Allergy Asthma Immunol Res.  2014 Nov;6(6):535-540. 10.4168/aair.2014.6.6.535.

Long-term Effects of Specific Allergen Immunotherapy Against House Dust Mites in Polysensitized Patients With Allergic Rhinitis

• Kim SH
• Shin SY
• Lee KH
• Kim SW
• Cho JS

• KMID: 2260176
• DOI: http://doi.org/10.4168/aair.2014.6.6.535

Abstract

PURPOSE
Allergen-specific immunotherapy is the only currently available treatment to modify the natural history of allergic rhinitis (AR). If patients are polysensitized, it is difficult to identify the allergen causing the allergic symptoms. We evaluated the effectiveness of immunotherapy against house dust mites (HDMs) in AR patients polysensitized to both HDMs and seasonal allergens.
METHODS
Thirty AR patients polysensitized to both HDMs and seasonal allergens (group A) and 30 patients sensitized to HDMs only (group B) were enrolled in this study. All subjects who received immunotherapy against HDMs for more than 2 years were evaluated by the multiple allergen simultaneous test (MAST) to determine the specific IgE level in luminescence units, total eosinophil counts in peripheral blood, serum total IgE, total nasal symptom scores, and the rhinoconjunctivitis quality of life questionnaire (RQLQ) before and after immunotherapy.
RESULTS
There were no statistical differences in levels of total and specific IgE, or total eosinophil count between the two groups. The total nasal symptom scores, RQLQ and medication scores significantly decreased after immunotherapy in both groups, however no significant differences were noted between the two groups.
CONCLUSIONS
We determined that the primary causative allergen of AR in Seoul, Korea is perennial allergens, such as HDMs, rather than seasonal allergens. This study provides a reference for the selection of allergens to use in immunotherapy for polysensitized AR patients living in an urban environment.

Keyword

Immunotherapy; allergic rhinitis; house dust mite; polysensitization

MeSH Terms

Allergens
Desensitization, Immunologic*
Eosinophils
Humans
Immunoglobulin E
Immunotherapy
Korea
Luminescence
Natural History
Pyroglyphidae*
Quality of Life
Rhinitis*
Seasons
Seoul
Surveys and Questionnaires
Allergens
Immunoglobulin E

Figure

• 

  Fig. 1 Number of patients with severe allergic rhinitis symptoms during the season (*P<0.05).

• 

  Fig. 2 Comparison of total nasal symptom scores pre- and post-treatment between Groups A and B (*P<0.05).

• 

  Fig. 3 Comparison of RQLQ scores pre- and post-treatment between Groups A and B (*P<0.05).

• 

  Fig. 4 Comparison of mean medication scores pre- and post-treatment between groups A and B (*P<0.05).

Reference

1. Finegold I. Immunotherapy historical perspective. Ann Allergy Asthma Immunol. 2001; 87:3–4.

2. Yu YI, Cho JS, Lee KH, Kim KH, Hong SM, Kim SW. Clinical statistical study on offending allergens of patients with allergic rhinitis: prevalence of multiple sensitization. Korean J Otolaryngol-Head Neck Surg. 2003; 46:48–53.

3. Jeong KY, Park JW, Hong CS. House dust mite allergy in Korea: the most important inhalant allergen in current and future. Allergy Asthma Immunol Res. 2012; 4:313–325.

4. Hur GY, Kim TB, Han MY, Nahm DH, Park JW. Allergen and Immunotherapy Work Group of the Korean Academy of Asthma, Allergy and Clinical Immunology (KAAACI). A survey of the prescription patterns of allergen immunotherapy in Korea. Allergy Asthma Immunol Res. 2013; 5:277–282.

5. Park KH, Cho JS, Lee KH, Shin SY, Moon JH, Cha CI. Rhinoconjunctivitis quality of life questionnaire (RQLQ) as an evaluator of perennial allergic rhinitis patients-the first report. Korean J Otolaryngol-Head Neck Surg. 2002; 45:254–262.

