A Three-year Follow-up of D.f- and D.p-Specific Conventional Immunotherapy in Asthmatic Children / 소아알레르기및호흡기학회지

PURPOSE: Immunotherapy (IT) with Dermatophagoides farinae (D.f) or Dermatophagoides pteronyssinus (D.p) has proven to be clinically effective treatment for patients with asthma, but the mechanism and prognostic index of IT are not completely understood. We evaluated the long-term effect of conventional IT with D.f or D.p, and also investigated whether IT could prevent new sensitizations to other new allergens. METHODS: The patient group included 23 asthmatic patients with D.f- and D.p-sensitivities who visited Asan Medical Center and were treated with conventional IT (Allergopharma, Germany). The control group contained 27 asthmatic patients with D.f- and D.p-sensitivities who were not treated with IT. We compared skin test reactivity, total IgE, specific IgE, total eosinophil counts, eosinophils fraction and bronchial hyperreactivity before and three years after IT. RESULTS: The skin test reactivity to D.p and total eosinophil counts were decreased significantly three years after IT. But total IgE, D.f- and D.p-specific IgE, and eosinophils fraction were not changed three years after IT. The bronchial hyperreactivity by methacholine was decreased in both groups after three years. In addition, development of sensitization to new allergens happened in 13.0 percent of the IT group and 22.2 percent of the control group, but did not reach statistical significance. CONCLUSION: The conventional IT with D.f and D.p could change the allergic responsiveness of the target organs, such as skin, but it could not prevent the development of new sensitizations in asthmatic children.

Influence of conventional house-dust-mite immunotherapy on histamine releasability from the basophil / 천식및알레르기

BACKGROUND: Allergen-specific immunotherapy has been shown to be clinically effective in the treatment of patients with atopic asthma, but the mechanisms are still unclear. Some of the immunologic changes include increase of an allergen-specific IgG antibody, decrease of allergen-specific IgE after transient increase, allergen-specific T-cell shift in cytokine expression from Th2 to Th1 cytokines, and decrease of basophil histamine releasability. OBJECTIVE: To investigate the influence of immunotherapy on basophil releasability, we examined the changes of IgE-mediated and non-IgE-mediated basophil histamine releasability during immunotherapy. METHODS: Fourteen Dermatophagoides farinae (D.f) sensitive asthmatic children with conventional immunotherapy were investigated. Basophil histamine releasability was measured prior to immunotherapy and 4 and 9 months after immunotherapy. Basophils were stimulated with D.f and goat antihuman IgE antibody as IgE-mediated stimuli which act on IgE-receptor, and formyl-Met-Leu-Phe (fMLP) as non-IgE-mediated stimuli which acts on non-IgE receptor, and calcium ionophore A23187 as non-IgE-mediated stimuli which does not act on cell surface receptors. Histamine was measured by automated fluorometric technique. RESULTS: Before immunotherapy, there were significant correlations between histamine release by D.f and histamine release by fMLP, and between histamine release by D.f and histamine release by anti-IgE antibody, but no correlation between histamine release by D.f and histamine release by calcium ionophore. Histamine release by D.f and by anti-IgE antibody decreased at and 9 months after immunotherapy compared to those before immunotherapy. Histamine release by fMLP and by calcium ionophore showed no significant changes after immunotherapy. There was no significant change of total histamine release after immunotherapy. CONCLUSION: Conventional immunotherapy has influenced only the IgE-mediated basophil releasability. IgE-mediated and non-IgE-receptor-mediated basophil releasability was correlated before immunotherapy, but only IgE-receptor-mediated basophil releasability decreased after immunotherapy. These findings suggest that a kind of physicochemical change may happen on the IgE receptors of basophil, which may induce decrease of IgE-mediated basophil histamine releasability after immunotherpy.

Inmunoterapia en el tratamiento de la conjuntivitis alérgica crónica / Inmunotherapy in the treatment of chronic allergic conjuntivitis

Con el objeto de evaluar la respuesta a dos esquemas de Inmunoterapia alergénica para el tratamiento de la conjuntivitis alérgica crónica (CAC) en Individuos sensibles a Dermatophagoides farinae (ácaro del polvo) y refractarios a los tratamientos convencionales, se realizó un ensayo clínico controlado y ciego en el Hospital Universitario San Vicente de Paúl de Medellín, Colombia, entre agosto de 1990 y junio de 1993. Se estudiaron 18 hombres (82 por ciento) y 4 (18 por ciento) mujeres con edades entre los 5 y 25 anos pero en su mayoría menores de 11 años (63.6 por ciento); la evolución de su enfermedad era mayor de 5 meses. Se excluyeron los pacientes que habían recibido previamente algún esquema de Inmunoterapia o que eran sensibles a otros aeroalergenos. En 14 pacientes (63.6 por ciento) se administró el esquema agrupado (tipo cluster) y en ocho (36.4 por ciento) el convencional. No se encontraron diferencias estadísticamente significativas entre las dos modalidades; en 16 pacientes (72.7 por ciento) hubo mejoría subjetiva parcial, demostrada por el interrogatorio, y en 15 (68.2 por ciento) mejoría objetiva parcial evidenciada por el examen oftalmológico. En tres pacientes de tratamiento agrupado no se obtuvo mejoría. Los síntomas que más disminuyeron al finalizar el seguimiento fueron el prurito en 16 casos (72.7 por ciento) y el lagrimeo (15 casos; 68.2 por ciento); sólo en 4 de los 11 pacientes (36.4 por ciento) que al Inicio del estudio tenían papilas se observó la desaparición de éstas, a pesar de una buena respuesta clínica. Se concluyó que la inmunoterapia es útil en el manejo de la CAC refractaria a tratamientos convencionales y no se encontraron diferencias significativas entre los dos esquemas utilizados

Between August 1990 and June 1993, a blind clinic assay was carried out at Hospital Universitario San Vicente de Paúl, in Mede1lín, Colombia, with the purpose of evaluating the response to two Immunotherapy schemes (cluster and conventional), for treatment of Chronic Allergic Conjunctivitis (CAC) refractory to conventional pharmacological treatments. In patients sensitized to Dermatophagoides farinae. The study was performed on 22 patients aged 5-25 years. The evolution of the disease had been 6 months or longer. Patients who had previously received an Im. munotherapy scheme or showed sensitivity to other aeroallergens were excluded. Fourteen patients (63.6%) received the cluster scheme and eight (36.4%) the conventional one. No statistically significant differences were found between the two groups. In 16 patientes (72.7%) partial subjective Improvement and in 15 (68.2%) partial objective improvement were observed. Most notoriously Improved were scratching (16 cases; 72.7%) and tearing (15 cases 68.2%). Papillary hyper. trophy persisted In 7 (63.6%) of the 11 patients that presented it at the begining of the study, regardless of good clinical response. It is concluded that immunotherapy is useful for the treatment of refractory CAC and that there are no significant differences between cluster and conventional schemes