Intradermal immunotherapy with low-dose house dust mite allergens in patients with allergic rhinitis: A proof-of-concept study
PubMed

Keywords

Allergic rhinitis
Blomia tropicalis
Dermatophagoides farinae
Dermatophagoides pteronyssinnus
Intradermal immunotherapy
House dust mites

Abstract

Background: High-dose aqueous subcutaneous immunotherapy is a validated and effective administration route for house dust mite and pollen allergens.

Objective: A proof-of-concept study using intradermal immunotherapy (IDIT) with low-dose house dust mite allergens (Dermatophagoides pteronyssinnus/Dermatophagoides farinae [Dp/Df] and Blomia tropicalis [Bt]) was carried out in children with allergic rhinitis symptomatic upon exposure to house dust.

Methods: Eight immunotherapy-naïve patients with positive prick skin tests and specific serum IgE to a Dp/Df mixture and to Bt were weekly administered 0.05 mL of an IDIT consisting of a phenolyzed albumin-saline preparation containing low-dose dust mites (8.3 AU [5 ng] of Dp/Df and 2.5 DBU of Bt), for 3 months. Nasal (Total Nasal Symptom Score) and facial symptoms (Visual Analog Scale) were recorded 2 weeks prior to treatment and once weekly during its course. Serial dilutions skin prick tests (1/100-1/1.000.000) and serum allergen-specific IgG4 determinations were performed at baseline and at treatment conclusion.

Results: Values on the scales suggested clinical improvement. There was a significant decrease in serial dilutions skin prick tests’ wheal diameters, as well as an increase in serum IgG4 values at treatment completion. IDIT was well tolerated.

Conclusion:If the present results are confirmed by further studies, allergen-specific immunotherapy wider use could be promoted.

 

PubMed

References

Nelson HS. Allergen immunotherapy now and in the future. Allergy Asthma Proc. 2016;37(4):268-272. DOI: 10.2500/aap.2016.37.3966

Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, et al. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol. 2012;127(Suppl 1):S1–S55. DOI: 10.1016/j.jaci.2010.09.034

Eifan AO, Calderon MA, Durham SR. Allergen immunotherapy for house dust mite: clinical efficacy and immunological mechanisms in allergic rhinitis and asthma. Expert Opin Biol Ther. 2013;13(11):1543-1556. DOI: 10.1517/14712598.2013.844226

Jacobsen L, Wahn U, Bilo MB. Allergen-specific immunotherapy provides immediate, long-term and preventive clinical effects in children and adults: the effects of immunotherapy can be categorized by level of benefit-the centenary of allergen specific subcutaneous immunotherapy. Clin Transl Allergy. 2012;2:8.

Des-Roches A, Paradis L, Knani J, Hejjaoui A, Dhivert H, Chanez P, et al. Immunotherapy with a standardized Dermatophagoides pteronyssinus extract. V. Duration of the efficacy of immunotherapy after its cessation. Allergy. 1996;51(6):30 -33. DOI: 10.1111/j.1398-9995.1996.tb04643.x

Sánchez-Borges M, Fernández-Caldas E, Capriles-Hulett A, Caballero-Fonseca F. Mite hypersensitivity in patients with rhinitis and rhinosinusitis living in a tropical environment. Allergol Immunopathol (Madr). 2014;42(2):120-126. DOI: 10.1016/j.aller.2012.07.011

Capriles-Hulett A, Iraola V, Pinto H, Sánchez-Borges M, Daboín-De-Veer M, Fernández-Caldas E. Monosensitization to Blomia tropicalis: is exposure the only factor involved? J Investig Allergol Clin Immunol. 2009;19(2):165-166.

Caplin J, Capriles-Hulett A, Iraola V, Pinto H, Sánchez-Borges M, De-Los-Santos G, et al. Allergic sensitization to domestic mites in Corpus Christi, Texas. Allergy Asthma Proc. 2009;30(2):166-170. DOI: 10.2500/aap.2009.30.3209

Sánchez-Borges M, Capriles-Hulett A, Caballero-Fonseca F, Fernández-Caldas E. Mite and cockroach sensitization in allergic patients from Caracas, Venezuela. Ann Allergy Asthma Immunol. 2003;90(6):664-668. DOI: 10.1016/S1081-1206(10)61873-X

Caraballo L, Zakzuk J, Lee BW, Acevedo N, Soh JY, Sánchez-Borges M, et al. Particularities of allergy in the Tropics. World Allergy Organ J. 2016;9:20. DOI: 10.1186/s40413-016-0110-7

Sánchez-Borges M, Capriles-Hulett A, Caballero-Fonseca F. Asthma care in resource-poor settings. World Allergy Organ J. 2011;4(4):68-72. DOI: 10.1097/WOX.0b013e318213598d

Nelson H. Injection Immunotherapy for inhalant allergens. En: Middleton’s Allergy. Principles and Practice. Volume 2. EE. UU.: Saunders; 2013.

