Clinical evaluation of rush immunotherapy using house dust mite allergen in Japanese asthmatics

Abstract

Background Allergen immunotherapy (AIT) is a specific treatment of administering clinically important allergens to patients who have allergic diseases. In Japan, the standardized house dust mite (HDM) allergen for subcutaneous immunotherapy (SCIT) was approved in 2015, and we then introduced rush-immunotherapy (rush-IT) using the standardized HDM allergen for HDM-sensitive asthmatics. However, little data are available on the safety and effectiveness of rush-HDM-IT, especially for Japanese asthmatics. Objective The objective of this study was to examine the safety and clinical effectiveness of rush-IT using the standardized HDM for HDM-sensitive Japanese asthmatics. Methods Thirteen HDM-sensitive asthmatics who received rush-HDM-IT and 12 HDM-sensitive asthmatic controls were enrolled. To evaluate the safety, the number of systemic reaction (SR) events, including anaphylaxis, was assessed. To evaluate the effectiveness, changes in the treatment step, dose of inhaled corticosteroid, and asthma control after rush-HDM-IT and the subsequent maintenance SCIT were assessed. Changes in the HDM-induced production of type 2 cytokines from peripheral blood mononuclear cells were also evaluated. Results Among the 12 patients who received rush-IT, 4 (30.7%) experienced a SR and 3 (23.1%) experienced anaphylaxis. However, the anaphylaxis was not severe (grade 3) in all cases, and they recovered in a short time. The treatment step of asthma was better and the dose of inhaled corticosteroid was lower in the rush-HDM-IT group than in the control group. The HDM-induced production of both interleukin (IL)-5 and IL-13 from peripheral blood mononuclear cells was significantly lower in the rush-HDM-IT group than in the control group. Conclusion Rush-HDM-IT can be performed relatively safely in Japanese asthmatics. Furthermore, rush-HDM-IT and the subsequent maintenance SCIT provided clinical improvement in asthma patients, and was accompanied by the suppression of HDM-specific Th2-mediated systemic immune responses.

Allergen Immunotherapy in Asthma

“…AIT suppresses local numbers of Th2 cells or production of Th2 cytokines, such as IL-4 and IL-5 [35][36][37]. We confirmed that AIT suppresses allergen-induced production of IL-5 and IL-13 from PBMCs obtained from patients with HDM-sensitized-allergic asthma (Figure 1) [8]. AIT also inhibits the allergen-induced thymus and activation-regulated chemokine production from PBMCs in allergic asthma [1].…”

“…The addition of HDM-SCIT reduced the use of inhalational β2-agonists and increased peak flow in mild-to-moderate HDM-sensitized asthma. Recently we reported that adding HDM-SCIT, introduced using rush methods, to the guideline treatment decreased the ICS dose and improved the treatment step of bronchial asthma with the inhibition of HDM-induced interleukin (IL)-5 and IL-13 production from peripheral blood mononuclear cells (PBMCs) (Figure 1) [8]. In childhood asthma, adding HDM-SCIT also decreased the ICS dose and increased peak flow [9].…”

The early-phase transcriptome and the clinical efficacy analysis in three modes of subcutaneous immunotherapy for allergic rhinitis

“…Uchida et al found that the secretion of IL-5 and IL-13 in peripheral blood PBMC decreased after Rush-HDM-IT, which is consistent with our results that Th2 cytokines (IL-4, IL-6) decreased. 24 Most immunotherapy suppressed Th2-mediated systemic immune responses. 12 , 25 Our study showed no significant increase in Th1 cytokines (IFN-γ, TNF), even IL-2 decreased after SCIT in the 3 groups.…”

Immunologic changes after house dust mite modified rush subcutaneous immunotherapy in allergic rhinitis children

“…There is an increase in intracellular IFN-γ/IL-5 ratio of the CD3+ and CD4+ cells in children receiving rush dust mite AIT [ 13 ]. A recent study demonstrated the decreased the production of IL-5 and IL-13 from PBMCs of asthmatic adult recieving HDM AIT [ 14 ]. The unsignificant changes in the serum IFN-γ and IL-4 after rush HDM AIT in the current study may be explained by the difference in the method of detecting the cytokine.…”