Novas perspectivas em imunoterapia: a importância das células dendríticas na imunoterapia alérgeno-específica / New perspectives in immunotherapy: the importance of dendritic cells in allergen-specific immunotherapy

A imunoterapia alérgeno-específica é o único tratamento capaz de alterar o curso natural da doença alérgica. Ensaios clínicos mostram que a imunoterapia é segura e eficaz para muitos pacientes. No entanto, ainda enfrenta problemas relacionados à eficácia, segurança, longa duração do tratamento e baixa adesão dos pacientes. Neste contexto, tem havido intensa pesquisa no desenvolvimento de adjuvantes com objetivo de aumentar a segurança, otimizar os esquemas de tratamento e melhorar a adesão dos pacientes. Alérgenos foram modificados (glicoconjugados) com carboidratos derivados de Saccharomyces cerevisae para aumentar sua captação e apresentação através dos receptores de carboidratos presentes nas células dendríticas, beneficiando-se da capacidade de atuarem na indução de tolerância para iniciar respostas imunes. À luz de novas evidências, essas células constituem alvo terapêutico chave para se obter uma resposta adequada à imunoterapia alérgeno-específica, com potencial de contribuição na inovação do campo da Imunoterapia.

Allergen-specific immunotherapy is the only treatment capable of altering the natural course of allergic disease. Clinical trials have shown that immunotherapy is safe and effective for many patients. However, it still faces problems related to efficacy, safety, long treatment duration and poor patient compliance. In this context, there has been intense research into the development of adjuvant treatments that increase safety, optimize treatment regimens, and improve patient compliance. Allergens were modified (glycoconjugated) with carbohydrates derived from Saccharomyces cerevisae to increase their uptake and presentation through carbohydrate receptors in dendritic cells, benefiting from their ability to induce tolerance and initiate immune response. In light of the new evidence, these cells are a key therapeutic target for adequate response to allergenspecific immunotherapy and can drive innovation in the field of immunotherapy.

Progress of peanut allergy in children / 国际儿科学杂志

Epidemiology suggests an increasing incidence of peanut allergy and is usually associated with severe allergic reactions.A variety of inflammatory mechanisms are involved in peanut allergy.The specific diagnosis of peanut allergy is particularly difficult due to the co-sensitization between peanut and other components, but the use of component-resolved diagnostic can greatly improve the diagnostic level, especially the distinction between primary and secondary peanut allergy.Basophil activation tests are also thought to be helpful in diagnosis.In terms of treatment, instead of avoiding all nuts, specific immunotherapy and the introduction of peanuts early in life have been proposed.This paper reviews the latest research progress on peanut allergy in children.

Effect of sublingual immunotherapy with Dermatophagoides Farinae on the expression of specific IgG4 in patients with allergic rhinitis in Hainan area / 临床耳鼻咽喉头颈外科杂志

The aim of this study is to investigate the effect of sublingual immunotherapy with Dermatophagoides Farinae on the expression of specific IgG4（sIgG4） in patients with allergic rhinitis （AR） in Hainan area. Seventy-two patients with dust-mite allergic rhinitis, all three generations of whom were local islanders in Hainan, were randomly divided into control group（36 cases） and SLIT group（36 cases）. sIgG4 and sIgE expression levels were detected before treatment, 6 months after treatment, 12 months after treatment, and 18 months after treatment. The patient's symptom score, medication score, VAS score and adverse reactions was also assessed. Finally, through statistical analysis of the relevant data collected at 4 time points in the two groups of patients, the efficacy, safety and changes of sIgG4 antibody expression level in patients with allergic rhinitis receiving sublingual specific immunotherapy in Hainan were observed. Symptoms scores, medication scores and VAS scores were significantly improved in the SLIT group after treatment compared with before treatment（0.05）. In the control group, symptom scores, medication scores and VAS scores were also significantly improved compared with before treatment（0.05）. When comparing the two groups, Symptoms scores, medication scores and VAS scores of the SLIT group were significantly lower than those of the control group at 12 months and 18 months after treatment（0.05）. No severe systemic adverse reactions occurred in the two groups, and 3 patients showed mild adverse reactions in the SLIT group. Sublingual immunotherapy of Dermatophagoides Farinae was effective and could increase the expression of sIgG4 in patients with Dermatophagoides farinae AR, sIgG4 is expected to be an immunological marker for the objective evaluation of the clinical efficacy of Hapten.

