IgE and Allergen Immunotherapy in Allergic Children
We retrospectively analyzed the data concerning 39 allergic children (22 males; mean age of 13.0 years): 11 with AR, five with asthma and 23 with both disorders. All were consecutively treated with AIT between January 2010 and December 2012. We considered the cut-off of 10 kU/l for subdividing the children: 31 children (17 males; mean age of 12.5 years) had levels of serum-sIgE to house dust mites (HDM) ≥10 kU/l. Eight allergic children (five males, mean age: 13.4 years) had levels of serum-sIgE to HDM <10 kU/l and were considered as control. We considered this cut-off value on the basis of the previous study, demonstrating that this value was able to discriminate AIT responders from nonresponders. The Institutional Review Board of Instituto Giannina Gaslini (Genoa, Italy) approved the study; all patients' parents gave written informed consent.
All children underwent SLIT as part of the therapy for AR and/or asthma for 3 years. Inclusion criteria were: documented diagnosis of allergic rhinitis and/or asthma based on patient-reported symptoms, physical examination, and lung function test (including bronchodilation test); documented sensitization to HDM; demonstration of a consistent relationship between inhalation of HDM and occurrence of respiratory symptoms for defining the causal allergen (e.g., true allergy). Exclusion criteria for this study were: to suffer from other allergic diseases (i.e., atopic dermatitis or food allergy); clinically relevant anatomic impairment (e.g., septum deviation or nasal polyps); acute or chronic disorders representing a contraindication to AIT (e.g., autoimmune disease and malignancy, among others); and polysensitization.
AIT efficacy was assessed by the patient's perception of improvement, using VAS; the score ranges from 0 cm (absence of perceived improvement) to 10 cm (perception of optimal benefit). The AIT benefit was evaluated, considering both clinical improvement and drug use reduction (prescribed on demand, e.g., oral second-generation H1-antihistamine for AR and inhaled short-acting β2-agonist for asthma symptoms). Patients globally evaluated both parameters, reporting their perception by the VAS. Responder patient was arbitrarily defined on the basis of a VAS score ≥6 at the end of the AIT course.
AIT efficacy was also assessed by VAS for nasal symptoms and by Asthma Control Test™ (ACT) for asthma control. VAS was used to assess the subjective perception of nasal symptoms: it ranges from 0 (absence of symptoms) to 10 cm (very severe symptoms). ACT ranges from 0 (very bad control) to 25 (optimal control).
SLIT (Staloral 300, Stallergenes Italia, Milan, Italy) was administered for 3 years without interruption. The maintenance dose was five drops administered three times a week on alternate days.
Serum HDM-specific IgE levels were determined by using the ImmunoFluoriMetric assay procedure (ImmunoCAP, Thermo Fisher Scientific, CA, USA) before AIT starting. Quantitative-specific IgE concentrations were expressed in kU/l according to the traceable calibration to the second Implementation Research Project WHO for Human IgE. sIgE levels were considered positive if they were over 0.35 kU/l.
Statistical analysis was performed with the GraphPad software package analysis (GraphPad Prism Software Inc., CA, USA). IgE levels, VAS values, and ACT scores were reported as median with first and third quartiles. Wilcoxon test and χ test were used to compare variables before and after AIT. Correlations were determined using a Spearman's rank correlation coefficient. The level of statistical significance was set at p < 0.05.
Methods
We retrospectively analyzed the data concerning 39 allergic children (22 males; mean age of 13.0 years): 11 with AR, five with asthma and 23 with both disorders. All were consecutively treated with AIT between January 2010 and December 2012. We considered the cut-off of 10 kU/l for subdividing the children: 31 children (17 males; mean age of 12.5 years) had levels of serum-sIgE to house dust mites (HDM) ≥10 kU/l. Eight allergic children (five males, mean age: 13.4 years) had levels of serum-sIgE to HDM <10 kU/l and were considered as control. We considered this cut-off value on the basis of the previous study, demonstrating that this value was able to discriminate AIT responders from nonresponders. The Institutional Review Board of Instituto Giannina Gaslini (Genoa, Italy) approved the study; all patients' parents gave written informed consent.
All children underwent SLIT as part of the therapy for AR and/or asthma for 3 years. Inclusion criteria were: documented diagnosis of allergic rhinitis and/or asthma based on patient-reported symptoms, physical examination, and lung function test (including bronchodilation test); documented sensitization to HDM; demonstration of a consistent relationship between inhalation of HDM and occurrence of respiratory symptoms for defining the causal allergen (e.g., true allergy). Exclusion criteria for this study were: to suffer from other allergic diseases (i.e., atopic dermatitis or food allergy); clinically relevant anatomic impairment (e.g., septum deviation or nasal polyps); acute or chronic disorders representing a contraindication to AIT (e.g., autoimmune disease and malignancy, among others); and polysensitization.
AIT efficacy was assessed by the patient's perception of improvement, using VAS; the score ranges from 0 cm (absence of perceived improvement) to 10 cm (perception of optimal benefit). The AIT benefit was evaluated, considering both clinical improvement and drug use reduction (prescribed on demand, e.g., oral second-generation H1-antihistamine for AR and inhaled short-acting β2-agonist for asthma symptoms). Patients globally evaluated both parameters, reporting their perception by the VAS. Responder patient was arbitrarily defined on the basis of a VAS score ≥6 at the end of the AIT course.
AIT efficacy was also assessed by VAS for nasal symptoms and by Asthma Control Test™ (ACT) for asthma control. VAS was used to assess the subjective perception of nasal symptoms: it ranges from 0 (absence of symptoms) to 10 cm (very severe symptoms). ACT ranges from 0 (very bad control) to 25 (optimal control).
SLIT (Staloral 300, Stallergenes Italia, Milan, Italy) was administered for 3 years without interruption. The maintenance dose was five drops administered three times a week on alternate days.
Serum HDM-specific IgE levels were determined by using the ImmunoFluoriMetric assay procedure (ImmunoCAP, Thermo Fisher Scientific, CA, USA) before AIT starting. Quantitative-specific IgE concentrations were expressed in kU/l according to the traceable calibration to the second Implementation Research Project WHO for Human IgE. sIgE levels were considered positive if they were over 0.35 kU/l.
Statistical analysis was performed with the GraphPad software package analysis (GraphPad Prism Software Inc., CA, USA). IgE levels, VAS values, and ACT scores were reported as median with first and third quartiles. Wilcoxon test and χ test were used to compare variables before and after AIT. Correlations were determined using a Spearman's rank correlation coefficient. The level of statistical significance was set at p < 0.05.
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