Kim Ji Hye, Lee Ji Ho, Ye Young Min, Lee Jae Hyun, Park Jung Won, Hur Gyu Young, Kim Joo Hee, Lee Hyn Young, Shin Yoo Seob, Yang Eun Mi, Park Hae Sim
Division of Respiratory, Allergy and Critical Care Medicine, Konyang University College of Medicine, Daejeon, Korea.
Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
Allergy Asthma Immunol Res. 2018 Nov;10(6):675-685. doi: 10.4168/aair.2018.10.6.675.
This study aims to determine the efficacy and safety of house dust mite (HDM)-sublingual immunotherapy (SLIT) in elderly patients with AR.
A total of 45 patients aged ≥ 60 years with HDM-induced AR who had ≥ 3 A/H ratio on skin prick test and/or ≥ 0.35 IU/L to both and by ImmunoCAP were enrolled in 4 university hospitals. To evaluate additional effects of HDM-SLIT, they were randomized to the SLIT-treated group (n = 30) or control group (n = 15). Rhinoconjunctivitis total symptom score (RTSS), rhinoscopy score, Korean rhinoconjunctivitis quality of life questionnaire, rhinitis control assessment test, asthma control test scores, and adverse reactions, were assessed at the first visit (V1) and after 1 year of treatment (V5); for immunological evaluation, serum levels of HDM-specific immunoglobulin A/IgE/IgG1/IgG4 antibodies and basophil response to HDMs were compared between V1 and V5 in both groups.
There were no significant differences in demographics, RTSS, skin reactivity to HDMs, or serum total/specific IgE levels to HDMs ( < 0.05, respectively) between the 2 groups. Nasal symptom score and RTSS decreased significantly at year 1 in the 2 groups ( < 0.05). There were no significant differences in percent decrease in nasal symptom score and RTSS at year 1 between the 2 groups ( < 0.05); however, rhinoscopic nasal symptom score decreased significantly in the SLIT-treated group ( < 0.05). Immunological studies showed that serum specific IgA levels (not specific IgE/IgG) and CD203c expression on basophils decreased significantly at V5 in the SLIT-treated group ( = 0.011 and = 0.001, respectively), not in the control group. The control group required more medications compared to the treatment group, but there were no differences in adverse reactions.
It is suggested that HDM-SLIT for 1 year could induce symptom improvement and may induce immunomodulation in elderly rhinitis patients.
本研究旨在确定屋尘螨（HDM）舌下免疫疗法（SLIT）对老年变应性鼻炎（AR）患者的疗效和安全性。
4家大学医院共纳入45例年龄≥60岁、由HDM诱发的AR患者，这些患者皮肤点刺试验A/H比值≥3，和/或ImmunoCAP检测对HDM的sIgE≥0.35 IU/L。为评估HDM-SLIT的额外效果，将患者随机分为SLIT治疗组（n = 30）和对照组（n = 15）。在首次就诊（V1）和治疗1年后（V5）评估鼻结膜炎总症状评分（RTSS）、鼻镜检查评分、韩国鼻结膜炎生活质量问卷、鼻炎控制评估测试、哮喘控制测试评分及不良反应；进行免疫学评估时，比较两组V1和V5时HDM特异性免疫球蛋白A/IgE/IgG1/IgG4抗体的血清水平及嗜碱性粒细胞对HDM的反应。
两组在人口统计学、RTSS、对HDM的皮肤反应性或HDM的血清总/特异性IgE水平方面均无显著差异（P均<0.05）。两组在第1年时鼻症状评分和RTSS均显著降低（P<0.05）。两组在第1年时鼻症状评分和RTSS的降低百分比无显著差异（P<0.05）；然而，SLIT治疗组鼻镜检查鼻症状评分显著降低（P<0.05）。免疫学研究表明，SLIT治疗组在V5时血清特异性IgA水平（而非特异性IgE/IgG）和嗜碱性粒细胞上的CD203c表达显著降低（P分别为0.011和0.001），而对照组未降低。与治疗组相比，对照组需要更多药物治疗，但不良反应无差异。
提示HDM-SLIT治疗1年可改善老年鼻炎患者的症状，并可能诱导免疫调节。
