Decreased Basophil Activation against House Dust Mite after Japanese Cedar Pollen Subcutaneous Immunotherapy: A Retrospective Study.

BACKGROUND: Allergen-specific immunotherapy (AIT), an established treatment for allergic diseases, prevents the development of other allergic manifestations. Although the mechanisms remain unclear, AIT has been shown to reduce basophil activation (BA) against nontarget allergens. OBJECTIVES: The aim of this study was to assess immunological changes in Dermatophagoides farinae (Der f) after Japanese cedar pollen (JCP)-based subcutaneous immunotherapy (SCIT) monotherapy. METHOD: The data of 16 patients (age: 6-37 years) with JCP-induced allergic rhinitis who were sensitive to Der f (serum Der f-specific immunoglobulin E [IgE] level >0.34 kUA/L) and received JCP-based SCIT for 5 years were reviewed retrospectively. BA by Der f and JCP extracts and serum-specific IgE and immunoglobulin G4 (IgG4) levels against these allergens were evaluated before and after completing 5 years of JCP-based SCIT monotherapy. RESULTS: The areas under the dose-response curves of BA by Der f and JCP extracts were significantly reduced (p = 0.02 and p = 0.002, respectively). JCP-specific IgE levels decreased and JCP-specific IgG4 levels increased significantly (p < 0.001 for both), whereas Der f-specific IgE and IgG4 levels did not change significantly. CONCLUSIONS: JCP-based SCIT monotherapy reduced Der f-specific BA. These findings suggest that JCP-based SCIT has the potential to modulate immune response toward nontarget allergens.

The IgE Blocking Activity Induced by Dermatophagoides pteronyssinus Subcutaneous Immunotherapy Does Not Correlate with Specific IgA but with IgG4 in both Serum and Saliva.

BACKGROUND: The role of salivary-specific IgG4 and IgA in subcutaneous immunotherapy (SCIT) is not well defined. We aimed to investigate the change of IgG4 and IgA in both serum and saliva and their correlations with IgE-blocking-factor (IgE-BF) during SCIT. METHOD: 307 Dermatophagoides pteronyssinus (DP) allergic rhinitis and/or asthma patients were recruited for this study. 286 patients received DP-SCIT for 1 year. Twenty-one patients received only symptomatic treatment. DP-, Der p 1-, and Der p 2-specific IgE in serum, specific-IgG4 and Der p 2-specific IgA1 and IgA2 in both serum and saliva were measured at timepoints 0, 4, and 12 months during DP-SCIT. Correlation between salivary and serological IgG4, IgA, and their correlation with DP-specific IgE-BF measured in serum was evaluated. RESULTS: During DP-SCIT, the allergen-specific IgG4 in both saliva and serum increased and correlated significantly, the correlation becomes stronger over the treatment time. DP-specific IgE-BF significantly correlated with DP-specific IgG4 in serum (p < 0.0001) at different timepoints and in saliva at 12 months of SCIT (p < 0.01). No change in Der p 2-specific IgA during DP-SCIT was observed, and the IgA in serum did not correlate with IgA in saliva. There was no correlation between DP IgE-BF and Der p 2-specific IgA in serum or saliva. The control group did not exhibit significant changes in any antibody level measured. CONCLUSION: The IgE blocking activity induced by DP-SCIT treatment correlated with specific IgG4 and not IgA. The IgG4 in saliva correlates with serum IgG4 and can be an alternative immunological marker beyond 1 year of SCIT treatment.

Clinical Response to Subcutaneous Dermatophagoides pteronyssinus Immunotherapy in Children with Allergic Rhinitis and Asthma Is Independent of Sensitization to Blomia tropicalis Allergens.

BACKGROUND: Dermatophagoides pteronyssinus (DP) and Blomia tropicalis (BT) are the dominant house dust mites inducing allergic diseases in tropical climates. It is not known whether the efficacy of DP subcutaneous immunotherapy (SCIT) is similar in patients sensitized to DP alone or to both DP and BT. METHOD: Ninety-five children (5-17 years old) affected by asthma with rhinitis and sensitized to both DP and BT received 3 years of DP-SCIT. Clinical symptom and medication scores, serum-specific IgE and IgG4 were evaluated during DP-SCIT. Patients were grouped based on DP and BT co-sensitization or cross-reactivity, according to positive or negative IgE to BT major allergen (BTMA). RESULTS: After 3 years of DP-SCIT, all patients had significant reductions in symptoms and medication use. In all, 65% of the patients were free of asthma symptoms and medication use; in addition, 3% was free of rhinitis symptoms. FEV1 in all patients were greater than 95% of predicted. DP-SCIT induced significant increases in DP- and BT-specific IgG4. In 50% of patients, DP-specific IgG4 increased more than 67-fold. BT-specific IgG4 increased more than 2.5 fold. A moderate correlation (r = 0.48-0.61, p < 0.01) was found between specific IgE against DP and BT in the BTMA- group (n = 34) before and after DP-SCIT, whereas no correlation was found in the BTMA+ group (n = 61). The 2 BTMA groups responded similarly with regard to clinical improvement and increase in specific IgG4 to both DP and BT. No safety finding of concern were reported in either group. CONCLUSION: DP-SCIT may be of clinical benefit to patients with IgE sensitizations to both DP and BT. DP-SCIT induces IgG4 that cross-react with BT allergens.

Debates in allergy medicine: specific immunotherapy efficiency in children with atopic dermatitis.

Allergen specific immunotherapy (AIT) has been the only pathogenetically relevant treatment of IgE-mediated allergic diseases (ADs) for many years. The use of AIT for atopic dermatitis (AD) treatment is dubious and has both followers and opponents. The improvement of subcutaneous AIT (SCIT) and introduction of Sublingual immunotherapy (SLIT) gives prospects of their application both for adults and children suffering from AD. This review presents results of scientific research, system and meta-analyses that confirm the clinical efficacy of AIT for children with AD who has the sensitization to allergens of house dust mite, grass and plant pollen suffering from co-occurring respiratory ADs and with moderate and severe course of allergic AD. There have been analyzed the most advanced achievements in AIT studies as well as there have been specified the unmet needs in AD. The preliminary diagnostics of IgE-mediated AD and pathophysiological disorders, including immune ones, will allow a doctor to develop appropriate comprehensive treatment algorithm for children's AD aimed at its correction. The including of AIT to the children's comprehensive therapy program is reasonable only if AD has the allergic form. It is necessary better to design the randomized research studies and to acquire extended clinical practice in children with AD. Use of the successes of molecular-based allergy diagnostics will help to optimize and personalize the process of selecting the necessary allergens to determine the most appropriate vaccines for children considering the results of the allergen component diagnostics. The strategy of treatment of children with AD in future will be based on individual target therapy.