СЛИТ экстрактами аллергенов) на основании клинических и иммунологических параметров. Материалы и методы. В исследование включены 60 пациентов с аллергическим ринитом (с/без астмы) в возрасте от 18 до 50 лет. Все пациенты случайным способом были распределены на 3 группы в зависимости от метода проведения АСИТ: группа 1 пациенты, получавшие сублингвальную АСИТ экстрактами аллергенов группа 2 пациенты, получавшие подкожную АСИТ экстрактами аллергенов группа 3 пациенты, получавшие подкожную АСИТ модифицированными аллергенами (аллергоидами). Результаты. Продемонстрирована эффективность предсезонной АСИТ (ПКИТ и СЛИТ) экстрактами аллергенов и аллергоидами в контроле симптомов аллергического риноконъюнктивита (с/без астмы). Анализ данных шкал (Total Symptom Scove TSS, Mediacation Scove MS) после окончания 1го курса предсезонной АСИТ выявил статистически значимые различия между группами пациентов, получавших ПКИТ аллергоидами, и пациентами, получавшими СЛИТ аллергенами: по шкалам TSS (р0,023), MS (р0,002). Кроме того, у пациентов, получавших ПКИТ аллергоидами, к концу поддерживающей фазы АСИТ уровень эозинофильного катионного протеина (ECP) в назальном лаваже снизился на 22 (p0,012), секреторного иммуноглобулина А (sIgA) в назальном лаваже увеличился на 70 (p0,001), интерлейкина10 (ИЛ10) в сыворотке крови увеличился на 126 (p0,006), аллергенспецифического IgG4 увеличился на 42 (p0,01) от исходных значений, что коррелирует с уменьшением выраженности клинических проявлений. В сезон естественной экспозиции аллергенов уровень ECP в назальном лаваже статистически значимо (p0,007) ниже в группе больных, получавших ПКИТ аллергоидами, по сравнению со СЛИТ аллергенами. Статистически значимо более высокие показатели сывороточного уровня ИЛ10 в сезон цветения также отмечены в группе больных, получавших ПКИТ аллергоидами, по сравнению с группами, получавшими СЛИТ (p0,013) и ПКИТ (p0,001) экстрактами аллергенов. Заключение. Результаты исследования углубляют имеющиеся представления о механизмах ПКИТ и СЛИТ. Они позволяют разработать схему комплексной оценки эффективности данной терапии, базирующейся на мониторинге клинических параметров, а также локальных (ECP, sIgA) и системных биомаркеров (ИЛ10, аллергенспецифический IgG4).Background. Allergenspecific immunotherapy (ASIT) is viewed as the only treatment that influences all pathogenetically significant parts of the allergic process in the initial and late phases of the IgEmediated allergic reaction and modifies the abnormal immune reactivity to a specific allergen. Currently, sublingual (SLIT) and subcutaneous (SCIT) immunotherapy are most commonly used in clinical practice. Despite long experience of sublingual and subcutaneous immunotherapy application, questions remain about the preferred ASIT method and comparative effectiveness of different ASIT methods. This article evaluates the efficacy, benefits of SCIT and SLIT and highlights new findings related mechanisms and potential biomarkers. The aim of the study. To evaluate the comparative efficacy of different methods of ASIT (subcutaneous and sublingual) based on clinical data and biomarkers in the blood serum and other biological fluids in adult patients with allergic rhinoconjunctivitis (with/without asthma). Materials and methods. 60 patients with allergic rhinoconjunctivitis (with/without asthma) aged 18 to 50 were randomly assigned to 3 groups treated by sublingual immunotherapy with extracts of allergens, subcutaneous immunotherapy with extracts of allergens and subcutaneous with modified allergens (allergoids) respectively. Results. The efficiency of the first course of preseason ASIT (SCIT and SLIT) with extracts of allergens and allergoids in the control of symptoms of allergic rhinoconjunctivitis (with/without asthma) was demonstrated. After the end of the first year preseason ASIT data analysis scales (Total Symptom Score TSS, Medircation Score MS) revealed the best performance in the group of patients receiving SCIT with allergoids compared with patients receiving the SLIT with extracts of allergens: the scales of the TSS (p0.023), MS (p0.002). In addition, at the end of the maintenance phase of ASIT in patients treated with SCIT with allergoids the level of eosinophilic cationic protein (ECP) in the nasal lavage decreased by 22 (p0.012), secretory immunoglobulin A (sIgA) in the nasal lavage increased by 70 (p0.001), interleukin10 (IL10) in serum increased by 126 (p0.006), allergenspecific IgG4 increased by 42 (p0.01) from the initial values, that correlates with a decrease in the severity of clinical manifestations. In pollen season ECP level in nasal lavage was significantly (p0.007) lower in a group of patients who received SCIT with allergoids compared with patients who received the SLIT with extracts of allergens. The most significant changes of serum level of IL10 in the pollen season occurred in a group of patients receiving SCIT with allergoids compared with patients who received SLIT (p0.013) and SCIT (p0.001) with extracts of allergens. Conclusion. The study results deepen the existing understanding of the mechanisms of SCIT and SLIT. They allow to develop a comprehensive assessment of the therapy efficacy scheme based on clinical parameters and on monitoring of local (ECP, sIgA) and systemic biomarkers (IL10, allergenspecific IgG4) as well.