6. Calderón MA, Cox L, Casale TB, Moingeon P, Demoly P. Multiple-allergen and single-allergen immunotherapy strategies in polysensitized patients: looking at the published evidence. J Allergy Clin Immunol. 2012; 129:929–934.

7. Bahceciler NN, Galip N, Cobanoglu N. Multiallergen-specific immunotherapy in polysensitized patients: where are we? Immunotherapy. 2013; 5:183–190.

8. Adkinson NF Jr, Eggleston PA, Eney D, Goldstein EO, Schuberth KC, Bacon JR, Hamilton RG, Weiss ME, Arshad H, Meinert CL, Tonascia J, Wheeler B. A controlled trial of immunotherapy for asthma in allergic children. N Engl J Med. 1997; 336:324–331.

9. Frew AJ, Powell RJ, Corrigan CJ, Durham SR. UK Immunotherapy Study Group. Efficacy and safety of specific immunotherapy with SQ allergen extract in treatment-resistant seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol. 2006; 117:319–325.

10. Ciprandi G, Incorvaia C, Puccinelli P, Soffia S, Scurati S, Frati F. Polysensitization as a challenge for the allergist: the suggestions provided by the Polysensitization Impact on Allergen Immunotherapy studies. Expert Opin Biol Ther. 2011; 11:715–722.

11. Veling MC, Trevino RJ. The treatment of allergic rhinitis with immunotherapy: a review of 1,000 cases. Ear Nose Throat J. 2001; 80:542–543.

12. Finegold I. Allergen immunotherapy: present and future. Allergy Asthma Proc. 2007; 28:44–49.

13. Portnoy JM. Immunotherapy for inhalant allergies. Guidelines for why, when, and how to use this treatment. Postgrad Med. 2001; 109:89–90. 93–94. 99–100.

14. Malling HJ. Allergen-specific immunotherapy in allergic rhinitis. Curr Opin Allergy Clin Immunol. 2001; 1:43–46.

15. Joint Task Force on Practice Parameters. Allergen immunotherapy: a practice parameter. American Academy of Allergy, Asthma and Immunology. American College of Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol. 2003; 90:1–40.

16. Sherman WB. Hypersensitivity: mechanisms and management. Philadelphia (PA): Saunders;1968.

17. Boulet LP, Turcotte H, Laprise C, Lavertu C, Bédard PM, Lavoie A, Hébert J. Comparative degree and type of sensitization to common indoor and outdoor allergens in subjects with allergic rhinitis and/or asthma. Clin Exp Allergy. 1997; 27:52–59.

18. Ortolani C, Pastorello E, Moss RB, Hsu YP, Restuccia M, Joppolo G, Miadonna A, Cornelli U, Halpern G, Zanussi C. Grass pollen immunotherapy: a single year double-blind, placebo-controlled study in patients with grass pollen-induced asthma and rhinitis. J Allergy Clin Immunol. 1984; 73:283–290.

19. Gehlhar K, Schlaak M, Becker W, Bufe A. Monitoring allergen immunotherapy of pollen-allergic patients: the ratio of allergen-specific IgG4 to IgG1 correlates with clinical outcome. Clin Exp Allergy. 1999; 29:497–506.

20. McHugh SM, Lavelle B, Kemeny DM, Patel S, Ewan PW. A placebo-controlled trial of immunotherapy with two extracts of Dermatophagoides pteronyssinus in allergic rhinitis, comparing clinical outcome with changes in antigen-specific IgE, IgG, and IgG subclasses. J Allergy Clin Immunol. 1990; 86:521–531.

21. Juniper EF, Thompson AK, Ferrie PJ, Roberts JN. Validation of the standardized version of the Rhinoconjunctivitis Quality of Life Questionnaire. J Allergy Clin Immunol. 1999; 104:364–369.