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Clinical efficacy and immunological mechanisms of sublingual and subcutaneous immunotherapy in asthmatic/rhinitis children sensitized to house dust mite: an open randomized controlled trial

Summary Background In children, the clinical efficacy and immunological mechanisms of sublingual immunotherapy (SLIT) compared with subcutaneous immunotherapy (SCIT) is still to be elucidated. Objectives To compare SLIT, SCIT and pharmacotherapy in relation to clinical efficacy and immunological mec...

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Published in:Clinical and experimental allergy 2010-06, Vol.40 (6), p.922-932
Main Authors: Eifan, A. O., Akkoc, T., Yildiz, A., Keles, S., Ozdemir, C., Bahceciler, N. N., Barlan, I. B.
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creator Eifan, A. O.
Akkoc, T.
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description Summary Background In children, the clinical efficacy and immunological mechanisms of sublingual immunotherapy (SLIT) compared with subcutaneous immunotherapy (SCIT) is still to be elucidated. Objectives To compare SLIT, SCIT and pharmacotherapy in relation to clinical efficacy and immunological mechanisms that govern its effect in asthmatic/rhinitis children who were sensitized to house dust mite (HDM). Methods In this single centre, prospective, randomized, controlled, open labelled, three parallel group trial, 48 patients mono‐sensitized to HDM were randomized to receive either SLIT (n=16), SCIT (n=16) or pharmacotherapy alone (n=16). Symptom, medication and visual analogue score (VAS) were collected and bronchial‐nasal hyper‐reactivity, skin prick tests, total‐specific IgE were performed at baseline and 12 months after treatment. In addition, peripheral blood mononuclear cells were cultured with recombinant Der p 1 and Bet v 1 extracts and allergen‐specific IL‐4, IL‐5, IL‐13, IFN‐γ, IL‐10, and TGF‐β secretions were measured. Results SLIT and SCIT demonstrated a significant reduction of total rhinitis and asthma symptom score, total medication score, VAS and skin reactivity to HDM (P
doi_str_mv 10.1111/j.1365-2222.2009.03448.x
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O. ; Akkoc, T. ; Yildiz, A. ; Keles, S. ; Ozdemir, C. ; Bahceciler, N. N. ; Barlan, I. B.</creator><creatorcontrib>Eifan, A. O. ; Akkoc, T. ; Yildiz, A. ; Keles, S. ; Ozdemir, C. ; Bahceciler, N. N. ; Barlan, I. B.</creatorcontrib><description>Summary Background In children, the clinical efficacy and immunological mechanisms of sublingual immunotherapy (SLIT) compared with subcutaneous immunotherapy (SCIT) is still to be elucidated. Objectives To compare SLIT, SCIT and pharmacotherapy in relation to clinical efficacy and immunological mechanisms that govern its effect in asthmatic/rhinitis children who were sensitized to house dust mite (HDM). Methods In this single centre, prospective, randomized, controlled, open labelled, three parallel group trial, 48 patients mono‐sensitized to HDM were randomized to receive either SLIT (n=16), SCIT (n=16) or pharmacotherapy alone (n=16). Symptom, medication and visual analogue score (VAS) were collected and bronchial‐nasal hyper‐reactivity, skin prick tests, total‐specific IgE were performed at baseline and 12 months after treatment. In addition, peripheral blood mononuclear cells were cultured with recombinant Der p 1 and Bet v 1 extracts and allergen‐specific IL‐4, IL‐5, IL‐13, IFN‐γ, IL‐10, and TGF‐β secretions were measured. Results SLIT and SCIT demonstrated a significant reduction of total rhinitis and asthma symptom score, total medication score, VAS and skin reactivity to HDM (P&lt;0.05) when compared with pharmacotherapy. A significant reduction of serum‐specific HDM‐IgE in SCIT and SLIT were observed. Moreover, titrated nasal provocative dose significantly increased in both immunotherapy groups when compared with the pharmacotherapy group. No adverse effects were reported in SLIT, while two patients demonstrated serious adverse events in SCIT. After 1 year of treatment, Der p 1‐driven IL‐10 significantly increased in SLIT compared with pharmacotherapy, whereas Bet v 1‐driven TGF‐β (negative control) increased significantly in SLIT only. No changes were observed for Th1–Th2 cytokines. Conclusion Both SLIT and SCIT demonstrated clinical improvement compared with pharmacotherapy in asthma/rhinitis children sensitized to HDM.