Long-term effect of sublingual and subcutaneous immunotherapy in dust mite–allergic children with asthma/rhinitis: a 3-year prospective randomized controlled trial

Background and Objective: Specific allergen immunotherapy is the only treatment modality that might change the natural course of allergic diseases in childhood. We sought to prospectively compare the long-term clinical and immunological effects of sublingual (SLIT) and subcutaneous (SCIT) immunotherapy compared with pharmacotherapy alone. Methods: In this single-center, prospective randomized controlled trial, 48 children with mild persistent asthma with/without rhinitis, monosensitized to house dust mites (HDMs) were followed for 3 years. At baseline and years 1 and 3 of follow-up, patients were evaluated and compared for total rhinitis (TRSS) and asthma (TASS) symptom scores, total symptom scores (TSS), total medication scores (TMS), safety profiles, skin-nasal-bronchial reactivity, and immunological parameters. Results: A significant reduction was observed in TASS for both HDM-SCIT and HDM-SLIT at year 3 of treatment compared with baseline and controls (P<.05 for both), with significant improvement in rhinitis symptoms for both groups compared with controls (P=.01 for both). TSS decreased significantly in both HDM-SCIT and HDM-SLIT at year 3 compared with baseline (P=.007 and P=.04, respectively) and controls (P<.01 for both). A significant reduction in TMS was observed in HDM-SCIT and HDM-SLIT compared with baseline and controls (P=.01 in all cases), with a reduction in skin reactivity to HDM (P<.05). Finally, a significant increase in allergen specific IgG4 was observed in the SCIT group at year 3 compared with baseline, the SLIT group, and controls (P<.001 in all cases). Conclusions: HDM-sensitized asthmatic children treated for at least 3 years with either SCIT or SLIT showed sustained clinical improvement (AU)

Antecedentes: La inmunoterapia con alérgenos es el único tratamiento que podría cambiar el curso natural evolutivo de las enfermedades alérgicas en la infancia. Nuestro objetivo era comparar, de manera prospectiva, la eficacia a largo plazo de la inmunoterapia sublingual (SLIT) y subcutánea (SCIT), con el tratamiento exclusivo con farmacoterapia convencional. Métodos:En este ensayo clínico, prospectivo de tres años de duración, realizado en un solo centro y aleatorizado, se incluyeron 48 niños con asma leve persistente, con o sin rinitis asociada, monosensibilizados a los ácaros del polvo (HDM). Los pacientes fueron evaluados al inicio, al año y a los tres años de tratamiento, comparándose los cambios en la puntuación de síntomas nasales (TRSS), bronquiales (TASS), puntuación total de síntomas (TSS) y consumo de medicación (TMS), perfil de seguridad, reactividad frente al alérgeno cutánea, nasal y bronquial y diversos parámetros inmunológicos. Resultados: Se observó una reducción significativa del TASS tanto para el grupo HDM-SCIT como HDM-SLIT al final del tercer año de tratamiento, tanto cuando se comparaba con la situación basal como con los cambios observados en el grupo control (p<0.05, respectivamente). El TRSS también mejoró significativamente en ambos grupos HDM-SCIT y HDM-SLIT en el tercer año de tratamiento, cuando los cambios se compararon con los observados en el grupo control (p=0,01, en ambos). El TSS y el TMS disminuyeron también significativamente en ambos grupos HDM-SCIT y HDM-SLIT en el tercer año, comparado con la situación basal (p=0,007, p=0,04/ p=0,01, p=0,01 respectivamente) y con el grupo control (p<0,01,p<0,01/ p=0,01, p=0,01, respectivamente). Tras tres años de tratamiento la reactividad cutánea frente a los alérgenos de los ácaros disminuyó significativamente (p<0,05). Los niveles de IgG4 específica frente a ácaros se incrementaron en el grupo SCIT-HDM, comparados con la situación basal y con los cambios observados en el grupo SLIT-HDM y control (p<0,001, respectivamente). Conclusiones: El tratamiento durante tres años con inmunoterapia específica tanto SCIT como SLIT se acompañó de una eficacia clínica sostenida, en este grupo de niños asmáticos sensibilizados a los ácaros del polvo. Ambas rutas de administración de la inmunoterapia parecen tener mecanismos de acción similares (AU)

Prevalence of immediate hypersensitivity reactions to cow’s milk in infants based on skin prick test and questionnaire

