Aqueous intradermal low-dose house dust mite immunotherapy in tropical settings: a valid cost-effective approach for developing nations?

INTRODUCTION: Aqueous allergen injections, an effective and century-old technique, is considered a second-line approach in daily clinical practice. Inconveniences still surround conventional subcutaneous immunotherapy (SCIT) administration, such as a need for frequent injections, prolonged up-dosing schedules, elevated costs, and the unlikely possibility of a systemic reaction. The intradermal immunotherapy route (IDR) might favorably impact many of the aforementioned issues (Table 1). House dust mite (HDM) allergens are the main perennial sensitizers in the tropics, and as such, are solely employed in immunotherapy treatments. METHODS: We carried out a year-long real-life study in 25 perennial allergic rhinitis children, symptomatic on exposure to house dust, employing an intradermal low-dose allergen mix consisting of 50 ng of Dermatophagoides pteronyssinus/Dermatophagoides farinae and 120 ng of Blomia tropicalis, under a unique cost-wise protocol. Basal symptoms/signs and face Visual Analog Scale (fVAS) scores were recorded for 2 weeks and later compared with those registered throughout the 1-year treatment. Serum-specific IgG4 and IL-10 levels were employed in the assessment of the immune responses. RESULTS: Symptoms/signs and fVAS scores were significantly reduced from days 42 and 49, respectively, and remained so until treatment completion. Increases in specific IgG4's and IL-10 levels reflected significant immune responses. Injections were well tolerated and families reported improved health status (quality of life, QoL). CONCLUSIONS: A unique cost-effective immunotherapy alternative for deprived allergic communities in tropical settings is depicted; further research is needed.

[Intradermal immunotherapy with low-dose house dust mite allergens in patients with allergic rhinitis: A proof-of-concept study]. / Inmunoterapia intradérmica con alérgenos de ácaros a bajas dosis en pacientes con rinitis alérgica: un estudio conceptual.

BACKGROUND: High-dose aqueous subcutaneous immunotherapy is a validated and effective administration route for house dust mite and pollen allergens. OBJECTIVE: A proof-of-concept study using intradermal immunotherapy (IDIT) with low-dose house dust mite allergens (Dermatophagoides pteronyssinnus/Dermatophagoides farinae [Dp/Df] and Blomia tropicalis [Bt]) was carried out in children with allergic rhinitis symptomatic upon exposure to house dust. METHODS: Eight immunotherapy-naïve patients with positive prick skin tests and specific serum IgE to a Dp/Df mixture and to Bt were weekly administered 0.05 mL of an IDIT consisting of a phenolyzed albumin-saline preparation containing low-dose dust mites (8.3 AU [5 ng] of Dp/Df and 2.5 DBU of Bt), for 3 months. Nasal (Total Nasal Symptom Score) and facial symptoms (Visual Analog Scale) were recorded 2 weeks prior to treatment and once weekly during its course. Serial dilutions skin prick tests (1/100-1/1.000.000) and serum allergen-specific IgG4 determinations were performed at baseline and at treatment conclusion. RESULTS: Values on the scales suggested clinical improvement. There was a significant decrease in serial dilutions skin prick tests' wheal diameters, as well as an increase in serum IgG4 values at treatment completion. IDIT was well tolerated. CONCLUSION: If the present results are confirmed by further studies, allergen-specific immunotherapy wider use could be promoted.

Antecedentes: La inmunoterapia subcutánea acuosa a altas dosis es una ruta validada y efectiva de administración de alérgenos para el ácaro del polvo doméstico y alergias al polen. Objetivos: Estudio de definición conceptual empleando inmunoterapia intradérmica (ITID) con alérgenos de ácaros (Dermatophagoides pteronyssinus/Dermatophagoides farinae [Dp/Df] y Blomia tropicalis [Bt]) a bajas dosis; se llevó a cabo en niños con rinitis alérgica sintomáticos a la exposición de polvo de casa. Métodos: A ocho pacientes sin uso previo de inmunoterapia, con pruebas de punción cutánea positivas e IgE sérica específica a una mezcla de Dp/Df y Bt, se les administraron por tres meses 0.05 mL de ITID semanalmente, provenientes de una preparación fenolizada albúmino-salina y contentiva de bajas dosis de ácaros (8.3 AU= 5 ng de Dp/Df y 2.5 DBU de Bt). Los síntomas nasales (Total Nasal Symptom Score) y los faciales (Escala Análoga Visual) fueron registrados dos semanas antes del tratamiento y en el transcurso una vez a la semana. Al comienzo y al final se realizaron pruebas cutáneas diluidas y seriadas (1/100-1/1.000.000) y determinaciones de IgG4 en el suero para los alérgenos. Resultados: Los valores de las escalas sugirieron mejoría clínica. Existió disminución significativa de los diámetros de las pápulas de las pruebas diluidas y seriadas, así como aumento de los valores de la IgG4 sérica al final del tratamiento. La ITID fue bien tolerada. Conclusión: Si estudios ulteriores confirman los presentes hallazgos, se podría promover una mayor utilización de la inmunoterapia alérgeno-específica.