</description><identifier>ISSN: 0954-7894</identifier><identifier>EISSN: 1365-2222</identifier><identifier>DOI: 10.1111/j.1365-2222.2009.03448.x</identifier><identifier>PMID: 20100188</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Administration, Sublingual ; Allergies ; Animals ; Antigens, Dermatophagoides - administration &amp; dosage ; Antigens, Dermatophagoides - immunology ; Arthropod Proteins ; Asthma ; Asthma - therapy ; Biological and medical sciences ; Child ; Child, Preschool ; Chronic obstructive pulmonary disease, asthma ; Cysteine Endopeptidases ; cytokines ; Dermatophagoides pteronyssinus ; Dermatophagoides pteronyssinus - immunology ; Female ; Fundamental and applied biological sciences. Psychology ; Fundamental immunology ; Humans ; Hypersensitivity - therapy ; Immunotherapy ; Immunotherapy - adverse effects ; Immunotherapy - methods ; Injections, Subcutaneous ; Male ; Medical sciences ; nasal provocation ; Non tumoral diseases ; Otorhinolaryngology. Stomatology ; Pneumology ; Pyroglyphidae - immunology ; rhinitis ; Rhinitis - therapy ; sublingual-subcutaneous immunotherapy ; Treatment Outcome ; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology</subject><ispartof>Clinical and experimental allergy, 2010-06, Vol.40 (6), p.922-932</ispartof><rights>2010 Blackwell Publishing Ltd</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c6128-fa11192718203c61a05f902fcdc67b04c493b2ae62b0807ceaa819e84b3691263</citedby><cites>FETCH-LOGICAL-c6128-fa11192718203c61a05f902fcdc67b04c493b2ae62b0807ceaa819e84b3691263</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=22694418$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20100188$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Eifan, A. O.</creatorcontrib><creatorcontrib>Akkoc, T.</creatorcontrib><creatorcontrib>Yildiz, A.</creatorcontrib><creatorcontrib>Keles, S.</creatorcontrib><creatorcontrib>Ozdemir, C.</creatorcontrib><creatorcontrib>Bahceciler, N. N.</creatorcontrib><creatorcontrib>Barlan, I. B.</creatorcontrib><title>Clinical efficacy and immunological mechanisms of sublingual and subcutaneous immunotherapy in asthmatic/rhinitis children sensitized to house dust mite: an open randomized controlled trial</title><title>Clinical and experimental allergy</title><addtitle>Clin Exp Allergy</addtitle><description>Summary Background In children, the clinical efficacy and immunological mechanisms of sublingual immunotherapy (SLIT) compared with subcutaneous immunotherapy (SCIT) is still to be elucidated. Objectives To compare SLIT, SCIT and pharmacotherapy in relation to clinical efficacy and immunological mechanisms that govern its effect in asthmatic/rhinitis children who were sensitized to house dust mite (HDM). Methods In this single centre, prospective, randomized, controlled, open labelled, three parallel group trial, 48 patients mono‐sensitized to HDM were randomized to receive either SLIT (n=16), SCIT (n=16) or pharmacotherapy alone (n=16). Symptom, medication and visual analogue score (VAS) were collected and bronchial‐nasal hyper‐reactivity, skin prick tests, total‐specific IgE were performed at baseline and 12 months after treatment. In addition, peripheral blood mononuclear cells were cultured with recombinant Der p 1 and Bet v 1 extracts and allergen‐specific IL‐4, IL‐5, IL‐13, IFN‐γ, IL‐10, and TGF‐β secretions were measured. Results SLIT and SCIT demonstrated a significant reduction of total rhinitis and asthma symptom score, total medication score, VAS and skin reactivity to HDM (P&lt;0.05) when compared with pharmacotherapy. A significant reduction