ABSTRACT
BACKGROUND: Allergy immunotherapy targets the immunological cause of allergic rhinoconjunctivitis and allergic asthma and has the potential to alter the natural course of allergic disease. OBJECTIVE: The primary objective was to investigate the effect of the SQ grass sublingual immunotherapy tablet compared with placebo on the risk of developing asthma. METHODS: A total of 812 children (5-12 years), with a clinically relevant history of grass pollen allergic rhinoconjunctivitis and no medical history or signs of asthma, were included in the randomized, double-blind, placebo-controlled trial, comprising 3 years of treatment and 2 years of follow-up. RESULTS: There was no difference in time to onset of asthma, defined by prespecified asthma criteria relying on documented reversible impairment of lung function (primary endpoint). Treatment with the SQ grass sublingual immunotherapy tablet significantly reduced the risk of experiencing asthma symptoms or using asthma medication at the end of trial (odds ratio = 0.66, P < .036), during the 2-year posttreatment follow-up, and during the entire 5-year trial period. Also, grass allergic rhinoconjunctivitis symptoms were 22% to 30% reduced (P < .005 for all 5 years). At the end of the trial, the use of allergic rhinoconjunctivitis pharmacotherapy was significantly less (27% relative difference to placebo, P < .001). Total IgE, grass pollen-specific IgE, and skin prick test reactivity to grass pollen were all reduced compared to placebo. CONCLUSIONS: Treatment with the SQ grass sublingual immunotherapy tablet reduced the risk of experiencing asthma symptoms and using asthma medication, and had a positive, long-term clinical effect on rhinoconjunctivitis symptoms and medication use but did not show an effect on the time to onset of asthma.
Subject(s)
Asthma , Rhinitis, Allergic, Seasonal , Sublingual Immunotherapy , Asthma/immunology , Asthma/pathology , Asthma/therapy , Child , Child, Preschool , Conjunctivitis, Allergic/immunology , Conjunctivitis, Allergic/pathology , Conjunctivitis, Allergic/therapy , Double-Blind Method , Female , Follow-Up Studies , Humans , Male , Rhinitis, Allergic, Seasonal/immunology , Rhinitis, Allergic, Seasonal/pathology , Rhinitis, Allergic, Seasonal/therapy , TabletsABSTRACT
UNLABELLED: Bronchial hyperreactivity, a inseparable feature of asthma in polish asthmatics is seldom evaluated. Its depends on at least two causes i.e. a lack of methacholine registration for BPT and an opinion, that challenge test can be harmful or dangerous for patients. That situation could correct wider prevalence of bronchial provocation test with hypertonic saline. To perform the test are needed: spirometer, ultrasonic nebuliser and hypertonic saline. The aim of the study was to compare sensitivity and specifity of both tests with methacholine and hypertonic saline. MATERIAL AND METHODS: Studies were carried out on a group of 79 subjects, where was 59 asthmatics and 20 healthy subjects (control group). Sensitivity and specifity of both tests were evaluated for a few different thresholds considered as a positive result. Usually a 20% decrease of FEV1 from baseline was considered as positive test result. Three different thresholds were considered for methacholine test i.e. PC20FEV1 = 8,0 or 16,0 or 32,0 mg/ml. Relative to BPT with hypertonic saline maximal inhalation time was constant, i.e. 930s, but different decreases in FEV1 (15% or 20% from baseline) were needed. RESULTS: The most comparable sensitivity and specifity of the both tests were following, for methacholine threshold = PC20FEV1 = 16 mg/ ml, and for 4,5% NaCl PT15FEV1 = 930s. CONCLUSION: Although BPT with hypertonic saline is less sensitive than methacholine challenge, it seems to be a good tool to evaluate of bronchial hyperreactivity and should be more often applied.
Subject(s)
Asthma/diagnosis , Bronchial Hyperreactivity/diagnosis , Bronchial Provocation Tests/methods , Methacholine Chloride , Saline Solution, Hypertonic , Administration, Inhalation , Adolescent , Adult , Asthma/complications , Bronchial Hyperreactivity/etiology , Child , Cross-Over Studies , Dose-Response Relationship, Drug , Female , Forced Expiratory Volume/physiology , Humans , Male , Methacholine Chloride/administration & dosage , Reproducibility of Results , Saline Solution, Hypertonic/administration & dosage , Sensitivity and Specificity , SpirometryABSTRACT
Specific immunotherapy in patients hypersensitive to Hymenoptera venom is effective method of preventing from severe adverse events after wasp or honey bee sting. In children very often the conventional method was used. In this method injections of vaccines in rising doses was repeated in intervals of 7 days during 3 or 4 months. After obtaining the dose of 100 microg/ml the maintenance therapy is continued during 3-5 years with prolongation of time between vaccine injection to 4-5 weeks. In this paper the "rush" method of immunotherapy was described. Using this method the maintenance dose of vaccine can obtained after 5 days therapy using 3 to 5 concentrations of vaccines during one day. The preliminary effects in 10 children showed that it is safe method and except one children who have the local manifestation of oedema did not observed adverse effects. The efficacy of sting immunotherapy was documented by presentation the 31 cases of children treated by conventional method. The immunotherapy in a short time after "rush" method in our opinion make progress in this treatment.
