Effective hyposensitization in allergic rhinitis using a potent partially purified extract of house dust mite

Abstract

Summary Thirty‐eight adults with allergic rhinitis have been treated with a new partially purified extract of house dust mite (Dermatophagoides pteronyssinus) in a double‐blind placebo‐controlled trial. Patients were randomized to active (Pharmalgen®, D. pteronyssinus) and placebo (histamine) treatment by sensitivity to D. pteronyssinus on nasal challenge. In the actively treated group nasal symptoms, assessed by visual analogue score, improved (P <0.01), sensitivity on nasal challenge with allergen was reduced (P <0.05) and weal size on skin‐prick test with allergen was reduced (P <0.01), compared with the placebo group. These results occurred after 3 months of treatment. Reduction in target organ sensitivity occurred, while the serum level of D. pteronyssinus IgE rose in the active group from 14.2 to 22.5 PRU/ml (geometric mean) but did not change significantly in the placebo group. As anticipated, because of the treatment schedule used, a number of generalized allergic reactions were induced by injections, but all responded promptly and easily to treatment. These results suggest this is an effective form of therapy, which now offers us the opportunity to study the immunological mechanisms of hyposensitization and to devise a modified schedule causing fewer reactions.

Immunotherapy as an effective tool in allergy treatment

“…Nine studies investigated other pollen allergens: mountain cedar (10,27,29), Parietaria (42,43,46), Cupressus (45), Cocos (41), and mixtures (6); efficacy was demonstrated in six. The efficacy of house-dust-mite immunotherapy (14,24,26,28,33) was based on five studies (three showing efficacy). In mold allergies, efficacy was documented in one study investigating Alternaria (31).…”

Ten‐Year Follow‐Up Study of Allergen‐Specific Immunoglobulin E and Immunoglobulin G4, Soluble Interleukin‐2 Receptor, Interleukin‐4, Soluble Intercellular Adhesion Molecule‐1 and Soluble Vascular Cell Adhesion Molecule‐1 in Serum of Patients on Immunotherapy for Perennial Allergic Rhinitis

“…All the patients were selected from our outpatients who satisfied all of the following conditions before enrolment: (1) well-documented history of severe typical perennial allergic rhinitis according to the criteria of Okuda et al [13] but no history of asthma; (2) positive skin test to D. farinae according to the criteria of Okuda et al [13]; (3) positive nasal provocation test to D. farinae according to the criteria of Okuda et al [13]; and (4) eosinophilia in nasal smears according to the criteria of Okuda et al [13].…”

“…Allergen-specific immunotherapy has been widely used in the treatment of allergic diseases for more than 80 years, and three recent double-blind placebo-controlled trials for perennial allergic rhinitis have all clearly shown the efficacy of immunotherapy [1][2][3]. Although several mechanisms for the clinical benefit of immunotherapy have been proposed, the exact mechanisms by which this therapeutic method exerts its action in improving patient symptoms have been the subject of much debate and still remain unclear.…”

Allergen Immunotherapy in Allergic Respiratory Diseases

“…A study of dust mite SCIT in perennial AR showed statistically signifi cant ( P , .01) improvement in rhinitis symptoms, rescue medication, and visual analog scores along with reductions in responses to nasal challenge and SPT. 73 Similarly, SCIT with animal dander demonstrated, in cat-allergic patients with perennial rhinoconjunctivitis, improved symptom scores and reduced responses to conjunctival provocation as well as decreases in skin test responses. 74 Like asthma, SCIT for AR also led to diseasemodifying effects as illustrated by preventing new sensitizations.…”