of serum‐specific HDM‐IgE in SCIT and SLIT were observed. Moreover, titrated nasal provocative dose significantly increased in both immunotherapy groups when compared with the pharmacotherapy group. No adverse effects were reported in SLIT, while two patients demonstrated serious adverse events in SCIT. After 1 year of treatment, Der p 1‐driven IL‐10 significantly increased in SLIT compared with pharmacotherapy, whereas Bet v 1‐driven TGF‐β (negative control) increased significantly in SLIT only. No changes were observed for Th1–Th2 cytokines. Conclusion Both SLIT and SCIT demonstrated clinical improvement compared with pharmacotherapy in asthma/rhinitis children sensitized to HDM.</description><subject>Administration, Sublingual</subject><subject>Allergies</subject><subject>Animals</subject><subject>Antigens, Dermatophagoides - administration &amp; dosage</subject><subject>Antigens, Dermatophagoides - immunology</subject><subject>Arthropod Proteins</subject><subject>Asthma</subject><subject>Asthma - therapy</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Chronic obstructive pulmonary disease, asthma</subject><subject>Cysteine Endopeptidases</subject><subject>cytokines</subject><subject>Dermatophagoides pteronyssinus</subject><subject>Dermatophagoides pteronyssinus - immunology</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Fundamental immunology</subject><subject>Humans</subject><subject>Hypersensitivity - therapy</subject><subject>Immunotherapy</subject><subject>Immunotherapy - adverse effects</subject><subject>Immunotherapy - methods</subject><subject>Injections, Subcutaneous</subject><subject>Male</subject><subject>Medical sciences</subject><subject>nasal provocation</subject><subject>Non tumoral diseases</subject><subject>Otorhinolaryngology. Stomatology</subject><subject>Pneumology</subject><subject>Pyroglyphidae - immunology</subject><subject>rhinitis</subject><subject>Rhinitis - therapy</subject><subject>sublingual-subcutaneous immunotherapy</subject><subject>Treatment Outcome</subject><subject>Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology</subject><issn>0954-7894</issn><issn>1365-2222</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><recordid>eNqNkt2K1DAUgIso7rj6ChIQ8aqz-W8ieLEM6yos6sWK4E1I03SbsW1mkxRnfDffzXRmHMEbzU2anO_LaXJOUQAElyiPi_USEc5KnMcSQyiXkFAqltsHxeIUeFgsoGS0rISkZ8WTGNcQQsKkeFycYYggREIsip-r3o3O6B7Yts2z2QE9NsANwzT63t_tQ4M1nR5dHCLwLYhTnZ27KQdmNC_NlPRo_RSPXups0JsdcCPQMXWDTs5chC4nSi4C07m-CXYE0Y4x7_ywDUgedNm3oJliAoNL9nU-HPhNxkLO4oc9ZvyYgu_72QhO90-LR63uo312nM-Lz2-vblfvypuP1-9Xlzel4QiLstX50SSukMCQ5C0NWSshbk1jeFVDaqgkNdaW4xoKWBmrtUDSCloTLhHm5Lx4dTh3E_z9ZGNSg4vG9v3h2qqinMAKcvFvkhACGWc0ky_-Itd-CmO-hkKMsqpikslMiQNlgo8x2FZtght02CkE1dwLaq3mkqu55GruBbXvBbXN6vNjgqkebHMSfxc_Ay-PgI65zG1-aOPiHw5zSSmauTcH7rvr7e6_f0Ctri7nr-yXB9_FZLcnX4dvilekYurLh2vFxddbROQnxcgvhMLiKw</recordid><startdate>201006</startdate><enddate>201006</enddate><creator>Eifan, A. 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Psychology</topic><topic>Fundamental immunology</topic><topic>Humans</topic><topic>Hypersensitivity - therapy</topic><topic>Immunotherapy</topic><topic>Immunotherapy - adverse effects</topic><topic>Immunotherapy - methods</topic><topic>Injections, Subcutaneous</topic><topic>Male</topic><topic>Medical sciences</topic><topic>nasal provocation</topic><topic>Non tumoral diseases</topic><topic>Otorhinolaryngology. Stomatology</topic><topic>Pneumology</topic><topic>Pyroglyphidae - immunology</topic><topic>rhinitis</topic><topic>Rhinitis - therapy</topic><topic>sublingual-subcutaneous immunotherapy</topic><topic>Treatment Outcome</topic><topic>Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Eifan, A. O.</creatorcontrib><creatorcontrib>Akkoc, T.</creatorcontrib><creatorcontrib>Yildiz, A.</creatorcontrib><creatorcontrib>Keles, S.</creatorcontrib><creatorcontrib>Ozdemir, C.</creatorcontrib><creatorcontrib>Bahceciler, N. N.</creatorcontrib><creatorcontrib>Barlan, I. B.