Monitoring the efficacy of immunotherapy by symptom scores and the skin prick test in patients with allergic rhinitis

Year 2003, Volume: 10 Issue: 6, 221 - 225, 24.12.2003

Yücel Akbaş Mustafa Rahmi Saatçi

Abstract

Objectives: We evaluated the role of the skin prick test, symptom scores, and total and specific IgE levels in monitor­ ing the efficacy of immunotherapy in allergic rhinitis.Patients and Methods: Thirty patients with allergic rhinitis were assigned to two treatment groups depending on their pref- erences and their conditions to comply with follow-ups. Thus, 20 patients 12 females, 8 males; mean age 26 years; range 12 to 40 years and 10 Controls 6 females, 4 males; mean age 28 years; range 16 to 48 years received immunotherapy and medical treatment, respectively. Ali the patients were evaluated by skin prick tests, symptom scores, and total and specific IgE lev­ els before, and after 6,12,24, and 36 months of, the treatment.Results: Symptom scores and skin test results differed signifi- cantly after treatment in the immunotherapy group p<0.01 , vvhereas similar results were obtained in the control group.These two parameters also differed significantly betvveen the two groups p<0.05 . No significant differences were found betvveen the total IgE and specific IgE results. Immunotherapy-associated adverse events were few, and none required discontinuation.Conclusion: Skin prick tests and symptom scores can be used in monitoring the efficacy of immunotherapy in patients with allergic rhinitis.

Keywords

Allergens/immunology/therapeutic use, antigens, Dermatophagoides, desensitization, immunologic, immunotherapy/ methods, monitoring, immunologic/methods, rhinitis, allergic, perennial/therapy/immunology, skin tests

Alerjik rinitte immünterapi etkinliğinin izlenmesinde semptom skoru ve deri testi

Abstract

Amaç: Alerjik rinitli hastalarda uyguladığımız immünterapinin etkinliğini izlemede semptom skoru, deri testi, ve total IgE ve spesifik IgE düzeylerinin rolü arafltırıldı.Hastalar ve Yöntemler: Öykü, fizik muayene, deri testi,total IgE ve spesifik IgE değerleri ile alerjik rinit tanısı konan 30 hasta, tercihlerine ve izleme uyum sağlayıp sağlayamayacaklarına göre immünterapi ve medikal tedavi gruplarına ayrıldı. Hastalarda tedavi öncesinde ve tedavinin 6,12, 24 ve 36. aylarında deri testi, semptom skoru, spesifikIgE ve total IgE ölçümleri yapıldı. Bulgular: İmmünterapi grubunda tedavi öncesi ve sonrası semptom skorları ve deri testlerinde anlamlı farklılık bulunurken p

Keywords

Alerjen/immünoloji/terapötik kullanım, antijen, Dermatophagoides, desensitizasyon, immünolojik, immünterapi/yöntem, izleme, immünolojik/yöntem, rinit, alerjik, perennial/tedavi, immünoloji, deri testi

