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

摘要

Background In children, the clinical efficacy and immunological mechanisms of sublingualimmunotherapy (SLIT) compared with subcutaneous immunotherapy (SCIT) is still to beelucidated.Objectives To compare SLIT, SCLT and pharmacotherapy in relation to clinical efficacy andimmunological mechanisms that govern its effect in asthmatic/rhinitis children who weresensitized to house dust mite (HDM).Methods In this single centre, prospective, randomized, controlled, open labelled, threeparallel group trial, 48 patients mono-sensitized to HDM were randomized to receive eitherSLIT (n = 16), SCIT (n= 16) or pharmacotherapy alone (n= 16). Symptom, medication andvisual analogue score (VAS) were collected and bronchial-nasal hyper-reactivity, skin pricktests, 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 1extracts and allergen-specific IL-4, IL-5, IL-13, IFN-y, IL-10, and TGF-(3 secretions weremeasured.Results SLIT and SCIT demonstrated a significant reduction of total rhinitis and asthmasymptom score, total medication score, VAS and skin reactivity to HDM (P<0.05) whencompared with pharmacotherapy. A significant reduction of serum-specific HDM-IgE in SCITand SLIT were observed. Moreover, titrated nasal provocative dose significantly increased inboth immunotherapy groups when compared with the pharmacotherapy group. No adverseeffects 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 withpharmacotherapy, whereas Bet v 1-driven TGF-P (negative control) increased significantly inSLIT only. No changes were observed for Thl-Th2 cytokines.Conclusion Both SLIT and SCIT demonstrated clinical improvement compared withpharmacotherapy in asthma/rhinitis children sensitized to HDM.