Salivary IgG4 Levels Contribute to Assessing the Efficacy of Dermatophagoides pteronyssinus Subcutaneous Immunotherapy in Children with Asthma or Allergic Rhinitis

Abstract

At present, there are no effective, non-invasive, and objective indicators to evaluate the efficacy of pediatric house dust mite (HDM)-specific allergen immunotherapy (AIT). A prospective, observational study was performed in children with Dermatophagoides pteronyssinus (Der p) asthma and/or allergic rhinitis (AR). Forty-four patients received subcutaneous Der p-AIT for 2 years, and eleven patients received only symptomatic treatment. The patients needed to finish their questionnaires at each visit. Serum and salivary Der p-specific IgE, IgG4, and IgE-blocking factors (IgE-BFs) were measured at 0, 4, 12, and 24 months during AIT. A correlation between them was also evaluated. Subcutaneous Der p-specific AIT improved the clinical symptoms of children with asthma and/or AR. The Der p-specific IgE-BF significantly increased at 4, 12, and 24 months after AIT treatment. Serum and salivary Der p-specific IgG4 significantly increased with the time of the AIT treatment, and significant correlations between them at different time points were observed (p < 0.05). Furthermore, there were significant correlations (R = 0.31–0.62) between the serum Der p-specific IgE-BF and Der p-specific IgG4 at the baseline, 4, 12, and 24 months after the AIT (p < 0.01). The salivary Der p-specific IgG4 levels also demonstrated a certain correlation with the Der p-specific IgE-BF. Der p-specific AIT is an effective treatment for children with asthma and/or AR. Its effect was associated with increased serum and salivary-specific IgG4 levels, as well as an increased IgE-BF. Non-invasive salivary-specific IgG4 may be useful for monitoring the efficacy of AIT in children.

Efficacy and safety of sublingual versus subcutaneous immunotherapy in children with allergic rhinitis: a systematic review and meta-analysis

“…A total of 4195 studies were retrieved through database search, and then 1968 duplicates were removed. Based on screening with titles and abstracts, and subsequently with full texts, 50 studies ( 14 – 19 , 23 – 33 , 40 – 72 ) were included in the end, with 48 studies included for quantitative analysis. Figure 1 shows the screening process of qualified studies.…”

“…SSs were evaluated in 5 studies ( 14 , 23 , 40 , 54 , 70 ), including 1279 patients in the SCIT group and 1223 in the non-SCIT group. Pooled analysis illustrated that compared with the non-SCIT group, the SCIT group had a significantly lower SS (pooled SMD: -2.52, 95%CI: -3.59, -1.46, I 2 = 95.9%, P < 0.001) ( Supplementary Figure 7 ).…”

“…MSs were assessed in 3 studies ( 14 , 23 , 54 ), including 1154 patients in the SCIT group and 1119 in the non-SCIT group. Pooled analysis demonstrated that the SCIT group had an equivalent MS to the non-SCIT group (pooled SMD: -1.42, 95%CI: -3.20, 0.36, I 2 = 96.9%, P = 0.119) ( Supplementary Figure 8 ).…”

“…Of the 50 included studies ( 14 – 19 , 23 – 33 , 40 – 72 ), merely 6 studies ( 18 , 19 , 61 , 63 , 71 , 72 ) directly compared SLIT and SCIT, no studies directly compared the effects of SLIT and SCIT on new sensitizations and development of asthma, and only one study ( 72 ) provided the direct comparison of SLIT and SCIT for SMSs and TRAEs despite significant differences between these two treatments. Thus, indirect comparison was conducted to further assess the efficacy and safety of SLIT versus SCIT.…”

“…The outcomes in this analysis included SSs, MSs, SMSs, new sensitizations, development of asthma, improvement, and TRAEs. Concerning SSs, the higher the SS, the more severe the symptom ( 23 ). Symptoms included itchy nose, sneezing, running nose, blocked nose, itchy eyes, etc.…”