References

• Kupa A. Allergic rhinitis and immunotherapy. Med J Aust 1992;157:9-11.
• McHugh SM, Ewan PW. A clinical index: a new method to assess efficacy of allergen immunotherapy. Allergy 1992;47(2 Pt 1):115-20.
• Yılmaz M, Bingöl G, Altıntafl D, Kendirli SG. Effect of SIT on quality of life. Allergy 2000;55:302.
• Malling HJ. Allergen-specific immunotherapy in aller- gic rhinitis. Curr Opin Allergy Clin Immunol 2001;1: 43-6.
• Berger WE. Treatment update: allergic rhinitis. Allergy Asthma Proc 2001;22:191-8.
• Veling MC, Trevino RJ. The treatment of allergic rhini- tis with immunotherapy: a review of 1,000 cases. Ear Nose Throat J 2001;80:542-3.
• Bousquet J, Demoly P, Michel FB. Specific immunother- apy in rhinitis and asthma. Ann Allergy Asthma Immunol 2001;87(1 Suppl 1):38-42.
• Frieri M. Treatment update for allergic rhinitis. Allergy Asthma Proc 2000;21:377-9.
• Ohashi Y, Nakai Y, Tanaka A, Kakinoki Y, Washio Y, Nakai Y. Allergen-specific immunotherapy for allergic rhinitis: a new insight into its clinical efficacy and mechanism. Acta Otolaryngol Suppl 1998;538:178-90.
• Malling HJ. Allergen-specific immunotherapy in the management of allergic rhinitis. Allergy 1999;54 Suppl 56:35-6.
• Ross RN, Nelson HS, Finegold I. Effectiveness of spe- cific immunotherapy in the treatment of allergic rhini- tis: an analysis of randomized, prospective, single- or double-blind, placebo-controlled studies. Clin Ther 2000;22:342-50.
• Nalebuff DJ. In vitro testing methodologies. Evolution and current status. Otolaryngol Clin North Am 1992; 25:27-42.
• King HC. Skin endpoint titration. Still the standard? Otolaryngol Clin North Am 1992;25:13-25.
• Trevino RJ. Comparison of results of immunotherapy based on skin end-point titration, prick testing, and scratch testing. Otolaryngol Head Neck Surg 1994;111: 550-2.
• Iliopoulos O, Proud D, Adkinson NF Jr, Creticos PS, Norman PS, Kagey-Sobotka A, et al. Effects of immunotherapy on the early, late, and rechallenge nasal reaction to provocation with allergen: changes in inflam- matory mediators and cells. J Allergy Clin Immunol 1 9 9 1 ; 8 7 : 8 5 5 - 6 6 .
• Einarsson R, Dre b o rg S, Hammarstrom L, Lofkvist T, Smith CI, Svensson G. Monitoring of mite Dermatophagoides farinae allergen-specific IgG and IgG subclass distribution in patients on immunotherapy. A l l e rgy 1992;47(2 Pt 1):76-82.
• Nalebuff DJ, Fadal RG, King W. Allergic rhinosinusitis: the total rhinologic disease. Ear Nose Throat J 1993; 72:430-1.
• Ohashi Y, Nakai Y, Kihara S, Nakagawa T, Miyamoto T. House dust mite-specific IgE, IgG1, and IgG4anti- bodies in patients with perennial rhinitis. Ann Otol Rhinol Laryngol 1987;96:434-7.
• Aas K, Backman A, Belin L, Weeke B. Standardization of allergen extracts with appropriate methods. The combined use of skin prick testing and radio-aller- gosorbent tests. Allergy 1978;33:130-7.
• Andri L, Senna G, Betteli C, Givanni S, Andri G, Falagiani P. Local nasal immunotherapy for Dermatophagoides- induced rhinitis: efficacy of a powder extract. J Allerg y Clin Immunol 1993;91:987-96.
• Mehta SB, Smith JM. Nasal hyposensitization and hay fever. Clin Allergy 1975;5:279-84.
• Klimek L, Reske-Kunz AB, Malling HJ. Methods for monitoring of therapeutic efficacy in immunotherapy of allergic rhinitis. Wien Med Wochenschr 1999;149: 394-402. [Abstract]
• McHugh SM, Lavelle B, Kemeny DM, Patel S, Ewan P W. A placebo-controlled trial of immunotherapy with two extracts of Dermatophagoides ptero n y s s i- nus in allergic rhinitis, comparing clinical outcome with changes in antigen-specific IgE, IgG, and IgG subclasses. J Allergy Clin Immunol 1990;86(4 Pt 1): 5 2 1 - 3 1.
• Piazza I, Bizzaro N. Humoral response to subcuta- neous, oral, and nasal immunotherapy for allergic rhinitis due to Dermatophagoides pteronyssinus. Ann Allergy 1993;71:461-9.
• Trevino RJ, Veling MC. The importance of quantifying skin reactivity in treating allergic rhinitis with immunotherapy. Ear Nose Throat J 2000;79:362-4, 366.
• van Cauwenberge P, Bachert C, Passalacqua G, Bousquet J, Canonica GW, Durham SR, et al. Consensus statement on the treatment of allergic rhini- tis. European Academy of Allergology and Clinical Immunology. Allergy 2000;55:116-34.
• Horst M, Hejjaoui A, Horst V, Michel FB, Bousquet J. Double-blind, placebo-controlled rush immunothera- py with a standardized Alternaria extract. J Allergy Clin Immunol 1990;85:460-72.
• Lockey RF, Benedict LM, Turkeltaub PC, Bukantz SC. Fatalities from immunotherapy (IT) and skin testing (ST). J Allergy Clin Immunol 1987;79:660-77.
• Hejjaoui A, Dhivert H, Michel FB, Bousquet J. Immunotherapy with a standardized Dermatophagoides p t e ronyssinus extract. IV. Systemic reactions according to the immunotherapy schedule. J Allergy Clin Immunol 1 9 9 0 ; 8 5 : 4 7 3 - 9 .
• Mellerup MT, Hahn GW, Poulsen LK, Malling H. Safety of allergen-specific immunotherapy. Relation between dosage regimen, allergen extract, disease and systemic side-effects during induction treatment. Clin Exp Allergy 2000;30:1423-9.
• Vervloet D, Khairallah E, Arnaud A, Charpin J. A p rospective national study of the safety of immunother- a p y. Clin Allergy 1980;10:59-64.