Allergy Asthma Immunol Res.  2016 May;8(3):257-263. 10.4168/aair.2016.8.3.257.

Induction of Bronchial Tolerance After 1 Cycle of Monophosphoryl-A-Adjuvanted Specific Immunotherapy in Children With Grass Pollen Allergies

• Rosewich M
• Girod K
• Zielen S
• Schubert R
• Schulze J

• KMID: 2391046
• DOI: http://doi.org/10.4168/aair.2016.8.3.257

Abstract

PURPOSE
Subcutaneous allergen-specific immunotherapy (SCIT) is a well-established and clinically effective method to treat allergic diseases, such as rhinitis and asthma. It remains unclear how soon after initiation of an ultra-short course of grass pollen immunotherapy adjuvanted with monophosphoryl lipid A (MPL)-specific bronchial tolerance can be induced.
METHODS
In a prospective study of 69 children double-sensitized to birch and grass pollens (51 males, average age 11.1 years), development of bronchial tolerance after 1 cycle of SCIT for grass was evaluated. In all the patients, the bronchial allergen provocation test (BAP) was performed before and after treatment. According to the results of the first BAP, the patients were divided into 2 groups: those showing a negative BAP with a decrease in FEV1 of <20% (seasonal allergic rhinitis [SAR] group, n=47); and those showing a positive BAP with a decrease in FEV1 of > or =20% (SAR with allergic asthma [SAR and Asthma] group, n=22). All the patients received MPL-adjuvanted, ultra-short course immunotherapy for birch, but only those with a positive BAP to grass received MPL-SCIT for grass.
RESULTS
After the pollen season, the BAP in the SAR group remained unchanged, while it was improved in the SAR and Asthma group (decrease in FEV1 of 28.8% vs 12.5%, P<0.01). The IgG4 levels increased after SCIT (median before SCIT 0.34 to 11.4 after SCIT), whereas the total and specific IgE levels remained unchanged.
CONCLUSIONS
After 1 cycle of MPL-SCIT, specific bronchial tolerance may be significantly induced, whereas in patients without SCIT, bronchial hyperactivity may remain unchanged.

Keyword

Allergic asthma; pollen allergy; bronchial allergen challenge; desensitization, immunologic; tolerance

MeSH Terms

Asthma
Betula
Bronchial Provocation Tests
Child*
Desensitization, Immunologic
Humans
Immunoglobulin E
Immunoglobulin G
Immunotherapy*
Lipid A
Male
Poaceae*
Pollen*
Prospective Studies
Rhinitis
Rhinitis, Allergic, Seasonal*
Seasons
Immunoglobulin E
Immunoglobulin G
Lipid A

Figure

• 

  Fig. 1 Randomization and follow-up. Of the 69 patients included, 57 completed the study. The dropout occurred because the patients or their legal representatives refused to undergo a second BAP or were lost to follow-up.

• 

  Fig. 2 Decreases in FEV1 after the first and second BAPs. Decreases in FEV1 after BAP with grass pollen at baseline (first and third columns) and after the second BAP (second and fourth columns) in the SAR group and the MPL-SCIT treated SAR and Asthma group, respectively.

• 

  Fig. 3 Total IgE and specific IgE against grass pollen. Total IgE and specific IgE against grass pollen at baseline (first and third columns) and in the SAR group after 1 year and the MPL-SCIT treated SAR and Asthma group (second and fourth columns, respectively).

• 

  Fig. 4 Specific IgG against grass pollen. Grass-specific IgG4 before and after SCIT in the MPL-SCIT treated SAR and Asthma group.

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