Effect of Vitamin D Adjuvant and Allergen Specific Immunotherapy on Serum IL-10 and IL-17 Levels in Childhood Asthma: A Controlled Clinical Trial

2021 ◽  
Vol 30 (1) ◽  
pp. 175-181
Author(s):  
Lobna A. El-Korashi ◽  
Ola E. Nafea ◽  
Lamiaa G. Zake ◽  
Faika Arab ◽  
Reham H. Anis
Keyword(s):  
Childhood Asthma ◽  
Specific Immunotherapy ◽  
Pediatric Asthma ◽  
Serum Levels ◽  
Atopic Asthma ◽  
Subcutaneous Immunotherapy ◽  
Controlled Clinical Trial ◽  
Inhaled Corticosteroid ◽  
Allergen Specific Immunotherapy ◽  
Few Data

Background: 1, 25-dihydroxy vitamin D3 (VitD3) can improve the effect of allergenspecific immunotherapy (SIT). Few data is available about its role in childhood asthma. Objective: To assess the immunological and clinical efficacy of VitD3 as an adjuvant to allergen specific immunotherapy in pediatric asthma. Methodology: Sixty nine children with atopic asthma were divided into three groups: a group received subcutaneous immunotherapy (SCIT) in combination with VitD3 (n=23), another group received SCIT alone (n=23), and the last group VitD3 alone (n=23). All children were assessed at baseline, and six months for rate of inhaled corticosteroid (ICS) discontinuation, and serum levels of IL-10, and IL-17A. Results: In the SCIT + vitD3, ICS discontinuation rate was higher compared to VitD3 alone group and SCIT alone group at the end of 6th month (P=0.555 and 0.016 respectively). The combined SCIT+ VitD3 group showed significant increase of serum IL-10 level in comparison to SCIT alone group and VitD3 alone group (P=0.000) and significant decrease in serum IL-17A level compared to VitD3 alone group (P= 0.011) Conclusion: VitD3 enhance the clinical and immunological outcomes of SIT in pediatric asthma. Further investigation is needed to evaluate this effect in a larger scale to confirm its role as an adjunct to SIT.

Long-term effects of allergen-specific subcutaneous immunotherapy for house dust mite induced allergic rhinitis

2017 ◽  
Vol 131 (11) ◽  
pp. 997-1001 ◽  
Author(s):  
E Sahin ◽  
D Dizdar ◽  
M E Dinc ◽  
A A Cirik
Keyword(s):  
Allergic Rhinitis ◽  
House Dust ◽  
House Dust Mite ◽  
Specific Immunotherapy ◽  
Subcutaneous Immunotherapy ◽  
Long Term Effects ◽  
Allergen Specific Immunotherapy ◽  
Dust Mite ◽  
Symptom Scores

AbstractBackground:Allergic rhinitis is strongly associated with the presence of house dust mites. This study investigated the long-term effects of allergen-specific immunotherapy. Allergen-specific immunotherapy was applied over three years. The study was based on a 10-year follow up of patients with allergic rhinitis.Methods:The study was conducted between 2001 and 2015. Skin prick test results and symptom scores were evaluated before (26 patients) and after 3 years (20 patients) of allergen-specific immunotherapy (using data from a previously published study), and 10 years after allergen-specific immunotherapy had ended (20 of 26 patients).Results:The symptom scores before allergen-specific immunotherapy were significantly higher than those obtained after 3 years of allergen-specific immunotherapy and 10 years after allergen-specific immunotherapy (p < 0.0175). There were no significant differences between the scores obtained at 3 years and 10 years after allergen-specific immunotherapy (p > 0.0175).Conclusion:Subcutaneous immunotherapy is an effective treatment for house dust mite induced allergic rhinitis.