Varney VA, Gaga M, Frew AJ, Aber VR, Durham SR. Usefulness of immunotherapy in patients with severe summer hay fever uncontrolled by antiallergic drugs. BMJ. 1991;302(6771):265-269.

Varney VA, Tabbah K, Mavroleon G, Frew AJ. Usefulness of specific immunotherapy in patients with severe perennial allergic rhinitis induced by house dust mite: a double blind randomized, placebo-controlled trial. Clin Exp Allergy. 2003;33(8):1076-1082. DOI: 10.1046/j.1365-2222.2003.01735.x

Franklin W, Lowell FC. Comparisons of two dosages of ragweed extract in the treatment of pollenosis. JAMA. 1967;201(12):915-917.

Van-Metre TE, Adkinson NF, Lichtenstein LM, Mardiney MR, Norman PS, Rosenberg GL, et al. A controlled study of the effectiveness of the Rinkel method of immunotherapy for ragweed pollen hay fever. J Allergy Clin Immunol. 1980;65(4):288-297. Disponible en: http://www.jacionline.org/article/0091-6749(80)90158-X/pdf

Canonica GW, Cox L, Pawankar R, Baena-Cagnani CE, Blaiss M, Bonini S, et al. Sublingual immunotherapy: World Allergy Organization position paper 2013 update. World Allergy Organization J. 2014;28;7(1):6. DOI: 10.1186/1939-4551-7-6

Cox L, Hankin C, Lockey R. Allergy immunotherapy adherence and delivery route: location does not matter. J Allergy Clin Immunol Pract. 2014;2(2):156-160. DOI: 10.1016/j.jaip.2014.01.010

Ordman D. Allergic desensitization by the intradermal route. S Afr Med J. 1961;35:617-620.

Phillips EW. Relief of hay-fever by intradermal injection of pollen extract. JAMA. 1926;86(3):182-184. DOI: 10.1001/jama.1926.02670290022008

Phillips EW. Intradermal pollen therapy during the attack. J Allergy Clin Immunol. 1933;5(1):29-36. DOI: 10.1016/S0021-8707(33)90167-7

Rotiroti G, Shamji M, Durham S, Till S. Repeated low-dose intradermal allergy injection suppresses allergen-induced cutaneous late responses. J Allergy Clin Immunol. 2012;130:918-924.

Benaim-Pinto C, Fassrainer A. Intradermal Immunotherapy in children with severe skin inflammatory reactions to Aedes aegypti and Culex quinquefasciatus mosquito bites. Int J Dermatol. 1990;29(8):600-601. DOI: 10.1111/j.1365-4362.1990.tb03479.x

Benson RL. Diagnosis and treatment of sensitization to mosquitoes. J Allergy Clin Immunol. 1933;8:47-59.

Slovick A, Douiri A, Muir R, Guerra A, Tsioulos K, Hay E, et al. Intradermal Grass Pollen immunotherapy increases TH2 and IgE responses and worsens respiratory allergic symptoms. J Allergy Clin Immunol. 2017;139 (6):1830-1839. DOI: 10.1016/j.jaci.2016.09.024

Makatsori M, Pfaar O, Calderon MA. Allergen immunotherapy: clinical outcomes assesment. J Allergy Clin Immunol. 2014;2(2):123-129. DOI: 10.1016/j.jaip.2014.01.005

Bousquet PJ, Combescure C, Neukirch F, Klosser JM, Mechin H, Daures JP et al. A randomized placebo-controlled trial investigating efficacy and mechanisms of low-dose intradermal allergen immunotherapy in treatment of seasonal allergic rhinitis; Visual Analog Scales can assess the severity of rhinitis graded according to ARIA guidelines. Allergy. 2007;62:367-372.

Demoly P, Bousquet PJ, Mesbah K, Devillier P. Visual analogue scale in patients treated for allergic rhinitis: an observational prospective study in primary care: asthma and rhinitis. Clin Exp Allergy. 2013;43(8):881-888. DOI: 10.1111/cea.12121

Casey N. Dying infants and no medicines: inside Venezuela’s failing hospitals. The New York Times 2016 May 15. Disponible en https://www.nytimes.com/2016/05/16/world/americas/dying-infants-and-no-medicine-inside-venezuelas-failing-hospitals.html

Oppenheimer JJ, Tankersley M, Burnett T, Engler DB, Filley WV, Larenas-Linnemann DE, et al. ACAAI´s Allergen Immunotherapy Extract Preparation. Physician Instruction Guide. EEUU: American College of Allergy, Asthma, and Immunology; 2017.