Effect of sublingual immunotherapy with Dermatophagoides Farinae on the expression of specific IgG4 in patients with allergic rhinitis in Hainan area / 临床耳鼻咽喉头颈外科杂志

Objective@#The aim of this study is to investigate the effect of sublingual immunotherapy with Dermatophagoides Farinae on the expression of specific IgG4（sIgG4） in patients with allergic rhinitis （AR） in Hainan area.@*Method@#Seventy-two patients with dust-mite allergic rhinitis, all three generations of whom were local islanders in Hainan, were randomly divided into control group（36 cases） and SLIT group（36 cases）. sIgG4 and sIgE expression levels were detected before treatment, 6 months after treatment, 12 months after treatment, and 18 months after treatment. The patient's symptom score, medication score, VAS score and adverse reactions was also assessed. Finally, through statistical analysis of the relevant data collected at 4 time points in the two groups of patients, the efficacy, safety and changes of sIgG4 antibody expression level in patients with allergic rhinitis receiving sublingual specific immunotherapy in Hainan were observed. @*Result@#Symptoms scores, medication scores and VAS scores were significantly improved in the SLIT group after treatment compared with before treatment（P<0.05）, and serum sIgG4 increased significantly（P<0.01）, serum sIgE showed no significant change（P>0.05）. In the control group, symptom scores, medication scores and VAS scores were also significantly improved compared with before treatment（P<0.05）, while serum sIgG4 and sIgE showed no significant change（P>0.05）. When comparing the two groups, Symptoms scores, medication scores and VAS scores of the SLIT group were significantly lower than those of the control group at 12 months and 18 months after treatment（P<0.05）. sIgG4 expression levels in the SLIT group were significantly higher than those in the control group after 6, 12 and 18 months of treatment（P<0.01）. There was no significant difference in sIgE expression level between the two groups（P>0.05）. No severe systemic adverse reactions occurred in the two groups, and 3 patients showed mild adverse reactions in the SLIT group. @*Conclusion@#Sublingual immunotherapy of Dermatophagoides Farinae was effective and could increase the expression of sIgG4 in patients with Dermatophagoides farinae AR, sIgG4 is expected to be an immunological marker for the objective evaluation of the clinical efficacy of Hapten.

Progress in sensitized protein components and subcutaneous specific immunotherapy for dust mites / 国际儿科学杂志

Dust mites are one of the most common inhalant allergens in the world.The prevalence of dust mite allergy is on the rise in the worldwide,it is a chronic worldwide health problem that seriously affects the work,study and daily life of patients.This review demonstrates the allergic diseases caused by dust mite,the sensitized protein components of the dust mite and the research progress of allergen-specific immunotherapy,and the application of anti-IgE monoclonal antibodies to IgE-mediated allergic reactions is also briefly described.

Factors Associated with Adherence to Allergen Specific Subcutaneous Immunotherapy

PURPOSE: Allergen-specific immunotherapy (AIT) is known to be the only therapeutic modality to alter the natural course of allergic diseases. However, at least 3 years of treatment is recommended for achieving long-term disease modifying effect. This study aimed to investigate factors associated with immunotherapy non-adherence in real practice. MATERIALS AND METHODS: We retrospectively reviewed medical records of patients who were diagnosed with allergic rhinitis, asthma, or atopic dermatitis, and received AIT to common allergens such as house dust mite and/or pollens from January 2007 to August 2014. In this study, non-adherence was defined as not completing 3 years of AIT. RESULTS: Among 1162 patients enrolled, 228 (19.6%) failed to complete 3 years of AIT. In multivariate analysis, age less than 20 years [odds ratio (OR) 3.11, 95% confidence interval (CI) 1.70–5.69] and 20 to 40 years (OR 2.01, 95% CI 1.17–3.43), cluster build-up (OR 1.78, 95% CI 1.05–3.02) and ultra-rush build-up schedules (OR 5.46, 95% CI 2.40–12.43), and absence of visit to other departments in the same hospital (OR 1.87, 95% CI 1.05–3.32) were independently associated with immunotherapy non-adherence. Disease duration of 5–10 years was negatively associated with non-adherence compared to shorter disease duration of less than 5 years (OR 0.61, 95% CI 0.40–0.94). Although male sex and commercial product of AIT, Tyrosine S®, compared to Novo-Helisen® were non-adherent factors in univariate analysis, no statistical significances were identified in multivariate analysis. CONCLUSION: Various factors are associated with immunotherapy adherence affecting the utility of immunotherapy. Clinicians should be aware of factors associated with adherence to maximize the utility of allergen-specific subcutaneous immunotherapy.