Year-round treatment initiation for a 6-grasses pollen allergoid in specific immunotherapy of allergic rhinoconjunctivitis and asthma

Immunotherapy ◽  
2019 ◽  
Vol 11 (18) ◽  
pp. 1569-1582
Author(s):  
Vera Mahler ◽  
Stefan Zielen ◽  
Martin Rosewich
Keyword(s):  
Grass Pollen ◽  
Pollen Season ◽  
Allergen Immunotherapy ◽  
Specific Immunotherapy ◽  
Treatment Initiation ◽  
Allergic Diseases ◽  
Phleum Pratense ◽  
Specific Igg4 ◽  
Group A ◽  
Group B

Aim: Allergen immunotherapy (AIT) is an effective treatment for allergic diseases. We investigate whether treatment-initiation during the pollen season is safe. Methods: RCT-IIIb-trial of 6-grass-pollen-allergoid (Allergovit®) in grass pollen-allergic patients (18–65 years) with moderate–severe rhinitis/rhinoconjunctivitis (± controlled asthma), randomized 2:1 to treatment-initiation during (Group-A) versus outside the pollen season (Group-B). Results: Of 240 patients (32.8 ± 9.9 years, 19.5% asthma) treated, 84.9% (Group-A) and 86.6% (Group-B) reached maintenance dose without delay. Treatment-emergent adverse events occurred in 108 (68.4%/Group-A) and 41 patients (56.2%/Group-B) leading to premature trial-termination in 11 patients (7%/A) versus 3 (4.1%/B). Across groups, physicians (for 190 patients; 85.2%) and patients (192; 86.1%) rated the tolerability as ‘very good’–‘good’. Phleum pratense-specific IgG4 increased in both groups (p < 0.0001). Conclusion: Year-round allergen immunotherapy-initiation with this preparation is safe.

scholarly journals Soluble trail as a marker of efficacy of allergen-specific immunotherapy in patients with allergic rhinoconjunctivitis

2012 ◽  
Vol 18 (10) ◽  
pp. CR617-CR621 ◽  
Author(s):  
Arzu Didem Yalcin ◽  
Saadet Gumuslu ◽  
Gizem Esra Parlak ◽  
Atil Bısgın
Keyword(s):  
Specific Immunotherapy ◽  
Allergic Rhinoconjunctivitis ◽  
Allergen Specific Immunotherapy ◽  
Soluble Trail

scholarly journals Allergen-specific immunotherapy: an update on immunological mechanisms of action

2016 ◽  
Vol 65 (1) ◽  
Author(s):  
G. Ciprandi ◽  
G.L. Marseglia ◽  
M.A. Tosca
Keyword(s):  
Specific Immunotherapy ◽  
T Regulatory Cells ◽  
Sublingual Immunotherapy ◽  
Mechanisms Of Action ◽  
Regulatory Cells ◽  
Allergen Specific Immunotherapy ◽  
Specific Antibodies ◽  
Immunological Mechanisms ◽  
Specific Igg4 ◽  
History Of

Specific immunotherapy (SIT) is the only treatment able to modify the natural history of the allergic subjects. Several aspects of the immunopathological response modified by SIT have been investigated; the first parameter historically studied was the production of allergen-specific antibodies. An increase of allergen-specific IgG4 and a decrease of IgE appear after SIT. A shift from Th2-polarized immune response toward Th1-oriented pattern has been reported after SIT. More recently, a crucial role for a subpopulation of T cells has been evidenced: T regulatory cells (Treg). Allergic patients have a defect of Tregs. SIT is able of inducing a specific Treg response. Sublingual immunotherapy is an alternative route of administration for SIT. Recent evidence shows that SLIT is also able of inducing a Treg response as detected by IL- 10 production.

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