Nasal ECP patterns and specific immunotherapy in mite-allergic rhinitis patients.

BACKGROUND: Specific immunotherapy (SIT) is an effective treatment in allergic rhinitis and it has been shown to decrease nasal ECP rise after allergen challenge. AIMS: To evaluate if the kynetics of nasal ECP release after specific nasal challenge could be changed by SIT and if these changes were related to the dose of allergen administered. MATERIAL AND METHODS: 75 allergic rhinitis patients, monosensitized to house dust mites were included: 25 controls and 50 SIT-treated patients. These patients were divided in two groups: one receiving a high dose of the allergenic extract (Group 2) and other receiving a lower dose (Group 1). Nasal challenges were performed at the beginning of the study (T0), after 6 (T1) and after 12 months (T2). Nasal ECP values were measured in nasal lavages before challenge and one and four hours after obtaining a positive reaction. Patients were also asked in every visit to evaluate on a visual analog scale the intensity of their disease in the previous month. RESULTS: SIT was effective in improving subjective (visual analog scale) and objective parameters (nasal allergenic reactivity). Both SIT groups had significant differences between T0 and T2 values and comparing with control patients. SIT reduced significantly mean post-provocation ECP values in both groups and reduced the number of patients that showed increase in nasal ECP > 100% of basal values in each of the SIT-treated groups. The changes in nasal ECP values and particularly in nasal ECP patterns were more pronounced in Group 2 than in Group 1 but the differences did not reach statistical significance. CONCLUSIONS: SIT can inhibit nasal ECP increase after allergen challenge, frequently present in non SIT-treated patients. This effect is more pronounced and reaches statistical significance earlier in patients receiving higher doses of the allergenic extract used in SIT.

Efficacy and safety of specific immunotherapy with a modified mite extract

Background: In specific immunotherapy (SIT), modified extracts have been used to allow safe administration of higher allergen doses. Schedules reaching maintenance doses in approximately 1 month, which may have greater efficacy, have even been proposed. Aims: To assess the safety and efficacy of SIT with modified (depigmented and polymerized) Dermatophagoides pteronyssinus extract in the treatment of allergic rhinitis. Material and methods: Fifty patients with moderate-to-severe persistent allergic rhinitis and who were monosensitized to Dermatophagoides were included in this controlled, pragmatic, 1-year open study. The patients were randomly allocated to receive treatment with a Dermatophagoides pteronyssinus 100% modified allergen vaccine (active group, n = 25) or pharmacological treatment only (control group, n = 25). All SIT-related adverse reactions were recorded. Efficacy was assessed primarily through the results of nasal allergen challenges, through visual analog scale (VAS) and symptom scores. Results: In SIT-treated patients, significant improvements were found in symptom scores (mean reduction > 40%), VAS scores (mean improvement > 20%) and nasal challenges (mean increase in allergen concentration threshold > 500%). For symptom and VAS scores, statistically significant differences between control and SIT-treated patients were recorded at 12 months. In nasal challenges statistically significant differences were observed as early as at 6 months. Control patients showed no significant differences during the study period. Local reactions were observed in 28% of SIT-treated patients (total 24 reactions). There was only one immediate grade I systemic reaction, which was successfully treated with an antihistamine. Conclusions: SIT with this modified extract appears to be a relatively safe treatment, which can rapidly improve nasal allergenic tolerance, reducesymptom scores and improve subjective self-evaluation measured through VAS, reflecting a general improvement in patients’ well-being

Antecedentes: En inmunoterapia específica (ITE) los extractos modificados han sido utilizados para permitir una mayor seguridad en la administración de dosis alergénicas más altas. Incluso, con tales extractos han sido propuestas pautas de inmunoterapia que llegan a dosis de mantenimiento en un mes y que se propone que tengan una mayor y más rápida eficacia. Objetivo: Evaluación de la eficacia y seguridad de ITE con extracto modificado (despigmentado y polimerizado) de Dermatophagoides pteronyssinus en el tratamiento de pacientes con rinitis alérgica. Material y métodos: Incluimos a 50 pacientes con rinitis alérgica persistente moderada a grave, monosensibilizados a Dermatophagoides, en un estudio abierto, pragmático, controlado y paralelo con duración de un año. Se les distribuyó de forma aleatoria para recibir tratamiento con una vacuna de alergeno modificado 100% Dermatophagoides pteronyssinus (grupo activo; n = 25) o sólo un tratamiento farmacológico (grupo control; n = 25). Se registraran todas las reacciones adversas asociadas con las inyecciones de la vacuna y se evaluó la eficacia por pruebas de provocación nasal, escala visual analógica (EVA) y puntuación de síntomas. Resultados: En los enfermos tratados con inmunoterapia se observó mejoría en la puntuación de síntomas (reducción media > 40%), en EVA (mejoría media > 20%) y en prueba de provocación nasal (aumento medio de concentración alergénica tolerada > 500%). En la puntuación de síntomas y EVA a los 12 meses se observaron diferencias estadísticamente significativas entre pacientes control y los tratados. En la prueba de provocación nasal ya existían diferencias significativas a los 6 meses de tratamiento. En el grupo control no se han observado diferencias significativas. Se registró un total de 24 reacciones locales (en 28% de pacientes tratados) y sólo una reacción inmediata sistémica de grado I, que fue tratada solamente con un antihistamínico. Conclusiones: Inmunoterapia específica con este extracto modificado parece ser un tratamiento relativamente seguro que puede rápidamente conseguir mejoría en la tolerancia alergénica nasal, en puntuación de síntomas y en la auto-evaluación sujetiva por EVA, lo que traduce una mejoría general en el bienestar de los pacientes alérgicos