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical and experimental allergy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Eifan, A. O.</au><au>Akkoc, T.</au><au>Yildiz, A.</au><au>Keles, S.</au><au>Ozdemir, C.</au><au>Bahceciler, N. N.</au><au>Barlan, I. B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical efficacy and immunological mechanisms of sublingual and subcutaneous immunotherapy in asthmatic/rhinitis children sensitized to house dust mite: an open randomized controlled trial</atitle><jtitle>Clinical and experimental allergy</jtitle><addtitle>Clin Exp Allergy</addtitle><date>2010-06</date><risdate>2010</risdate><volume>40</volume><issue>6</issue><spage>922</spage><epage>932</epage><pages>922-932</pages><issn>0954-7894</issn><eissn>1365-2222</eissn><abstract>Summary Background In children, the clinical efficacy and immunological mechanisms of sublingual immunotherapy (SLIT) compared with subcutaneous immunotherapy (SCIT) is still to be elucidated. Objectives To compare SLIT, SCIT and pharmacotherapy in relation to clinical efficacy and immunological mechanisms that govern its effect in asthmatic/rhinitis children who were sensitized to house dust mite (HDM). Methods In this single centre, prospective, randomized, controlled, open labelled, three parallel group trial, 48 patients mono‐sensitized to HDM were randomized to receive either SLIT (n=16), SCIT (n=16) or pharmacotherapy alone (n=16). Symptom, medication and visual analogue score (VAS) were collected and bronchial‐nasal hyper‐reactivity, skin prick tests, total‐specific IgE were performed at baseline and 12 months after treatment. In addition, peripheral blood mononuclear cells were cultured with recombinant Der p 1 and Bet v 1 extracts and allergen‐specific IL‐4, IL‐5, IL‐13, IFN‐γ, IL‐10, and TGF‐β secretions were measured. Results SLIT and SCIT demonstrated a significant reduction of total rhinitis and asthma symptom score, total medication score, VAS and skin reactivity to HDM (P&lt;0.05) when compared with pharmacotherapy. A significant reduction of serum‐specific HDM‐IgE in SCIT and SLIT were observed. Moreover, titrated nasal provocative dose significantly increased in both immunotherapy groups when compared with the pharmacotherapy group. No adverse effects were reported in SLIT, while two patients demonstrated serious adverse events in SCIT. After 1 year of treatment, Der p 1‐driven IL‐10 significantly increased in SLIT compared with pharmacotherapy, whereas Bet v 1‐driven TGF‐β (negative control) increased significantly in SLIT only. No changes were observed for Th1–Th2 cytokines. Conclusion Both SLIT and SCIT demonstrated clinical improvement compared with pharmacotherapy in asthma/rhinitis children sensitized to HDM.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>20100188</pmid><doi>10.1111/j.1365-2222.2009.03448.x</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record>
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subjects Administration, Sublingual
Allergies
Animals
Antigens, Dermatophagoides - administration & dosage
Antigens, Dermatophagoides - immunology
Arthropod Proteins
Asthma
Asthma - therapy
Biological and medical sciences
Child
Child, Preschool
Chronic obstructive pulmonary disease, asthma
Cysteine Endopeptidases
cytokines
Dermatophagoides pteronyssinus
Dermatophagoides pteronyssinus - immunology
Female
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Humans
Hypersensitivity - therapy
Immunotherapy
Immunotherapy - adverse effects
Immunotherapy - methods
Injections, Subcutaneous
Male
Medical sciences
nasal provocation
Non tumoral diseases
Otorhinolaryngology. Stomatology
Pneumology
Pyroglyphidae - immunology
rhinitis
Rhinitis - therapy
sublingual-subcutaneous immunotherapy
Treatment Outcome
Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology
title Clinical efficacy and immunological mechanisms of sublingual and subcutaneous immunotherapy in asthmatic/rhinitis children sensitized to house dust mite: an open randomized controlled trial
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