Sensibilidad y especificidad de los marcadores serológicos para diagnóstico y seguimiento de la condición celíaca / Sensitivity and specificity of serological markers for diagnosis and monitoring of celiac condition

Introducción: El diagnóstico precoz y seguimiento de la condición celíaca ha sido objeto de importantes cambios, y según la guía ESPGHAN (2012) la serología es ahora una herramienta fundamental. Los principales son los anticuerpos anti-gliadina IgG/IgA, anti-transglutaminasa IgG/IgA, anti-endomisiales (EMA), y los recientemente descritos anti-péptidos deaminados de gliadina (anti-DGPs). El propósito del estudio fue determinar la sensibilidad y especificidad de estos marcadores en 308 individuos con y sin patología. Materiales y métodos: A cada individuo se le realizaron determinaciones de: TTGG y TTGA Qual (AESKU Diagnostics ®, Germany), TgTG, TgTA, AAGG y AAGA por ENEASYSTEM III® (Byogenetix, Italia), Neoep. IgG/A (AESKU Diagnostics®, Germany), EMA IgG e IGA y GAF3X IgG e IgA (Euroimmun, Germany ®). Resultados: Los valores de sensibilidad (S) y especificidad (E) fueron: Para anti-IgA Celicheck: S: 44.44%, E: 97.59%; anti-TTG Qual: S: 14.28%, E: 97.61%; anti-neoepítopes IgG/IgA: S: 54.44%, E: 91.59%; AAG IgG: S: 89.11%, E: 63.19%; AAG IgA: S: 79.11%, E: 68.16%; anti-DGPs IgA: S: 86.67%, E: 96.21% (p<0,05). Conclusiones: Los ATgT IgG e IgA solo son superados por los anti-DGPs. Se debe ampliar las investigaciones para estandarizar este nuevo método de valoración.

Introduction: The diagnosis and management of celiac disease has undergone significant changes, according to the ESPGHAN guide (2012) serology is now an essential tool. The main ones are the anti-gliadin IgG/IgA anti-transglutaminase IgG/IgA, anti-endomysial and the recently described anti-deaminated gliadin peptides (anti-DGPs). The purpose of the study was to determine the sensitivity and specificity of these markers in 308 individuals with and without pathology. Materials and Methods: Each individual is simultaneously made the following determinations: TTGG and TTGA Qual (AESKU Diagnostics®, Germany), TgTG, TgTA, AAGG and AAGA ENEASYSTEM III® (Byogenetix, Italia), Neoep. IgG/A (AESKU Diagnostics®, Germany), EMA IgG, IGA and GAF3X IgG-IgA (Euroimmun, Germany®). Results: The sensitivity (S) and specificity (Sp) were: anti-IgA To Celicheck: S: 44.44%, E: 97.59% anti-TTG Qual: S: 14.28%, E: 97.61% anti-neoepitopes IgG/IgA: S: 54.44%, E: 91.59%; AAG IgG: S: 89.11%, E: 63.19%; AAG IgA: S: 79.11%, E: 68.16% IgA anti-DGPs: S: 86.67% E: 96.21% (p<0.05). Conclusions: IgG and IgA ATGT are surpassed only by anti-DGPs However, it is important to extend the research to standardize this new method of assessment.

Primer estudio de prevalencia de la condición celíaca en Venezuela / First study of prevalence of celiac condition in Venezuela

Introducción: La celiaquía es una enteropatía inmune desencadenada por la ingestión de cereales que contienen gluten en individuos predispuestos genéticamente, caracterizada por un síndrome de malabsorción intestinal con un espectro variable de manifestaciones. Objetivo: Determinar la prevalencia de esta enfermedad en una población de Venezuela. Materiales y Métodos: Se estudiaron 308 individuos de diversas ciudades del país. En cada caso se determinó anticuerpos anti-gliadina IgG e IgA, anti-transglutaminasa IgG e IgA, y anti-endomisiales. En el análisis estadístico se utilizó Instad, SPSS y EPI INFO. Resultados: Se obtuvo 3% de individuos con marcadores positivos; el 20.13% se encontraban entre 1 y 15 años, 11,6% de 16 a 24 años, 7,14% de 25 a 40 años, 26,62% de 41 a 50 años y 34,51% de 51 y 72 años. Aún cuando la mayoría provenían de Caracas, fueron reportados casos en Carabobo, Aragua, Lara, Zulia, Táchira, Anzoátegui, Mérida, Monagas, Guárico, Cojedes, Bolívar, Sucre, Portuguesa y Miranda. Conclusión: Los resultados sugieren una importante prevalencia de esta condición en el país, siendo necesario ampliar estas investigaciones, a fin de determinar la relevancia exacta del problema con una población más representativa e implementar medidas de salud pública adecuadas.

Introduction: Celiac condition is a immune-mediated enteropathy triggered by ingestion of gluten-containing cereals in genetically predisposed individuals, characterized by intestinal malabsorption syndrome a variable spectrum of manifestations. Objective: To determine the prevalence of this disease in the population of Venezuela. Materials and Methods: We studied 308 individuals from various cities. In each case, the determination was made of anti-gliadin IgG and IgA anti-transglutaminase IgG and IgA and anti-endomysial. The statistical analysis was used Entreat, SPSS and EPI INFO. Results: We obtained 3% of patients with positive markers for this condition, of which the 20.13% were between 1 and 15 years, 11.6% from 16 to 24 years, 7.14% from 25 to 40, 26.62% from 41 to 50 and 34.51% of 51 and 72. Although most came from Caracas, positive cases were reported in Carabobo, Aragua, Lara, Zulia, Táchira, Anzoategui, Merida, Monagas, Guárico, Cojedes, Bolívar, Sucre, Portuguesa and Miranda. Conclusion: The results strongly suggest a significant prevalence of this condition in the country, being necessary to extend these investigations to determine the exact significance of the problem with a more representative population and implement appropriate public health measures.