Friday, 16 October 2015
Hall D1 Foyer (Floor 3) (Coex Convention Center)
MO Xian, Physician of Allergology
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Department of Allergy and Clinical Immunology,, State Key Laboratory of Respiratory Disease,the First Affiliated Hospital, Guangzhou Medical University, GuangZhou, China
Background Specific subcutaneous immunotherapy (SCIT) with house dust mite (HDM) has been shown to improve clinical symptoms in patients with allergic rhinitis and asthma in China, while less data regarding efficacy, safety and immunological mechanisms of specific sublingual immunotherapy (SLIT) in allergic patients. The aim of our study was to evaluate the efficacy, immunological mechanisms of SLIT HDM compared to SCIT HDM in rhinitis patients with HDM during 1 year of treatment. Method Recruitment took place from November 2009 to September 2010. The study enrolled 67 patients aged 5`55 years old with moderate-severe HDM induced allergic rhinitis with or without asthma. They were randomized (2:2:1) in three groups (SLIT group, n=27; SCIT group, n=26; Placebo, n=14, following the same schedule as SLIT group). The allergic rhinitis and asthma symptom and medication score collected from patient diary cards (from baseline to 1 year) were used for assessment of efficacy. Visual analogue score (VAS) were collected and skin prick tests, total-specific IgE were performed at baseline and 12 months after treatment. In addition, patients underwent Der p IgG4 and CD4+CD25+FoxP3+ Treg cells measurements. Results SCIT groups had a significant improvement for the change from baseline in mean total rhinitis symptom score compared with placebo after 1 year therapy (P=0.015), but between SLIT and placebo groups there were no significant difference(P=0.060). Both two groups had a significant improvement in mean rhinitis medication score compared with placebo (P<0.05), and the analysis of rhinitis VAS score change from baseline showed the same results. The mean asthma symptom or medication score did not show significant difference among the three groups. There was a trend toward up-regulation in the rate of CD4+CD25+FoxP3+ Treg cells from baseline to 1 year in both SCIT and SLIT subjects compared with Placebo group(P<0.05). The level of Der p IgG4 showed a significant increase in both SLIT and SCIT compared with placebo (P<0.05), furthermore, the mean level of Der p IgG4 of SCIT group was almost thirty times higher than SLIT group after 1 year therapy (P<0.05). Conclusion Both SCIT and SLIT had the efficacy in patients with moderate-severe HDM sensitized allergic rhinitis after 1 year of treatment, and SCIT also afford significant therapeutic benefits with respect to rhinitis symptom score. Serum Der p IgG4 and CD4+CD25+ FoxP3+ Treg cells may play roles in modulate immunoresponse to specific immunotherapy, but their relationship between clinical efficacy needs further study.