Comparison of efficacy, safety and immunologic effects of subcutaneous and sublingual immunotherapy in birch pollinosis: a randomized study.

BACKGROUND: Sublingual immunotherapy (SLIT) is currently considered a valid option to subcutaneous immunotherapy (SCIT), but only a few studies made a direct comparison of their effectiveness. The aim of this study was to compare the clinical and immunological effects of SCIT and SLIT in pollinosis induced by Betulaceae. METHODS: Forty-seven adult patients were randomized to receive SCIT or SLIT, performed by Betulaceae (alder, birch, and hazel) extracts from Stallergenes (Antony, France) standardized in index of reactivity (IR) with the treatment schedules proposed by the producer. The clinical effects were established by symptom-medication scores recorded during the month of March. Side effects were reported directly by the physicians for SCIT and were registered in diary cards by the patients for SLIT. Immunologic evaluation was done by measuring specific IgE and IgG4 to Bet v 1. RESULTS: Thirty-four patients (19 for SCIT and 15 for SLIT) completed the registration of symptoms and drug consumption during pollen period of Betulaceae. Mean cumulative doses of respectively 50.65 IR by SCIT and 4653.1 IR by SLIT were administered, with a SLIT/SCIT ratio of 92. There was no significant difference in mean symptom-medication score between SCIT and SLIT. Systemic reactions occurred in 16% of SCIT treated but in none of SLIT treated. As to immunologic evaluation, Bet v 1 specific IgE did not rise after the pollen season in SCIT treated, while increased non significantly in SLIT treated. Bet v 1 specific IgG4 increased in both treatment, buy only the increase with SCIT was significant (p = 0.001). CONCLUSION: SLIT and SCIT with a ratio of about 100 are equally effective in controlling rhinoconjunctivitis caused by tree pollen allergy. SLIT is safer than SCIT, but does not show the same immunologic effects on serum specific IgE and lgG4 antibodies.

Virological response to interferon treatment in hepatitis C virus carriers with normal aminotransferase levels and chronic hepatitis.

Hepatitis C virus (HCV) carriers with normal aminotransferase levels often show histological chronic hepatitis. This study was undertaken to determine the effect of interferon (IFN) in such patients. Nineteen HCV carriers with normal aminotransferase activities and chronic hepatitis were randomized to receive IFN-alpha2b (3 million units 3 times weekly for 12 months) or no treatment. Therapy was monitored by qualitative and quantitative determination of viral RNA. Patients who did not clear HCV RNA after 6 months discontinued therapy. In all, 9 patients constituted the control group, while 10 patients were treated. Five of these patients, still viremic after 6 months, stopped IFN. The remaining 5 patients, who cleared the viral RNA within 6 months, completed the 12-month course. Three of these patients relapsed off treatment, and 2 were still free of viremia 12 months after stopping therapy. A transient flare-up of aminotransferase activities was detected in 2 patients during treatment and in 3 patients after. None of the 9 control patients cleared the viral RNA during follow-up. A variable degree of sequence heterogeneity was detected in the hypervariable region before therapy, and IFN treatment decreased sequence diversity in all patients. These results indicate that IFN therapy can be effective in chronic HCV carriers with normal aminotransferase activities, inducing short-term virological response in 3 of 10 patients and sustained response in 2. The effects of treatment on viral load and quasispecies complexity were similar to those reported previously in patients with increased aminotransferase activities.

Virological characterization and liver histology in HCV positive subjects with normal and elevated ALT levels.

We analyzed HCV genotype and RNA titer in 36 chronically infected subjects, 20 with persistently normal or near-normal alanine aminotransferase (ALT) activity and 16 with raised ALT activity. All subjects underwent liver biopsy and evaluation of the histological activity index (HAI) by both Knodell's and Ishak's scoring systems. Genotype 2 was detected in most subjects with normal ALT activity, whereas genotype 1 was more frequent among subjects with raised ALT activity. HCV-RNA titer was higher in subjects with increased ALT. Histological evidence of chronic hepatitis was documented in all cases, but higher scores for grading and for staging were associated with increased ALT activity. HCV genotype had no statistical relationship with RNA titer or with liver histology. In logistic regression analysis, viral genotype, RNA titer or with liver histological scores for grading and staging were correlated independently with the ALT profile. The evidence of chronic hepatitis in all subjects with persistently normal ALT activity suggests that healthy HCV carriage is a rare event.

Long-term follow-up of and infectivity in blood donors with hepatitis C antibodies and persistently normal alanine aminotransferase levels.

BACKGROUND: Little is known about the prevalence of serum hepatitis C virus (HCV) RNA in blood donors with HCV antibodies and persistently normal alanine aminotransferase (ALT) levels. STUDY DESIGN AND METHODS: Thirty-nine anti-HCV-positive donors with normal ALT on four determinations at 3-month intervals were further tested monthly for 6 months, and they had normal ALT values. The presence of HCV RNA was determined in these 39 donors. RESULTS: Serum HCV RNA was detected in 16 of 39 donors, 14 of 14 who reacted on second-generation recombinant immunoblot assay (RIBA-2) and 2 of 15 who were indeterminate. None of the 10 RIBA-2-nonreactive donors had evidence of viremia. The 15 RIBA-2-indeterminate samples were tested with third-generation RIBA (RIBA-3); the results showed reactivity in 5 (including the 2 HCV RNA positive), an indeterminate pattern in 7, and nonreactivity in 3 (all RNA negative). Among HCV RNA-positive subjects, mean age (p < 0.05), mean ALT (p < 0.001), signal-to-cutoff (S:CO) ratio on second-generation enzyme-linked immunosorbent assay (p < 0.001), and gamma globulin levels (p < 0.05) were higher than those among HCV RNA-negative subjects. During 6 additional months of ALT monitoring, completed by 36 of 39 donors, increased values were detected in 6 (5 HCV RNA positive). In 4 of those 6, however, ALT levels were less than 1.5-fold the upper normal limit. HCV RNA results were unchanged at the end of 1-year follow-up. CONCLUSION: Forty-one percent of anti-HCV-positive donors with persistently normal ALT had active HCV infection. Long-term ALT monitoring allowed the detection of significantly increased enzyme values in only 2 of 16 viremic donors. Reactivity on RIBA-2 or -3, greater age, mean ALT levels in the upper range of normal, higher S:CO ratio on second-generation enzyme-linked immunosorbent assay, and higher gamma globulin levels were predictive of viremia.

Effect of UVB plus tar therapy on serum levels of interleukin-2 receptors in patients with psoriasis.

Baseline serum levels of interleukin-2 receptor (IL2R) were measured in 65 patients with active psoriasis. IL2R levels in psoriatic patients were significantly higher than in healthy controls (582.4 +/- 289.23 u/ml vs. 369.64 +/- 111.10 u/ml; P less than 0.05), but did not differ statistically from values found in an atopic dermatitis control group (619.88 +/- 254.27 u/ml). Sex, age and severity of the disease do not affect levels of IL2R. The same IL2R levels were measured in 26 psoriatic patients receiving UVB plus tar therapy. This therapy, continued until clinical remission, lowered IL2R levels to values comparable to controls. This decrease may be due to an immunosuppressive effect of therapy.