Analysis of the efficacy and compliance of conventional immunotherapy and rush immunotherapy in patients with allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

To analyze the efficacy and compliance of conventional immunotherapy(CIT)and rush immunotherapy(RIT)in patients with allergic rhinitis.This trial was a prospective study involved 404 patients with persistent AR who were allergic to house dust mite.328 patients were assigned to the conventional immunotherapy reaching the maintenance dose within 14 weeks,and 76 patients were assigned to the rush immunotherapy reaching the maintenance dose within 1 week.The visual analog scale(VAS)score and the patients' compliance were recorded during treatment and follow-up.After CIT and RIT,the VAS score were significantly reduced in each group,but the decrement of VAS score of RIT group was more evident than that of CIT in half ayear(<0.05).After 5 years follow-up,the VAS score of two groups was also significantly reduced.The rate of treatment continuation of CIT group in 1 year,2 years and 3 years were 18.5%,39.0% and 57.3%,higher than RIT group(11.8%,26.3%,42.1%),respectively.Both CIT and RIT were beneficial for allergic rhinitis patients,and the clinical efficacy lasts for at least 5 years.But RIT has the superiority of faster onset and better compliance.

Clinical analysis of non-specific immunotherapy in patients with hepatocellular carcinoma after radiofrequency ablation / 国际肿瘤学杂志

Objective To study the curative efficacy of non-specific immunotherapy in patients with hepatocellular carcinoma after radiofrequency ablation.Methods The clinical data of 120 patients with hepatocellular carcinoma in our hospital from December 2012 to December 2014 were retrospectively analyzed.According to the different methods of treatment after the operation,they were divided into the observation group (n =60) and the control group (n =60).All the patients underwent elective operation of radiofrequency ablation,and the control group was treated with routine treatment after operation,while the observation group was treated with non-specific immunotherapy (recombinant human interleukin-2 injection + thymalfasin + disodium cantharidinate and vitamin B6 injection).After 3 weeks of treatment,the changes of cellular immune function,humoral immune function and quality of life were compared between the two groups before and after treatment,and the clinical efficacy and 1-,2-and 3-year survival rates were compared.Results After treatment,in the cellular immune function,the CD3+ [(62.31 ± 9.65)％ vs.(57.08 ± 8.03)％],CD8+ [(26.85 ± 3.22) ％ vs.(33.41 ± 3.86) ％],CD4 +/CD8 + (1.95 ± 0.34 vs.1.53 ± 0.27) and natural killer cells [(25.76 ± 4.53) ％ vs.(21.14 ± 4.20) ％] of the observation group were better than those of the control group,and the differences were statistically significant (t =3.227,P ＜ 0.001;t =10.109,P ＜ 0.001;t =7.493,P ＜ 0.001;t =5.793,P ＜ 0.001).In the humoral immune function,the IgG [(19.45 ± 2.45) g/L vs.(15.93±2.07) g/L],IgM [(2.15±0.42) g/Lvs.(1.83±0.31) g/L],IgA [(3.08±0.79) g/Lvs.(2.73 ±0.56) g/L] of the observation group were better than those of the control group,and the differences were statistically significant (t =8.501,P ＜0.001;t =4.748,P ＜0.001;t =2.800,P ＜0.001).In the quality of life scale,the social function score (59.73 ± 4.62 vs.53.91 ± 3.84),physical function score (55.83 ±5.62 vs.47.85 ±5.17),role function score (51.64 ±5.83 vs.46.82 ±5.46),cognitive function score (64.82 ±5.19 vs.58.04 ±4.92) and emotional function score (68.94 ±5.62 vs.60.38 ±5.10) of the observation group were significantly higher than those of the control group,and the differences were statistically significant (t =7.504,P＜0.001;t =8.095,P＜0.001;t =4.674,P＜0.001;t =7.344,P＜0.001;t=8.737,P ＜ 0.001).The clinical efficacy of the observation group was significantly higher than that of the control group (81.67％ vs.65.00％),and the difference was statistically significant (x2 =4.261,P =0.039).The 1-year survival rate (91.67％ vs.78.33％),2-year survival rate (85.00％ vs.68.33％) and 3-year survival rate (75.00％ vs.53.33％) of the observation group were significantly higher than those of the control group,and the difference was statistically significant (x2 =4.781,P =0.029).Conclusion Non-specific immunotherapy for patients with hepatocellular carcinoma after radiofrequency ablation can effectively improve immune function,and it is helpful to improve clinical efficacy and quality of life.

