Changes of specific IgE, Bronchial hyperreactivity and sinusitis after immunotherapy in asthmatic children

Kim, Soh Yeon; Lee, Joon Sung

Abstract

BACKGROUND: Though immunotherapy(IT) has become an effective rnethod in extrinsic allergic patients who didn't respond to pharmacologic therapy or couldn't avoid allergen, the mechanism, termination index and prognostic index of IT have not been clarified yet. METHOD: We selected 81 asthmatic children on immunotherapy with house dust mite (Dermatophagoides pteronyssinus and Dermatophagoides farinae). We measured the hematologic findings, the levels of serum IgG and IgE, allergen(house dust, Dermatophagoides pteronyssinus and Dermatophagoides farinae)-specific IgE concentrations, lymphocyte subsets and methacholine challenge test yearly during IT, and checked the radiographs of chest and paranasal sinus.
RESULTS
Peripheral white blood cell count, the percentage of eosinophil and total eosinophil count decreased significantly after 2 years of IT. Serum IgG level increased significantly after 3 years of IT. Serum total and specific IgE levels decreased significantly after 3 years of IT, but they were still higher than the normal values. CD4+, CD8+, and B lymphocytes did not change with the IT, but CD3+ lymphocytes increased significantly after 2 years of IT. PC20-methacholine increased significantly after 1 year of IT, but no correlation was found between the duration of IT and bronchial hyperreactivity. Twenty-eight patients(34.6%) had abnormal findings on chest radiographs: 15 patients(53.6%) as bronchitis, 10 patients(35.7%) as bronchopneumonia, 2 patients(7.1%) as hyperinflation and 1 patient(3.6%) as atelectasis. Sixty-three patients(77.8%) had abnormal findings on paranasal sinus radiographs. In the follow-up radiographs of 49 patients, 28 patients(57.1%) showed improvement of paranasal sinusitis after 1 year of IT.
CONCLUSION
This study showed some changes of the immunologic findings such as eosinophil count, IgG, IgE, allergen-specific IgE and CD3+ lymphocytes, and improvement of bronchial hyperreactivity and paranasal sinusitis' in asthmatic children during IT. These findings were closely related to clinical improvement.