Objective: Cow’s milk (CM) hypersensitivity is one of the most frequent hypersensitivities in infants.The objective of our study was to investigate the prevalence of immediate hypersensitivity to CM based on skin prick test results and to evaluate associated allergic conditions ascertained by questionnaire in infants living in Istanbul. Methods: All infants born between June 2001 and May 2002 were recalled to the hospital according to their dates of birth, and 1015 infants aged between 8-18 months were included in the study. An interview was conducted with each mother and a questionnairere questing data on cow’s milk hypersensitivity and other allergic diseases was completed during this interview. A cow’s milk skin prick test (SPT) was applied to all infants. An open CM challenge test was then carried out on infants with a positive SPT to CM. Results: Among the 1015 infants who underwent SPT, six (0.59%) demonstrated immediate hypersensitivity to the CM allergen and three (0.29 %) developed a positive response to the CM challenge test. The results of the questionnaire revealed that 112 (11.0 %) of the infants had family history of allergic diseases, 96 infants (9.5 %) had a positive history of recurrent wheezing, and 166 (16.4 %) had a history of skin rash resembling atopic dermatitis. Conclusions: Our results suggest that CM hypersensitivity, with its low prevalence, might not be a serious health concern in Turkish infants

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Prevalence of egg sensitization in Turkish infants based on skin prick test

Aim: Egg allergy is one of the most frequent allergies in infants. The aim of this study was to determine the frequency of sensitization to egg in infants based on skin prick test results and to evaluate associated allergic conditions by questionnaire. Methods: All infants born between June 2001 and May 2002 were recalled to the hospital according to their dates of birth, and 1015 infants aged between 8-18 months were included in the study. An interview was conducted with each mother and a questionnaire requesting data on food allergy and other allergic diseases was completed during this interview. An egg skin prick test (whole egg) was applied to all infants. Results: Positive skin prick test results were recorded in 19 infants (1.87 %). There was no difference between the prick test-positive and -negative groups with respect to any of the demographic characteristics investigated (gender, age, birth weight, egg consumption, age of introduction of egg and other solids, breastfeeding). No significant association was demonstrated between sensitization to egg and family history of allergy. Moreover, there was no association between sensitization to egg and occurrence of atopic dermatitis, recurrent wheezing, gastrointestinal symptoms and doctor diagnosis of asthma. Conclusion: The prevalence of egg sensitization based on skin prick test results has been found as 1.87 % among Turkish infants in Istanbul. However, no significant relationship was found between allergic sensitization to egg and occurrence of allergic diseases in this study population

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The inverse association between serum anti-streptolysin-O titers and the frequency of exacerbations of asthma in childhood

Background: the decline in infections in childhood may contribute to the rising severity and prevalence of atopic disorders in developed countries. Support for this hypothesis has been obtained from findings of an inverse association between tuberculin responses and atopy and from findings of high prevalence of asthma in certain islands with low prevalence of respiratory infections. With this regard, we investigated the association between serum antistreptolysin- O (ASO) titers and the frequency of exacerbations of asthma in childhood. Methods: thirty atopic asthmatic children who has no sign of upper respiratory tract infection at the time of presentation or during the previous two months were included in the study. Serum ASO titer was measured as an indicator of past streptococcal upper respiratory tract infections. ASO titer > or = 200 Todd units was accepted as positive. Results: a statistically significant association is found between high anti-streptolysin-O titers and decreased number of exacerbations in those children. Conclusions: our data suggests that streptococcal infections might be a factor attenuating asthma in childhood (AU)

Fundamento: la disminución de las infecciones en la infancia puede contribuir a aumentar la gravedad y prevalencia de los trastornos atópicos en los países desarrollados. Esta hipótesis ha sido respaldada a partir de los hallazgos de una asociación inversa entre las respuestas a la tuberculina y la atopia y a partir de los hallazgos de una alta prevalencia de asma en algunas islas con una baja prevalencia de infecciones respiratorias. Partiendo de esta base, investigamos la asociación entre los títulos séricos de antiestreptolisina O (ASO) y la frecuencia de exacerbaciones de asma en la infancia. Método: fueron incluidos en el presente estudio 30 niños con asma atópica sin signos de infección de vías respiratorias altas en el momento de la presentación o durante los dos meses previos. Se determinó el título ASO en suero como indicador de infecciones estreptocócicas previas de las vías respiratorias altas. Se aceptó como positivo un título ASO > o = 200 unidades Todd.Resultados: se identificó una asociación estadísticamente significativa entre unos títulos antiestreptolisina O altos y una disminución del número de exacerbaciones en estos niños. Conclusiones: los datos del presente estudio sugieren que las infecciones estreptocócicas pueden ser un factor atenuante del asma en la infancia (AU)