Latest research topics on allergic asthma / 中国免疫学杂志

The prevalence of allergic asthma has been growing steadily worldwide including China.Complex genetic and envi-ronmental factors have been assumed to contribute to disease pathogenesis.Key players in the barrier system such as airway epithelia secret allergic mediators in response to allergen stimulation.The micro-environment composed of innate immune cells,e.g.,innate lymphoid cells,and various immune effector molecules is critical in regulating the production of cytokines/chemokines,which further impacts the cells in adaptive immunity.The revelation of the neuron-ILC2 axis confirms the importance of the cross-talk between the nervous system and local immune responses on the regulation of tissue homeostasis.Furthermore,accumulating data implicate the involvement of the epigenetics and microbiota in allergic diseases.The concept of endotype has improved personalized medicine that aims to select the most suitable patient for a therapy according to the patient-specific patterns of disease pathology.There is also a demand for more precise biomarkers that can identify the appropriate treatment recipient.Lastly,the validity of experimental animal models of allergic asthma may need to be re-evaluated.This review summarizes recent progress addressing these issues in our understanding of allergic pathology.

Attaching importance to diagnosis and treatment of allergic conjunctivitis / 中华实验眼科杂志

Allergic conjunctivitis is one of the most common eye diseases,and its incidence is ever increasing every year.The disease has unbearable ocular symptoms and repeated attacks,which seriously affect the daily life and work of patients.Ophthalmologist has not paid enough attention for the diagnosis and treatment of allergic conjunctivitis.Ophthalmologists can give appropriate laboratory examinations in combination with the medical history and signs of patients with allergic conjunctivitis,so that patients can be fully and clearly diagnosed.While giving appropriate drug treatment,the patients can get appropriate desensitization treatment by defining allergens.Ophthalmologists should take full care of the allergic conjunctivitis,especially for allergen testing and allergen-specific immunotherapy,in their practices.

A Retrospective Study of Clinical Response Predictors in Subcutaneous Allergen Immunotherapy With House Dust Mites for Allergic Rhinitis

PURPOSE: House dust mites (HDM) are major allergens that cause allergic rhinitis (AR). Allergen-specific subcutaneous immunotherapy (SCIT) has been shown to be clinically beneficial in many clinical trials. Such trials, however, are not reflective of all patient populations. The aim of this study was to describe the efficacy and safety of SCIT in routine clinical practice in Korean adults with AR sensitized to HDM. METHODS: We reviewed medical records of 304 patients with AR treated at an allergy clinic of a tertiary hospital using SCIT with aluminum hydroxide-adsorbed allergen extract targeting HDM alone or with pollens for at least 1 year from 2000 to 2012. Patients with asthma were excluded. Rates of remission, defined as no further requirement of maintenance medication, over time were determined by means of life tables and extension of survival analysis. Specific immunoglobulin E (IgE) levels to HDM were categorized into 6 classes. RESULTS: The mean time until achieving remission was 4.9±0.1 years, and the cumulative incidence of remission from AR was 76.6%. Severe AR (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.23-0.69; P=0.001), specific IgE levels to HDM ≥17.5 kU/L (OR, 1.85; 95% CI, 1.01-3.37; P=0.045), and duration of immunotherapy ≥3 years (OR, 7.37; 95% CI, 3.50-15.51; P<0.001) were identified as significant predictors of clinical remission during SCIT for patients with AR sensitized to HDM. Overall, 73 patients (24.0%) experienced adverse reactions to SCIT, and only 1 case of anaphylaxis (0.3%) developed. CONCLUSIONS: SCIT with HDM was found to be effective and safe for patients with AR. Specific IgE levels to HDM and a duration of SCIT ≥3 years may be predictors of clinical responses to SCIT in AR patients.

