Three‐year follow‐up of clinical and inflammation parameters in children monosensitized to mites undergoing sub‐lingual immunotherapy

Abstract

Parallel follow-up of clinical and inflammatory markers during sub-lingual immunotherapy (SLIT) is highly beneficial. Twenty-four children (age 4-16) monosensitized to house dust mite were randomized to receive either active or placebo SLIT for 1 yr in a double-blind placebo controlled design (Marcucci et al., Allergy 2003: 58: 657-62). Thereafter, for 2 yr they all received active treatment. Symptom scores for rhinitis, asthma, and drug usage were daily recorded. Eosinophil cationic protein (ECP) and tryptase in sputum and nasal secretions, serum and nasal mite-specific immunoglobulin E (IgE) were recorded before treatment and at 10-12 months intervals. Nasal ECP and nasal tryptase after specific nasal provocation tests were significantly reduced as compared to baseline values (p = 0.0043 and 0.0195, respectively) in the third year of active treatment. None of the other inflammatory parameters was increased. In placebo treated patients all these parameters tended to decrease only after switching to active treatment. Clinical scores did not improve in treated vs. placebo patients in the double-blind placebo-controlled phase of the study. In both cohorts a clinical benefit was observed as intra-group score reduction as compared to baseline. A significant difference was reached in patients treated for 2 yr for rhinitis and asthma (p = 0.0009 and 0.0019, respectively) but not for drug usage and in patients treated for 3 yr for rhinitis, asthma, and drug usage (p = 0.0105, 0.0048, and 0.02, respectively). SLIT in children monosensitized to mites reverted the spontaneous increase in nasal IgE and in local parameters of allergic inflammation. These outcomes were followed by a consolidated clinical improvement in the second and third year of treatment.

Mite immunotherapy

“…However, more recently, several studies have also shown efficacy using SLIT in pediatric and adult patients with asthma and/or rhinitis [26][27][28][29][30]. SLIT has been shown to reduce nasal symptoms and drug consumption in several of these studies.…”

Release of Mast Cell Tryptase into Saliva: A Tool to Diagnose Food Allergy by a Mucosal Challenge Test?

“…After a local allergen challenge, a significant increase in MCT was demonstrable in tear fluid only after 20 min [9,13] , and in nasal secretions only after 30 min [7] . Although MCT has a half-life of several hours, it is measurable only during a short period of time because saliva is swallowed and because tears and nasal secretions are removed quickly.…”

“…After a local allergen challenge, MCT concentrations also rise in nasal secretions [6][7][8] , tears [9] , bronchoalveolar lavage fluid [10] , and sputum [7] .…”

Specific Immunotherapy in Children: The Evidence

“…SCIT seems to be associated with a decrease in IL-4 and IL-5 production by CD4+ Th2 cells, and a shift towards increased IFN-gamma production by Thl cells (24,25). Few data concerning the immunologic changes induced by SLIT (40) are known and these studies have shown a relevant effect on the IgG4 response thus it could seem that SLIT does not consistently reduce the IgE production and increase the IgG4 synthesis (41,42). On the contrary, a decrease of serum IL-13 and of T-cell proliferative response (43) was demonstrated after SLIT therapy (44).…”