Plunkett G. Stability of major allergen proteins in extract mixes diluted in serum albumin (HSA), normal saline (NSP) or glycerin (GLY). J Allergy Clin Immunol. 2007;119(1):S105. DOI: 10.1016/j.jaci.2006.11.629

Plunkett G, Schell M. Stability of allergen extracts diluted in saline or human serum albumin solutions (abstract). Ann Allergy Asthma Immunol. 2010;105:A1-A 140.

Dreborg S. The skin prick test: methodological studies and clinical applications. Suecia: Department of Pediatrics Linköping University, 1987.

Baena-Cagnani CE, Larenas-Linnemann D, Gómez M, Díaz SG, Solé D, Borges MS, et al. Allergy training and immunotherapy in Latin America: results of a regional overview. Ann Allergy Asthma Immunol. 2013;111(5):415-419. DOI: 10.1016/j.anai.2013.08.011

Vaswani R, Garg A, Parikh L, Vaswani S. Non-adherence to subcutaneous allergen immunotherapy: inadequate health insurance coverage is the leading cause. Ann Allergy Asthma Immunol. 2015;115(3):241-243. DOI: 10.1016/j.anai.2015.06.018

Tabar AI, Echechipía S, García BE, Olaguibel JM, Lizaso MT, Gómez B, et al. Double-blind comparative study of cluster and conventional immunotherapy schedules and dermatophagoides pteronyssinus. J Allergy Clin Immunol. 2005;116(1):109-118. DOI: 10.1016/j.jaci.2005.05.00538

Mauro M, Rusello M, Alesina R, Sillano V, Alessandrini A, Dama A, et al. Safety and pharmacoeconomics of a cluster administration of mite immunotherapy compared to the traditional one. Eur Ann Allergy Clin Immunol. 2006;38(1):31-34.

Bousquet J, Maasch H, Martinot B, Hejjaoui A, Wahl R, Michel FB. Double-blind placebo-controlled immunotherapy with mixed grass pollen allergoid. II. Comparison between parameters assessing the efficacy of immunotherapy. J Allergy Clin Immunol. 1998; 82(3 Pt 1):439-446. Disponible en: http://www.jacionline.org/article/0091-6749(88)90017-6/pdf

Nanda A, O'connor M, Anand M, Dreskin SC, Zhang L, Hines B, et al. Dose dependence and time course of the immunologic response to administration of standardized cat allergen extract. J Allergy Clin Immunol. 2004;114(6):1339-1344. DOI: 10.1016/j.jaci.2004.08.049

Lent AM, Harbeck R, Strand M, Sills M, Schmidt K, Efaw B, et al. Immunologic response to administration of standardized dog allergen extract at differing doses. J Allergy Clin Immunol. 2006;118(6):1249-1256. DOI: 10.1016/j.jaci.2006.07.055

Francis JN, James LK, Paraskevopoulos G, Wong C, Calderon MA, Durham SR, Till SJ. Grass pollen immunotherapy: IL-10 induction and suppression of late responses precedes IgG4 inhibitory antibody activity. J Allergy Clin Immunol. 2008;121(5):1120-1125. DOI: 10.1016/j.jaci.2008.01.072

Capriles-Hulett A, Yibirin MG, Garcia A, Hurtado D. Montelukast for the high impact of asthma exacerbations in Venezuela: a practical and valid approach for Latin America? World Allergy Organ J. 2014;7(1):20. DOI: 10.1186/1939-4551-7-20

Rodríguez E, Vera V, Pérez-Puigbo A, Capriles-Hulett A, Ferro S, Manrique J, et al. Equivalence of a single saline nebulized dose of formoterol powder vs three doses of nebulized Albuterol every twenty minutes in acute asthma in children: a suitable cost effective approach for developing nations. Allergol Immunopathol (Madr). 2008;36(4):196-200. DOI: 10.1016/S0301-0546(08)72549-7

Capriles E, Do-Campo A, Verde O, Pluchino S, Capriles-Hulett A. Children's asthma and the third world: an approach. J Investig Allergol Clin Immunol. 2006;16(1):11-8. Disponible en: http://www.jiaci.org/issues/vol16issue01/3.pdf

Hulett AC, Yibirin MG, Brandt RB, García A, Hurtado D, Puigbó AP. Home/social environment and asthma profiles in a vulnerable community from Caracas: lessons for urban Venezuela? J Asthma. 2013;50(1):14-24. DOI: 10.3109/02770903.2012.747205

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