The International Study of the Allergic Rhinitis Survey: outcomes from 4 geographical regions

BACKGROUND: Allergic rhinitis (AR) is a global health problem and is characterised by one or more symptoms, including sneezing, itching, nasal congestion and rhinorrhea. OBJECTIVE: We investigated the features of AR and the physician's approach to the management of AR patients in four geographical regions. METHODS: In this cross-sectional study, a questionnaire survey concerning AR was completed by Honorary and Corresponding Members of the Italian Society of Rhinology from different countries among 4 world geographical regions—Asia, Europe, the Americas, and Africa. RESULTS: The prevalence of AR was reported to be 15%–25%. Children and adolescents, as well as young adults, were the age groups more affected by AR with comorbidities of asthma, sinusitis, conjunctivitis, and nasal polyposis. Nasal symptoms of AR were more intense in the spring (51.92%) and autumn (28.85%). The most common aero-allergens were pollen and mites (67.31%), animal dander and pollutants (23.08%), and fungal allergens (21.15%). Allergen-specific immunotherapy was prescribed for both perennial and seasonal allergens (32.69%) via sublingual swallow (46.15%) and subcutaneous (32.69%) routes. For the AR patients, the most prescribed drugs were intranasal corticosteroids (86.54%) and oral H₁-antihistamines (82.69%). CONCLUSION: A network of experts can improve our knowledge concerning AR epidemiology, and together with guidelines, could assist practitioners and otolaryngologists in standardising the diagnosis and treatment of AR.

Effects of allergen-specific immunotherapy on FEV1 and airway responsiveness in patients with idiopathic asthma / 中国生化药物杂志

Objective To investigate the effect of allergen-specific immunotherapy on FEV1 and airway responsiveness in patients with idiopathic asthma.Methods 90 patients with idiopathic asthma from January 2013 to August 2015 in Deqing City People's Hospital were selected and randomly divided into control group and study group with 45 cases in each group.Control group were treated with anti-infection, relieving cough and eliminating phlegm, relieving spasm and relieving asthma, the study group was treated with allergen specific immunotherapy based on the control group, and a total of 3 months for a course of treatment.Blood samples were used to measure inflammatory mediators , airway sensitivity index, pulmonary function and airway responsiveness, at the same time, the clinical efficacy and complications were compared.Results Compared with before treatment, the levels of FVC, PEF, FEV1 and FEV1/FVC in the two groups increased, levels of AI, AO, T and WA decreased, levels of serum IL-4 decreased, levels of IL-10, IFN-γincreased, levels of serum IgE, SIgE, TIgE and EOS decreased, the difference was statistically significant (P<0.05), compared with the control group, the levels of FVC, PEF, FEV1 and FEV1/FVC in the study group were higher, the levels of AI, AO, T and WA were lower, serum IL-4 levels were lower after treatment, levesls of IL-10, IFN-γwere higher, levels of serum IgE, SIgE, TIgE and EOS were lower, the difference was statistically significant (P<0.05), and the effective rate in the control group (71.11%) was lower than the study group (88.89%), the difference was statistically significant(P <0.05).Conclusion Allergen-specific immunotherapy was effective for cough variant asthma, it can improve pulmonary function, inflammation and airway sensitivity.

Application of allergen specific immunotherapy in children with allergic diseases / 国际儿科学杂志

Allergen specific immunotherapy(AIT) is a desensitization treatment for IgE-mediated allergic diseases.Combined with pharmacological therapy,AIT is used to treat allergic asthma,allergic rhinitis and atopic dermatitis caused by allergens that cannot be avoided.AIT is the only treatment modality that can alter the natural course of allergic disease.However,because of the lack of studies,there still exists controversy about the application of immunotherapy in children with allergic diseases.The mechanism ofAIT,its clinical efficacy and safety in children with allergic diseases are reviewed.

A Pilot Study of Intralymphatic Immunotherapy for House Dust Mite, Cat, and Dog Allergies

