Effect of Dermatophagoides pteronyssinus Immunotherapy on Upper and Lower Airway Eosinophilic Inflammatory Response to Nasal Allergen Challenge

Abstract

Purpose It remains unknown whether allergen-specific immunotherapy (AIT) could attenuate airway inflammatory response triggered by allergen exposure. Methods We performed Dermatophagoides pteronyssinus ( Der-p ) nasal provocation tests (NPTs) in allergic rhinitis (AR) and/or asthma patients without AIT (non-AIT), or at 16, 52, 104, or 156 weeks after Der-p AIT. Rhinitis and asthma visual analog scale (VAS; VAS of nasal symptoms [VAS-NS], VAS of asthma symptoms), the rhinoconjunctivitis quality of life questionnaire (RQLQ), nasal lavage, sputum induction, fractional exhaled nitric oxide (FeNO), nasal airway resistance, pulmonary function, and airway hyperresponsiveness were performed before and after NPT. Results Non-AIT subjects demonstrated significantly higher VAS-NS before and after NPT compared to AIT subjects ( P < 0.05). NPT response was positive in 14 (100%) non-AIT, 7 (70%) 16 weeks-AIT, 6 (60%) 52 weeks-AIT, 6 (60%) 104 weeks-AIT, and 2 (20%) 156 weeks-AIT subjects. The NPT grade significantly correlated with AIT duration and baseline RQLQ score ( r = −0.561, P < 0.001 and r = 0.525, P < 0.001, respectively). Sputum and nasal lavage eosinophil count, and FeNO in non-AIT subjects were significantly increased 6 hours after NPT ( P < 0.05). AIT subjects did not change their sputum or nasal lavage eosinophil count before and after NPT. Subjects with 156 weeks-AIT demonstrated significantly lower levels of sputum and nasal lavage eosinophil count before and after NPT when compared with non-AIT patients ( P < 0.05). Sputum eosinophil counts positively correlated with nasal lavage eosinophil counts at baseline and 6 hours after NPT ( r = 0.719, P = 0.006 and r = 0.823, P < 0.001, respectively) in non-AIT patients. Conclusion Our results show that AIT can attenuate both upper and lower airway immune response to nasal allergen exposure in patients with AR and/or asthma.

Diagnostic Value of a Novel Eosinophil Cationic Protein-Myeloperoxidase Test Paper Before and After Treatment for Allergic Rhinitis

“…31 The TNSS, RQLQ, and VAS are the most commonly used indicators to evaluate symptoms in clinical trials and clinical practice. 32 Previous studies have shown that the eosinophil count is related to symptoms such as nasal hyperresponsiveness and nasal congestion in AR. 33,34 Moreover, another study has shown that the TNSS score was significantly associated with eosinophil count in the blood and nose of patients with AR.…”

“…35 The RQLQ score is usually used in conjunction with the eosinophil count to evaluate the treatment effect and prognosis in AR patients. 32,36 After antihistamine treatment, it has been reported that the RQLQ scores and eosinophil counts decreased significantly. 36 Additionally, the RQLQ score was positively associated with the speed and degree of symptom development.…”

Allergen-specific immunotherapy with Alutard SQ improves allergic inflammation in house-dust mites-induced allergic asthma rats through inactivation of the HMGB1/TLR4/NF-κB pathway

“…Both effects promote the inflammation of allergic asthma. Huang et al showed that AIT attenuates both upper and lower airway immune response to nasal allergen exposure in patients with asthma to improve airway inflammatory response ( 33 ). AIT increases secretoglobin 1A1 expression in cells of the lower airways from patients with allergic asthma to improve airway inflammatory response ( 34 ).…”