速发免疫疗法对哮喘患者变应原支气管激发后气道炎症和气道高反应性的影响。

Effect of rush immunotherapy on airway inflammation and airway hyperresponsiveness after bronchoprovocation with allergen in asthma.

作者信息

Kohno Y, Minoguchi K, Oda N, Yokoe T, Yamashita N, Sakane T, Adachi M

机构信息

First Department of Internal Medicine, Showa University, Tokyo, Japan.

出版信息

J Allergy Clin Immunol. 1998 Dec;102(6 Pt 1):927-34. doi: 10.1016/s0091-6749(98)70330-6.

DOI:10.1016/s0091-6749(98)70330-6

PMID:9847433

Abstract

BACKGROUND

Rush immunotherapy (RIT) has been shown to be effective in allergic asthma.

OBJECTIVE

We investigated the mechanisms of RIT on the basis of cytokine production by T-cell lines and airway inflammation and responsiveness.

METHODS

Subjects were 8 patients with house dust mite-allergic asthma treated with dust mite extract RIT for 6 months and 6 RIT-untreated control patients. IL-5 production by Dermatophagoides farinae -specific T-cell lines, eosinophil percentages, and eosinophil cationic protein (ECP) in induced sputum and airway responsiveness to allergen and histamine were evaluated before and after treatment. Changes in eosinophil percentages and ECP in induced sputum and responsiveness to histamine 24 hours after allergen inhalation were also studied.

RESULTS

After 6 months of RIT, percentages of total eosinophils (43. 0% +/- 6.90% to 16.8% +/- 2.48%; P <.01), percentages of EG2(+ ) eosinophils (32.6% +/- 6.39% to 19.7% +/- 4.68%; P <.01) and ECP (362.7 +/- 125.3 ng/mL to 26.2 +/- 5.15 ng/mL; P <.05) decreased in induced sputum, and IL-5 production by T-cell lines decreased (617 +/- 93.2 pg/mL to 200.0 +/- 34.1 pg/mL; P <.01). RIT decreased both early- and late-phase bronchoconstriction (early phase: 33.2% +/- 3. 46% to 25.4% +/- 1.42%; P <.03; late phase: 16.2% +/- 3.52% to 6.2% +/- 1.96%; P <.03) and suppressed increases in the percentages of total (61.8% +/- 4.89% to 42.0% +/- 4.67%; P <.01) and EG2-positive eosinophils (55.54% +/- 7.21% to 36.5% +/- 6.43%; P <.01) and ECP (685.6 +/- 217.0 ng/mL to 85.4 +/- 23.4 ng/mL; P <.05) in induced sputum after allergen inhalation. RIT also decreased airway responsiveness to dust mite (1:303.7 +/- 123.7 wt/vol to 1:65.0 +/- 13.2 wt/vol; P <.03) and to histamine before (397.1 +/- 206.9 microgra/mL to 1391.3 +/- 283.3 microgram/mL; P <.03) and after allergen inhalation (139.2 +/- 36.5 microgram/mL to 629.1 +/- 196.3 microgram/mL; P <.03).

CONCLUSION

RIT decreases airway inflammation and airway hyperresponsiveness before and after bronchial provocation with allergen, possibly by inhibiting both allergen-specific T-cell- and mast cell-dependent pathways. RIT is an effective antiinflammatory treatment in allergic asthma.

摘要

背景

速发型免疫疗法（RIT）已被证明对过敏性哮喘有效。

目的

我们基于T细胞系产生的细胞因子、气道炎症和反应性来研究RIT的作用机制。

方法

研究对象为8例接受尘螨提取物RIT治疗6个月的屋尘螨过敏性哮喘患者和6例未接受RIT治疗的对照患者。在治疗前后评估粉尘螨特异性T细胞系产生的白细胞介素-5、诱导痰中的嗜酸性粒细胞百分比和嗜酸性粒细胞阳离子蛋白（ECP）以及气道对过敏原和组胺的反应性。还研究了吸入过敏原24小时后诱导痰中嗜酸性粒细胞百分比和ECP的变化以及对组胺的反应性。

结果

RIT治疗6个月后，诱导痰中总嗜酸性粒细胞百分比（43.0%±6.90%降至16.8%±2.48%；P<.01）、EG2(+)嗜酸性粒细胞百分比（32.6%±6.39%降至19.7%±4.68%；P<.01）和ECP（362.7±125.3 ng/mL降至26.2±5.15 ng/mL；P<.05）降低，T细胞系产生的白细胞介素-5减少（617±93.2 pg/mL降至200.0±34.1 pg/mL；P<.01）。RIT降低了早发和迟发相支气管收缩（早发相：33.2%±3.46%降至25.4%±1.42%；P<.03；迟发相：16.2%±3.52%降至6.2%±1.96%；P<.03），并抑制了吸入过敏原后诱导痰中总嗜酸性粒细胞（61.8%±4.89%降至42.0%±4.67%；P<.01）和EG2阳性嗜酸性粒细胞（55.54%±7.21%降至36.5%±6.43%；P<.01）百分比以及ECP（685.6±217.0 ng/mL降至85.4±23.4 ng/mL；P<.05）的增加。RIT还降低了气道对尘螨的反应性（1:303.7±123.7 wt/vol降至1:65.0±13.2 wt/vol；P<.03）以及吸入过敏原前（397.1±206.9 μg/mL降至139.1±283.3 μg/mL；P<.03）和吸入过敏原后（139.2±36.5 μg/mL降至629.1±196.3 μg/mL；P<.03）对组胺的反应性。