Allergen-Specific IgE and IgG4 as Biomarkers for Immunologic Changes during Subcutaneous Allergen Immunotherapy

(1) Background: Biomarkers of efficacy for subcutaneous immunotherapy (SCIT) on allergic rhinitis have not been evaluated in details. The present study aims to assess the relevance of measuring of sIgE, sIgG4 and IgE/IgG4 ratio during SCIT in patients with allergic rhinitis; (2) Methods: 20 patients, 13 men and 7 women aged 19 to 58 years, with clinically manifested seasonal and perennial allergic rhinitis were studied. At the initiation and in the end of the three-year course of SCIT serum allergen-specific IgE and IgG4 were measured with ImmunoCAP system. The sIgE/sIgG4 ratio was calculated as a biomarker for immunologic effectiveness; (3) Results: There was a significant increase of sIgG4 antibodies (p < 0.05), while at the end of SCIT for the sIgE levels no significant changes were seen (p > 0.05). Moreover, 90% of patients showed a decrease of the IgE/IgG4 ratio; (4) Conclusions: In most of treated patients with AR, SCIT with Bulgarian allergen products leads to clear immunological changes. After a 3-year of SCIT there is a significant increase in allergen specific IgG4 levels and both decrease of sIgE and IgE/IgG4 ratio. sIgE, sIgG4 and IgE/IgG4 ratio can be used as a substantial biomarker for predicting immunological effectiveness of SCIT.

Efficacy of Hypertonic Saline Irrigation for Nasal Symptoms in Children with Perennial Allergic Rhinitis: A Randomized Double-Blind Study

Background: Nasal saline irrigation was an adjunctive therapy of allergic rhinitis (AR). It has been suggested that the use of hypertonic saline (HS) is better than normal saline (NSS) in treatment of AR. Reduction of mucosal edema by hypertonicity induced water transport through nasal mucosa, nasal congestion reduction and mucociliary clearance improvement. Objective: To compare total nasal symptom score (TNSS) between 3% HS and NSS irrigation in perennial allergic rhinitis children. Materials and Methods: The present study was conducted at the Allergy Center of Bhumibol Adulyadej Hospital (BAH), Royal Thai Airforce, Bangkok, Thailand between January and March 2021. Sixty-two perennial AR children were enrolled and categorized in severity level, namely mild, moderate or severe. Subjects were randomized into two groups. Each participant was blind-randomized to nasal irrigation of either 3% HS or NSS twice-daily for 4 weeks by the same investigator. The primary outcome was TNSS improvement between both groups. Secondary outcomes were quality of life, nasal congestion severity improvement, nasal cytology change and side effects. Results: TNSS improvement of 3% HS was more than NSS group (4.03±2.36 versus 2.73±3.06, p=0.034). Nasal congestion was the only symptom that differed significantly between the two groups (1.32±1.01 in 3% HS versus 0.70±1.24 in NSS, p=0.024). Reduction of congestion severity by physical examination, nasal cytology changes and side effects were comparable. Conclusion: Nasal irrigation with 3% HS in children with perennial AR had more improvement than NSS in TNSS., especially nasal congestion. Keyword: Hypertonic saline; Nasal irrigation; Allergic rhinitis; Nasal symptom score

Modern H1- antihistamines in the treatment of allergic rhinitis: focus on bilastine

The second generation of H1-antihistamines is approved for the stepwise treatment of seasonal and perennial allergic rhinitis in adults and children by international and national guidelines. They reduce the severity of nasal and ocular symptoms of rhinitis and improve the quality of life of patients. Bilastine, a piperidine derivative, is a novel H1-antihistamine. It has a potent and selective effect on H1- receptors and a rapid onset and long duration of action and substantially reduces nasal and ocular symptoms of seasonal and perennial allergic rhinitis. Bilastine has no clinically substantial hepatic metabolism and has a high safety profile: it has no sedative effect, does not affect cognitive functions, has no cardiotoxic effects, and does not interact with alcohol and benzodiazepines in normal and high doses. Tachyphylaxis does not develop despite long-term (up to 1 year) use. Bilastine is registered for clinical use in adults and children aged 12 years. The results of clinical and experimental studies have demonstrated that bilastine has many of the features of modern H1-antihistamines recommended by international guidelines.

Perennial allergic rhinitis in children: efficiency and safety of using «Ergocetal»

Purpose — to evaluate the efficacy and safety of levocetirizine («Ergocetal») in children with perennial allergic rhinitis (PAR). Materials and methods. 30 children aged 6–16 years with PAR were examined. All children were prescribed levocetirizine («Ergocetal») 5 mg in the form of tablets once a day for a month for the treatment of PAR. The criteria for the effectiveness of the treatment were: regression of the main nasal and ocular symptoms of PAR (rhinorrhea, nasal congestion, nasal itching, sneezing, itching and redness of the eyes) according to the visual analogue scale (VAS); dynamics of nasal eosinophilia in a smearst from the nasal mucosa. Results. The studies have shown that prescribe of levocetirizine «Ergocetal» in monotherapy for school-age children with mild and intermittent PAR had a positive therapeutic effect on nasal and ocular symptoms, as well as on the intensity of eosinophilic inflammation in the nasal mucosa. Established good tolerance and the absence of side effects of «Ergotal» in the examined children. Conclusions. Therapeutic efficacy, absence of adverse reactions, high adherence to treatment make it possible to recommend levocetirizine («Ergocetal») as monotherapy for mild and intermittent PAR in school children. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of an participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: allergic rhinitis, treatment, levocetirizine.

EXPERIENCE IN THE USE OF ALLERGEN-SPECIFIC IMMUNOTHERAPY IN TREATMENT OF PERENNIAL ALLERGIC RHINITIS AND CONCOMITANT ATOPIC DERMATITIS

Allergen-specific immunotherapy (ASIT) is currently recognized as the only treatment that can affect all links in the pathological process of allergic diseases. Airway hyperresponsiveness is significantly reduced in case of allergy respiratory manifestations, which reduces symptoms severity and the need for drugs. The article describes a clinical observation of the ASIT positive effect in persistent atopic dermatitis (AtD) with concomitant respiratory allergy and complete atopic triad development. The authors propose to consider ASIT as a preventive therapy for bronchial asthma and allergic rhinitis if patient has AtD manifestations with confirmed sensitization to aeroallergens.