Several recent clinical trials reported that intralymphatic immunotherapy (ILIT) for some allergens, such as cat dander and pollen, induce tolerance more rapidly than conventional subcutaneous or sublingual immunotherapy, have a comparable duration of effect after only 3 injections, and do not provoke serious local or systemic reactions. However, the efficacy and safety of ILIT are using Dermatophagoides farinae (Df), Dermatophagoides pteronyssinus (Dp), and dog, which are indoor allergens that are commonly found globally, need to be evaluated. Furthermore, use of multiple allergens in ILIT should be investigated. We assessed the clinical efficacy and adverse effects of ILIT using aqueous Df, Dp, dog, and cat allergens or mixtures thereof in patients with allergic rhinitis. A total of 11 subjects with AR sensitized to Df, Dp, cat, and/or dog allergens received 3 intralymphatic inguinal injections of sensitized allergen extract (HollisterStier, New Orleans, LA, USA). Clinical parameters were assessed before ILIT, and 4 months and 1 year after the first injection. Rhinitis symptoms were alleviated and quality of life was improved 4 months after ILIT (P=0.012 and P=0.007, respectively), and these improvements lasted for 1 year after ILIT (P=0.047 and P=0.009, respectively). However, we observed 2 cases of anaphylaxis, one case of a moderate-to-severe systemic hypersensitivity reaction and the other case of a severe local reaction at the injection site after ILIT. In conclusion, ILIT can rapidly improve allergy symptoms and quality of life, and this effect lasts for 1 year. In hypersensitized patients, however, ILIT can provoke severe systemic and/or local hypersensitivity reactions when performed using aqueous allergen extracts.

Subcutaneous Immunotherapy for Allergic Asthma in a Single Center of Korea: Efficacy, Safety, and Clinical Response Predictors

Allergen-specific immunotherapy is the only causal treatment for allergic diseases. However, the efficacy of immunotherapy may vary around the world due to differences in climate, the nature of aero-allergens and their distribution. The aim of this study was to describe the effects of subcutaneous immunotherapy (SCIT) in Korean adults with allergic asthma (AA). As a retrospective cohort study, we reviewed medical records for 627 patients with AA in Korea who were sensitized to house dust mite (HDM) and/or pollens and who underwent SCIT with aluminum hydroxide adsorbed allergen extract from 2000 to 2012. Rates of remission, defined as no further requirement of maintenance medication, over time were determined by means of life tables and extension of survival analysis. Herein, 627 asthmatic patients achieved remission within a mean of 4.7 ± 0.2 years. The cumulative incidence rates of remission from AA were 86.9% upon treatment with SCIT. Baseline forced expiratory volume in the first second (FEV1) ≥ 80% (hazard ratio [HR], 3.10; 95% confidence interval [CI], 1.79–5.39; P < 0.001), and maintenance of immunotherapy for more than 3 years (HR, 1.82; 95% CI, 1.21–2.72; P = 0.004) were significant predictors of asthma remission during SCIT. In 284 patients on SCIT with HDM alone, initial specific immunoglobulin E (IgE) levels to Dermatophagoides pteronyssinus and Dermatophagoides farinae did not show significant difference between remission and non-remission group after adjusting demographic variables. In conclusion, SCIT was effective and safe treatment modality for patients with AA. Initial FEV1 ≥ 80% and immunotherapy more than 3 years were found to be associated with favorable clinical responses to SCIT.

Retrospective Analysis on the Effects of House Dust Mite Specific Immunotherapy for More Than 3 Years in Atopic Dermatitis

PURPOSE: In extrinsic atopic dermatitis (AD), house dust mites (HDM) play a role in eliciting or aggravating allergic lesions. The nature of skin inflammation in AD has raised a growing interest in allergen-specific immunotherapy (SIT). Thus, we assessed clinical improvement and laboratory parameters for evaluation of the benefit of long-term SIT. MATERIALS AND METHODS: A total of 217 AD patients who were treated with SIT for at least 3 years were retrospectively assessed, by using their investigator global assessment, pruritus scores, loss of sleep (LOS), total serum IgE, and eosinophil counts collected. Patients were additionally classified into subgroups according to age, initial AD severity and mono- or multi-sensitization to include different individual factors in the evaluation of SIT efficacy. Lastly, we compared laboratory data of good responders to SIT with that of poor responders to SIT. RESULTS: Improvement after SIT therapy was observed in 192 out of 217 patients (88.4%). Among these patients, 138 (63.5%) achieved excellent, near-complete or complete clinical remission. Significant reduction of pruritus, LOS, and the mean value of total serum IgE were observed (p0.05). CONCLUSION: We emphasize the usefulness of long-term HDM SIT as a disease-modifying therapy for AD.

