Dynamical changes of lung function and immunologic markers in asthmatic children receiving specific immunotherapy with standardized house dust mite extract
FENG Hui, XIANG Li, SHEN Kun-Ling
Beijing Children's Hospital Affiliated to Capital Medical University, Beijing 100045, China. Email: kunlingshen@hotmail.com
Abstract OBJECTIVE: To study the effects of specific immunotherapy with standardized house dust mite extract on the lung function and immunologic markers in children with asthma. METHODS: Thirty-two children with mild to moderate asthma who were allergic to house dust mite were assigned to two groups: an immunotherapy group that received subcutaneous specific immunotherapy with standardized house dust mite extract beside glucocorticoids treatment (n=15) and a control group that received glucocorticoids treatment alone (n=17). Lung function was determined before treatment and 3, 6, 12, 18 and 24 months after treatment. The frequency of asthma attacks was observed before treatment and 12 and 24 months after treatment. Serum immunological markers, including total IgE, specific IgE and specific IgG4 against house dust mite (Dermatophagoides pteronyssinus, Der P), ECP, IL-10, IL-4, and IFN-γ, were measured before treatment and 12 and 24 months after treatment. RESULTS: The parameters of lung function were kept at the normal level or near normal level after treatment in the immunotherapy group. Compared with before treatment, the percentage of patients without asthma attacks increased significantly after treatment in the immunotherapy group (P<0.05) and increased more significantly with a prolonged treatment time (P<0.05). The level of serum sIgG4 against Der P increased significantly throughout the period of the immunotherapy treatment compared with before treatment (P<0.01). There were no significant differences in the levels of serum total IgE, sIgE against Der P, ECP, IL-10, IL-4 and IFN-γ before and after treatment in the immunotherapy group. There were no significant differences in all the parameters measured before and after treatment in the control group. CONCLUSIONS: Subcutaneous specific immunotherapy with standardized house dust mite extract for two years decreases the frequency of asthma attacks and the lung functions are kept in a normal level in children with asthma. The role of the specific immunotherapy may attribute to the increased level of serum sIgG4 against Der P.[Chin J Contemp Pediatr, 2010, 12 (9):715-719]
FENG Hui,XIANG Li,SHEN Kun-Ling. Dynamical changes of lung function and immunologic markers in asthmatic children receiving specific immunotherapy with standardized house dust mite extract[J]. 中国当代儿科杂志, 2010, 12(09): 715-719.
FENG Hui,XIANG Li,SHEN Kun-Ling. Dynamical changes of lung function and immunologic markers in asthmatic children receiving specific immunotherapy with standardized house dust mite extract[J]. CJCP, 2010, 12(09): 715-719.
[4]Jacobsen L. Preventive aspects of specific immunotherapy[J]. Arb Paul Ehrlich Inst Bundesamt Sera Impfstoffe Frankf A M, 2003, (94):141-145.
[5]Eng PA, Borer-Reinhold M, Heijnen IA, Gnehm HP. Twelve-year follow-up after discontinuation of preseasonal grass pollen immunotherapy in childhood[J].Allergy, 2006, 61(2):198-201.
[6]Jacobsen L, Niggemann B, Dreborg S, Ferdousi HA, Halken S, H-st A, et al. Specific immunotherapy has long-term preventive effect of seasonal and perennial asthma: 10-year follow-up on the PAT study[J]. Allergy, 2007, 62(8):943-948.
[7]Cevit O, Kendirli SG, Yilmaz M, Altintas DU, Karakoc GB. Specific allergen immunotherapy: effect on immunologic markers and clinical parameters in asthmatic children[J]. Investig Allergol Clin Immunol, 2007,17(5):286-291.
[8]Platts-Mills TA, Vaughan JW, Blumenthal K, Pollart Squillace S, Sporik RB. Serum IgG and IgG4 antibodies to Fel d 1 among children exposed to 20 μg Fel d 1 at home: relevance of a nonallergic modified Th2 response[J]. Int Arch Allergy Immunol, 2001, 124(1-3):126-129.
[10]Basomba A, Tabar AI, Rojas DH, García BE, Alamar R, Olaguíbel JM, et al. Allergen vaccination with a liposome-encapsulated extract of Dermatopbagoides pteronyssinus: a randomized, double-blind, placebo-controlled trial in asthmatic patients[J]. J Allergy Clin Immunol, 2002,109(6):943-948.
[11]Mothes N, Heinzkill M, Drachenerg KJ, Sperr WR, Krauth MT, Majlesi Y, et al. Allergen-specific immunotherapy with a monophosphoryl lipid A-adjuvanted vaccine: reduced seasonnaly boosted immunoglobulin E production and inhibition of basophil histamine release by therapy-induced blocking antibodies[J]. Clin Exp Allergy, 2003, 33(9):1198-1208.
[12]Wachholz PA, Durham SR. Induction of ‘blocking’ IgG antibodies during immunotherapy[J]. Clin Exp Allergy, 2003, 33(9):1171-1174.
[13]Van Neerven RJ, Wikborg T, Lund G. Blocking antibodies induced by specific allergy vaccination prevent the activation of CD4+ T cell by inhibiting serum-IgE-facilitated allergen presentation[J]. J Immunol, 1999, 163(5):2944-2952.
[14]Jutel M, Akdis M, Budak F, Aebischer-Casaulta C, Wrzyszcz M, Blaser K, et al. IL-10 and TGF-beta cooperate in the regulatory T cell response to mucosal allergens in normal immunity and specific immunotherapy[J]. Eur J Immunol, 2003, 33(5):1205-1214.
[15]Ferreira MB, Santos AS, Santos MC, Carlos ML, Barbosa MA, Carlos AG. Nasal ECP patterns and specific immunotherapy in mite-allergic rhinitis patients[J]. Eur Ann Allergy Clin Immunol, 2005, 37(3):96-102.
[16]O′Brien RM, Byron KA, Varigos GA, Thomas WR. House dust mite immunotherapy results in a decrease in Der p2-specific IFN-γ and IL-4 expression by circulating T lymphocytes[J]. Clin Exp Allergy, 1997,27(1): 46-51.
[17]Gardner LM, Thien FC, Douglass JA, Rolland JM, O′Hehir RE. Induction of T ‘regulatory’ cells by standardized house dust mite immunotherapy: an increase in CD4+CD25+interleukin 10+ T cells expressing peripheral tissue trafficking markers[J]. Clin Exp Allergy, 2004, 34(8):1209-1219.