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http://dx.doi.org/10.4168/aair.2018.10.6.675

Efficacy and Safety of Sublingual Immunotherapy in Elderly Rhinitis Patients Sensitized to House Dust Mites  

Kim, Ji Hye (Division of Respiratory, Allergy and Critical Care Medicine, Konyang University College of Medicine)
Lee, Ji Ho (Department of Allergy and Clinical Immunology, Ajou University School of Medicine)
Ye, Young-Min (Department of Allergy and Clinical Immunology, Ajou University School of Medicine)
Lee, Jae-Hyun (Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine)
Park, Jung Won (Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine)
Hur, Gyu-Young (Division of Respiratory and Critical Care Medicine, Korea University College of Medicine)
Kim, Joo-Hee (Division of Pulmonary, Allergy, and Critical Care Medicine, Hallylm University Sacred Heart Hospital)
Lee, Hyn-Young (Department of Statistics, Clinical Trial Center, Ajou University Medical Center)
Shin, Yoo Seob (Department of Allergy and Clinical Immunology, Ajou University School of Medicine)
Yang, Eun-Mi (Department of Allergy and Clinical Immunology, Ajou University School of Medicine)
Park, Hae-Sim (Department of Allergy and Clinical Immunology, Ajou University School of Medicine)
Publication Information
Allergy, Asthma & Immunology Research / v.10, no.6, 2018 , pp. 675-685 More about this Journal
Abstract
Purpose: This study aims to determine the efficacy and safety of house dust mite (HDM)-sublingual immunotherapy (SLIT) in elderly patients with AR. Methods: A total of 45 patients aged ${\geq}60years$ with HDM-induced AR who had ${\geq}3$ A/H ratio on skin prick test and/or ${\geq}0.35IU/L$ to both Dermatophagoides farinae and Dermatophagoides pteronyssinus by ImmunoCAP were enrolled in 4 university hospitals. To evaluate additional effects of HDM-SLIT, they were randomized to the SLIT-treated group (n = 30) or control group (n = 15). Rhinoconjunctivitis total symptom score (RTSS), rhinoscopy score, Korean rhinoconjunctivitis quality of life questionnaire, rhinitis control assessment test, asthma control test scores, and adverse reactions, were assessed at the first visit (V1) and after 1 year of treatment (V5); for immunological evaluation, serum levels of HDM-specific immunoglobulin A/IgE/IgG1/IgG4 antibodies and basophil response to HDMs were compared between V1 and V5 in both groups. Results: There were no significant differences in demographics, RTSS, skin reactivity to HDMs, or serum total/specific IgE levels to HDMs (P > 0.05, respectively) between the 2 groups. Nasal symptom score and RTSS decreased significantly at year 1 in the 2 groups (P < 0.05). There were no significant differences in percent decrease in nasal symptom score and RTSS at year 1 between the 2 groups (P > 0.05); however, rhinoscopic nasal symptom score decreased significantly in the SLIT-treated group (P < 0.05). Immunological studies showed that serum specific IgA levels (not specific IgE/IgG) and CD203c expression on basophils decreased significantly at V5 in the SLIT-treated group (P = 0.011 and P = 0.001, respectively), not in the control group. The control group required more medications compared to the treatment group, but there were no differences in adverse reactions. Conclusions: It is suggested that HDM-SLIT for 1 year could induce symptom improvement and may induce immunomodulation in elderly rhinitis patients.
Keywords
Allergic rhinitis; elderly; house dust mite; sublingual immunotherapy;
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1 Hill DA, Grundmeier RW, Ram G, Spergel JM. The epidemiologic characteristics of healthcare providerdiagnosed eczema, asthma, allergic rhinitis, and food allergy in children: a retrospective cohort study. BMC Pediatr 2016;16:133.   DOI
2 Becerril Angeles M, Vazquez Merino CL, Angeles Garay U, Alvarado Moctezuma LE, Vilchis Guizar E. Prevalence of allergic diseases in the elderly. Rev Alerg Mex 2008;55:85-91.
