Chiewchalermsri Chirawat, Sangkanjanavanich Sasipa, Pradubpongsa Panitan, Mitthamsiri Wat, Jaisupa Nattapon, Jindarat Sarawut, Buranapraditkun Supranee, Jacquet Alain, Sangasapaviliya Atik, Boonpiyathad Tadech
Division of Allergy and Clinical Immunology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand.
Department of Medicine, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand.
Allergy Asthma Immunol Res. 2023 May;15(3):336-347. doi: 10.4168/aair.2023.15.3.336. Epub 2023 Jan 2.
Vitamin D (VitD) is an immunomodulatory molecule capable of alleviating allergic symptoms. However, the effectiveness of allergen-specific immunotherapy (AIT) is not commonly evidenced in the early build-up phase. The aim of the study was to determine the potential of VitD supplementation in this treatment phase.
Thirty-four house dust mite (HDM)-allergic adult patients treated with subcutaneous AIT were randomized to receive VitD2 60,000 IU/week or placebo for 10 weeks and followed up for 10 weeks. The primary endpoints were the symptom-medication score (SMS) and the treatment response rate. The secondary endpoints were eosinophil count and levels of plasma IL-10, Der p 2-specific IgG4, and dysfunctional regulatory T (CRTH2 Treg) cells.
Of 34 patients, 15 in each group completed the study. Patients with VitD deficiency receiving a VitD supplement showed significantly lower mean change SMS than the placebo group in weeks 10 (mean difference -54.54%, = 0.007) and 20 (mean difference -42.69%, = 0.04). The percentage of treatment responders reached 78% and 50% in the VitD and placebo groups, respectively, and the effect remained in week 20 (89% and 60%). No significant difference was observed for the tested immunological read-outs, with the exception of the frequency of CRTH2 Treg cells, which was remarkably reduced in the VitD-treated patients. Moreover, improvement in SMS was correlated to the number of CRTH2 Treg cells. Our experiment indicated that VitD downregulated activation markers, whereas it improved the function of CRTH2 Treg cells.
VitD supplementation in the build-up phase of AIT could relieve symptoms and decrease Treg cell dysfunction, especially in patients with VitD deficiency.
维生素D（VitD）是一种能够缓解过敏症状的免疫调节分子。然而，在过敏原特异性免疫治疗（AIT）的早期累积阶段，其有效性并不常见。本研究的目的是确定在该治疗阶段补充VitD的潜力。
34名接受皮下AIT治疗的屋尘螨（HDM）过敏成年患者被随机分为两组，一组每周接受60,000 IU VitD2，另一组接受安慰剂，为期10周，并随访10周。主要终点是症状-药物评分（SMS）和治疗反应率。次要终点是嗜酸性粒细胞计数、血浆IL-10水平、Der p 2特异性IgG4以及功能失调的调节性T（CRTH2 Treg）细胞水平。
34名患者中，每组各有15名完成研究。接受VitD补充剂的VitD缺乏患者在第10周（平均差异-54.54%，P = 0.007）和第20周（平均差异-42.69%，P = 0.04）的平均SMS变化显著低于安慰剂组。VitD组和安慰剂组的治疗反应者百分比分别达到78%和50%，且在第20周时效果依然存在（分别为89%和60%）。除CRTH2 Treg细胞频率外，所检测的免疫学指标未观察到显著差异，在接受VitD治疗的患者中CRTH2 Treg细胞频率显著降低。此外，SMS的改善与CRTH2 Treg细胞数量相关。我们的实验表明，VitD下调激活标志物，同时改善CRTH2 Treg细胞功能。
在AIT的累积阶段补充VitD可缓解症状并减少Treg细胞功能障碍，尤其是在VitD缺乏的患者中。
