Background. In European countries, the prevalence of pollen sensitization reaches 30–40%. In Russia pollen allergy ranges from 12,7 to 38%. In the southern regions of Russia, the main one is ragweed and weed pollen. The efficacy of the subcutaneous medicinal ragweed allergen has not previously been evaluated using modern symptom scales. Methods. Open-label, single-center, placebo-uncontrolled study of 60 patients aged 16–55 years with allergic rhinitis in combination with bronchial asthma and without it. A 2-preseason course of AIT with a subcutaneous allergen of Ambrosia was used for patients with monosensitization and an allergen Ambrosia + Artemisia (for oligosensitized patients) and Ambrosia + a mix of pollen of causal allergen for polysensitized patients. Treatment started 4 months before and stopped 2–4 weeks before the beginning of pollination. The RTSS (the rhinoconjunctivitis total symptom score) scale was used to assess the symptoms, and the DMS (Daily medical score) was used to estimate of medical treatment. Results. After 1-st season of treatment, there was a rapid decrease in the RTSS to 5,0 [4,0; 9,0] compared to the initial values of 13 [10, 15] points. By the second year, the decline in RTSS amounted to 4,5 [3,0; 4,5] points (p <0,001), the total effect size by second course was 0,96 (strong effect of the intervention). DMS (before treatment) was 2,0 [2,0; 2,0] points, after the first and second courses — 1,0 [1,0; 2,0] points (p=0,002), with a moderate effect size of 0,67 after the first year; by the second year, the effect size is 0,75 versus baseline (p <0,01). Conclusion. Monotherapy with a subcutaneous ragweed allergen or its combination with other allergens show high effectiveness, starting from the first course of therapy. In the second year, the improvement continues, but the dynamics decreases. The study demonstrated a strong size of the effect of medical intervention, which cannot be explained by the placebo effect.
BACKGROUND: Allergen-specific immunotherapy (ASIT) helps to reduce spontaneous and to induce basophil reactivity, which is one of the major mechanisms of its effectiveness. A number of studies, though, have not confirmed the informative value of the basophil activation test (BAT), in case of ASIT, with house dust mites, meadow grass pollen, and wasp venom. BAT outcomes are likely to be influenced by the properties of the sensitizing allergen, the duration of ASIT, and the BAT markers that are used. AIMS: To evaluate the basophils reactivity in the patients sensitized to weed pollen and treated with allergen-specific therapy. MATERIALS AND METHODS: The study involved 60 patients (aged 1655) with allergic rhinitis sensitized to weed pollen. The diagnosis was based on the skin test outcomes as well as on identifying specific antibodies to major allergens of ragweed, wormwood, timothy, and birch. The pre-seasonal ASIT involved water-salted extracts of pollen allergens during 2 years. Clinical symptoms and the immunotherapy effectiveness were evaluated 6 and 18 months after the ASIT started. BATs were made before the treatment, after the first and second courses of pre-seasonal ASIT, which corresponded to zero, the 3rd and the 15th months of the treatment. The activated basophils were identified based on the CRTH2pos CD203brightCD3neg phenotype. RESULTS: The first treatment course was completed by 52 patients, while the second one by 43 patients. A statistically significant decrease in spontaneous basophil reactivity was detected only after the second course of ASIT. The decrease in the allergen-induced basophil activation was identified in 67.4% of the samples obtained after the first ASIT course, and in 67.6% of samples taken after the second immunotherapy course. A decrease in the BAT stimulation index (BAT SI) was identified mainly in the patients featuring positive treatment outcomes. CONCLUSIONS: ASIT influences on the basophil reactivity indicators in the patients sensitized to weed pollen. The basophil activation test may be considered as a potential predictor of ASIT effectiveness.
BACKGROUND: The basophil activation test (BAT) reflects the presence of IgE on the cell surface and can be a tool for monitoring the effectiveness of allergen-specific immunotherapy (ASIT). It is likely that spontaneous and allergen-induced BAT levels may change after effective subcutaneous immunotherapy (SCIT) and this is of clinical importance. AIMS: determination of basophil activation markers in patients sensitized to weed pollen during SCIT. MATERIALS AND METHODS: A real clinical study (2 years, 60 patients) with allergic rhinitis who underwent SCIT with weed allergens for 2 seasons. The proportion of basophils expressing CD203c spontaneously and after exposure to a trigger allergen was determined. BAT was performed before treatment, after the first and second courses of pre-season SCIT (0, 3, 15 months of treatment). The effectiveness of SCIT was assessed by the dynamics of the symptom scale (Rhinoconjunctivitis total symptom score) and the drug assessment (Daily medical score). RESULTS: SCIT with water-salt extracts was effective: median RTSS in patients after two courses decreased from 13.0 [10.0; 15.0] to 4.5 [3.00; 7.25] points (p 0.001), DMS score from 2.0 [2.0; 2.0] vs 1.0 [1.0; 2.0] points (p0.001). Spontaneous BAT remained unchanged after the first course of ASIT. Mean BAT values before therapy and after the first course of SCIT did not differ (8.15 [6.10; 11.9] vs 9.0 [6.30; 12.0] %). After the second course of treatment, spontaneous BAT decreased (8.15 [6.10; 11.9] vs 6.20 [4.27; 9.00] %, 2 = 15.5, p0.001). Allergen-induced BAT decreased significantly from the first year of treatment. The overall change in the total group for BAT with ragweed after the first course of SCIT was 11.25 (CI 95 %: 7.10; 15.10) %, p 0.001. The overall difference in the induced ВAT test at the end of therapy reached 8.63 (CI 95: 5.30; 12.05) %, p 0.001. After the first course of therapy with mugwort allergens, the indices of induced BAT decreased by 12.0 (CI 95 %: 6.95; 17.90) %, p 0.001; after the second course, the difference from the initial values was 9.67 (CI 95%: -6.85; 15.90) %, p0.001. CONCLUSIONS: SCIT with ragweed and mugwort allergens was effective. The change in spontaneous and induced BAT is associated with a positive effect of ASIT.
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