3 Bozek A, Ignasiak B, Filipowska B, Jarzab J. House dust mite sublingual immunotherapy: a double-blind, placebo-controlled study in elderly patients with allergic rhinitis. Clin Exp Allergy 2013;43:242-8.   DOI
4 Ohn J, Paik SH, Doh EJ, Park HS, Yoon HS, Cho S. Allergen sensitization pattern by sex: a cluster analysis in Korea. Ann Dermatol 2017;29:735-41.   DOI
5 Feng B, Xiang H, Jin H, Gao J, Huang S, Shi Y, et al. Efficacy of sublingual immunotherapy for house dust mite-induced allergic rhinitis: a meta-analysis of randomized controlled trials. Allergy Asthma Immunol Res 2017;9:220-8.   DOI
6 Wardzynska A, Kubsik B, Kowalski ML. Comorbidities in elderly patients with asthma: association with control of the disease and concomitant treatment. Geriatr Gerontol Int 2015;15:902-9.   DOI
7 Baptist AP, Nyenhuis S. Rhinitis in the elderly. Immunol Allergy Clin North Am 2016;36:343-57.   DOI
8 Pinto JM, Jeswani S. Rhinitis in the geriatric population. Allergy Asthma Clin Immunol 2010;6:10.   DOI
9 Sanz ML, Sanchez G, Gamboa PM, Vila L, Uasuf C, Chazot M, et al. Allergen-induced basophil activation: CD63 cell expression detected by flow cytometry in patients allergic to Dermatophagoides pteronyssinus and Lolium perenne. Clin Exp Allergy 2001;31:1007-13.   DOI
10 Eberlein B, Santos AF, Mayorga C, Nopp A, Ferrer M, Rouzaire P, et al. Basophil activation testing in diagnosis and monitoring of allergic disease - an overview. Allergo J 2016;25:26-33.
11 Ebo DG, Hagendorens MM, Schuerwegh AJ, Beirens LM, Bridts CH, De Clerck LS, et al. Flow-assisted quantification of in vitro activated basophils in the diagnosis of wasp venom allergy and follow-up of wasp venom immunotherapy. Cytometry B Clin Cytom 2007;72:196-203.
12 Van Overtvelt L, Baron-Bodo V, Horiot S, Moussu H, Ricarte C, Horak F, et al. Changes in basophil activation during grass-pollen sublingual immunotherapy do not correlate with clinical efficacy. Allergy 2011;66:1530-7.   DOI
13 Jutel M, Kosowska A, Smolinska S. Allergen immunotherapy: past, present, and future. Allergy Asthma Immunol Res 2016;8:191-7.   DOI
14 Pagano F. Therapeutic compliance in elderly patients with COPD. J Gerontol Geriat 2016;64:147-51.
15 Bozek A, Kolodziejczyk K, Warkocka-Szoltysek B, Jarzab J. Grass pollen sublingual immunotherapy: a double-blind, placebo-controlled study in elderly patients with seasonal allergic rhinitis. Am J Rhinol Allergy 2014;28:423-7.   DOI
16 Kim SY, Kim JH, Jang YS, Choi JH, Park S, Hwang YI, et al. The Basophil activation test is safe and useful for confirming drug-induced anaphylaxis. Allergy Asthma Immunol Res 2016;8:541-4.   DOI
17 Prince MJ, Wu F, Guo Y, Gutierrez Robledo LM, O'Donnell M, Sullivan R, et al. The burden of disease in older people and implications for health policy and practice. Lancet 2015;385:549-62.   DOI
18 Slavin RG. Special considerations in treatment of allergic rhinitis in the elderly: role of intranasal corticosteroids. Allergy Asthma Proc 2010;31:179-84.   DOI
19 Scichilone N, Ventura MT, Bonini M, Braido F, Bucca C, Caminati M, et al. Choosing wisely: practical considerations on treatment efficacy and safety of asthma in the elderly. Clin Mol Allergy 2015;13:7.   DOI