Efficacy of dermatophagoides farinae drops in treatment of children with allergic rhinitis and its influence on serum IL-4 and IL-35 levels / 重庆医学

Objective To explore the efficacy of dermatophagoides farinae drops for treating allergic rhinitis in children and its influence on serum IL‐4 and IL‐35 levels .Methods A total of 80 children with mite sensitized allergic rhinitis in the Central Hospital of Nanyang city from January 2012 to October 2013 were selected as the research subjects and randomly divided into the control group and the observation group according to random number table method ,40 cases in each group .The control group was given the symptomatic treatment ,while the observation group was given sublingual dermatophagoides farinae drops .The treatment lasted for 18 months .The efficacy ,symptom score and eosinophil count value (Eos) were observed .ELISA was used to detect ser‐um IL‐4 ,IL‐35 levels .Results The total effective rate after treatment in the observation group was 97 .50% ,which was higher than 92 .50% in the control group ,but without statistically significant difference between them(χ2 =1 .052 6 ,P=0 .305) .After treat‐ment ,the symptom scores ,medication scores and Eos count had statistical differences in the two groups were significantly lower than before(P<0 .05) ,but which had statistical differences between the two groups after treatment(P<0 .05);serum IL‐4 level af‐ter treatment in the two groups were significantly lower than before(P<0 .05) ,while the IL‐35 level was significantly higher than before(P<0 .05) ,the serum IL‐4 and IL‐35 levels after treatment had statistically significant differences between the two groups (P<0 .05) .The incidence rate of adverse reactions showed no statistically significant difference between the two groups (χ2 =0 .213 3 ,P=0 .644) .Conclusion Sublingual specific immunotherapy of dermatophagoides farinae drops can effectively improve the symptoms of mite sensitized allergic rhinitis in children ,reduces proinflammatory cytokine IL‐4 level and increases suppressing in‐flammatory cytokine IL‐35 level .

Specific Immunotherapy in Atopic Dermatitis

Allergen specific immunotherapy (SIT) using house dust mite (HDM) extracts has been performed mainly with patients of asthma and allergic rhinitis. In the meanwhile, there has been a long debate on the efficacy of SIT in atopic dermatitis (AD) with only a few double-blind placebo-controlled trials. However, several randomized controlled trials of SIT in AD revealed significant improvement of clinical symptoms and also, positive result was shown by a following meta-analysis study of these trials. In order to predict and evaluate the treatment outcome, finding a biomarker that can predict treatment responses and treatment end-points is critical but it is very challenging at the same time due to the complexity of causes and mechanisms of AD. Other considerations including standardization of the easiest and safest treatment protocol and optimizing the treatment preparations should be studied as well. This review summarizes the basics of SIT in AD including the brief mechanisms, treatment methods and schedules, and also highlights the clinical efficacy of SIT in AD along with mild, controllable adverse reactions. Immunologic effects and studies of various biomarkers are also introduced and finally, future considerations with upcoming studies on SIT were discussed.

IgE-Binding Epitope Mapping and Tissue Localization of the Major American Cockroach Allergen Per a 2

PURPOSE: Cockroaches are the second leading allergen in Taiwan. Sensitization to Per a 2, the major American cockroach allergen, correlates with clinical severity among patients with airway allergy, but there is limited information on IgE epitopes and tissue localization of Per a 2. This study aimed to identify Per a 2 linear IgE-binding epitopes and its distribution in the body of a cockroach. METHODS: The cDNA of Per a 2 was used as a template and combined with oligonucleotide primers specific to the target areas with appropriate restriction enzyme sites. Eleven overlapping fragments of Per a 2 covering the whole allergen molecule, except 20 residues of signal peptide, were generated by PCR. Mature Per a 2 and overlapping deletion mutants were affinity-purified and assayed for IgE reactivity by immunoblotting. Three synthetic peptides comprising the B cell epitopes were evaluated by direct binding ELISA. Rabbit anti-Per a 2 antibody was used for immunohistochemistry. RESULTS: Human linear IgE-binding epitopes of Per a 2 were located at the amino acid sequences 57-86, 200-211, and 299-309. There was positive IgE binding to 10 tested Per a 2-allergic sera in 3 synthetic peptides, but none in the controls. Immunostaining revealed that Per a 2 was localized partly in the mouth and midgut of the cockroach, with the most intense staining observed in the hindgut, suggesting that the Per a 2 allergen might be excreted through the feces. CONCLUSIONS: Information on the IgE-binding epitope of Per a 2 may be used for designing more specific diagnostic and therapeutic approaches to cockroach allergy.