20 Burks AW, Calderon MA, Casale T, Cox L, Demoly P, Jutel M, et al. Update on allergy immunotherapy: American Academy of Allergy, Asthma & Immunology/European Academy of Allergy and Clinical Immunology/PRACTALL consensus report. J Allergy Clin Immunol 2013;131:1288-96.e3.   DOI
21 Hur GY, Lee JH, Park HS. Allergen immunotherapy for the treatment of respiratory allergies in the elderly. Curr Opin Allergy Clin Immunol 2017;17:304-8.   DOI
22 Kim MA, Ye YM, Ban GY, Shin YS, Nahm DH, Park HS. Linguistic adaptation of the rhinitis control assessment test in Korean. Allergy Asthma Respir Dis 2017;5:205-10.   DOI
23 Kwon HS, Lee SH, Yang MS, Lee SM, Kim SH, Kim DI, et al. Correlation between the Korean version of Asthma Control Test and health-related quality of life in adult asthmatics. J Korean Med Sci 2008;23:621-7.   DOI
24 Park KH, Cho JS, Lee KH, Shin SY, Moon JH, Cha CI. Rhinoconjunctivitis quality of life questionnaire (RQLQ) as an evaluator of perennial allergic rhinitis patients-the first report. Korean J Otolaryngol-Head Neck Surg 2002;45:254-62.
25 Kim JH, Yoon MG, Seo DH, Kim BS, Ban GY, Ye YM, et al. Detection of allergen specific antibodies from nasal secretion of allergic rhinitis patients. Allergy Asthma Immunol Res 2016;8:329-37.   DOI
26 Mathur SK. Allergy and asthma in the elderly. Semin Respir Crit Care Med 2010;31:587-95.   DOI
27 Lue KH, Lin YH, Sun HL, Lu KH, Hsieh JC, Chou MC. Clinical and immunologic effects of sublingual immunotherapy in asthmatic children sensitized to mites: a double-blind, randomized, placebocontrolled study. Pediatr Allergy Immunol 2006;17:408-15.   DOI
28 Trebuchon F, Lheritier-Barrand M, David M, Demoly P. Characteristics and management of sublingual allergen immunotherapy in children with allergic rhinitis and asthma induced by house dust mite allergens. Clin Transl Allergy 2014;4:15.   DOI
29 Bozek A. Pharmacological management of allergic rhinitis in the elderly. Drugs Aging 2017;34:21-8.   DOI
30 Bottcher MF, Haggstrom P, Bjorksten B, Jenmalm MC. Total and allergen-specific immunoglobulin A levels in saliva in relation to the development of allergy in infants up to 2 years of age. Clin Exp Allergy 2002;32:1293-8.   DOI
31 Kulis M, Saba K, Kim EH, Bird JA, Kamilaris N, Vickery BP, et al. Increased peanut-specific IgA in saliva correlates with food challenge outcomes following peanut sublingual immunotherapy. J Allergy Clin Immunol 2012;129:1159-62.   DOI
32 Sugimoto M, Kamemura N, Nagao M, Irahara M, Kagami S, Fujisawa T, et al. Differential response in allergen-specific IgE, IgGs, and IgA levels for predicting outcome of oral immunotherapy. Pediatr Allergy Immunol 2016;27:276-82.   DOI
33 Gomez E, Campo P, Rondon C, Barrionuevo E, Blanca-Lopez N, Torres MJ, et al. Role of the basophil activation test in the diagnosis of local allergic rhinitis. J Allergy Clin Immunol 2013;132:975-976.e1-5.   DOI
34 Oh JH, Hur GY, Ye YM, Kim JE, Park K, Park HS. Correlation between specific IgA and eosinophil numbers in the lavage fluid of patients with perennial allergic rhinitis. Allergy Asthma Proc 2008;29:152-60.   DOI
35 Kim JH, Kim SH, Palikhe S, Yang EM, Ye YM, Park HS. Increased basophil activation in adult patients with anaphylaxis. Ann Allergy Asthma Immunol 2015;115:523-5.e1.   DOI