Allergy Asthma Immunol Res.  2018 Jan;10(1):18-24. 10.4168/aair.2018.10.1.18.

A Retrospective Study of Clinical Response Predictors in Subcutaneous Allergen Immunotherapy With House Dust Mites for Allergic Rhinitis

• Lee JH
• Kim SC
• Choi H
• Jung CG
• Ban GY
• Shin YS
• Nahm DH
• Park HS
• Ye YM

• KMID: 2428846
• DOI: http://doi.org/10.4168/aair.2018.10.1.18

Abstract

PURPOSE
House dust mites (HDM) are major allergens that cause allergic rhinitis (AR). Allergen-specific subcutaneous immunotherapy (SCIT) has been shown to be clinically beneficial in many clinical trials. Such trials, however, are not reflective of all patient populations. The aim of this study was to describe the efficacy and safety of SCIT in routine clinical practice in Korean adults with AR sensitized to HDM.
METHODS
We reviewed medical records of 304 patients with AR treated at an allergy clinic of a tertiary hospital using SCIT with aluminum hydroxide-adsorbed allergen extract targeting HDM alone or with pollens for at least 1 year from 2000 to 2012. Patients with asthma were excluded. Rates of remission, defined as no further requirement of maintenance medication, over time were determined by means of life tables and extension of survival analysis. Specific immunoglobulin E (IgE) levels to HDM were categorized into 6 classes.
RESULTS
The mean time until achieving remission was 4.9±0.1 years, and the cumulative incidence of remission from AR was 76.6%. Severe AR (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.23-0.69; P=0.001), specific IgE levels to HDM ≥17.5 kU/L (OR, 1.85; 95% CI, 1.01-3.37; P=0.045), and duration of immunotherapy ≥3 years (OR, 7.37; 95% CI, 3.50-15.51; P<0.001) were identified as significant predictors of clinical remission during SCIT for patients with AR sensitized to HDM. Overall, 73 patients (24.0%) experienced adverse reactions to SCIT, and only 1 case of anaphylaxis (0.3%) developed.
CONCLUSIONS
SCIT with HDM was found to be effective and safe for patients with AR. Specific IgE levels to HDM and a duration of SCIT ≥3 years may be predictors of clinical responses to SCIT in AR patients.

Keyword

Allergen-specific immunotherapy; house dust mites; remission; rhinitis, allergic

MeSH Terms

Adult
Allergens
Aluminum
Anaphylaxis
Asthma
Desensitization, Immunologic*
Dust*
Humans
Hypersensitivity
Immunoglobulin E
Immunoglobulins
Immunotherapy
Incidence
Life Tables
Medical Records
Pollen
Pyroglyphidae*
Retrospective Studies*
Rhinitis, Allergic*
Tertiary Care Centers
Allergens
Aluminum
Dust
Immunoglobulin E
Immunoglobulins

Figure

• 

  Fig. 1 Target allergens and treatment status in patients with AR. AR, allergic rhinitis; HDM, house dust mites.

• 

  Fig. 2 Remission probability by AIT for patients with AR who were sensitized to HDM only or HDM and pollens. Survival curve and life tables were generated by the Kaplan-Meier method. AIT, allergen-specific immunotherapy; AR, allergic rhinitis; HDM, house dust mites; S.E, standard error; CI, confidence interval.

• 

  Fig. 3 A significant temporal correlation for total IgE levels over the SCIT period between the remission and non-remission groups of AR patients was indicated in a generalized estimating equation model. Error bars indicate standard error means of total serum IgE levels. IgE, immunoglobulin E; SCIT, subcutaneous immunotherapy; AR, allergic rhinitis. *P<0.05.

Reference

1. Pawankar R, Bunnag C, Khaltaev N, Bousquet J. Allergic rhinitis and its impact on asthma in Asia Pacific and the ARIA update 2008. World Allergy Organ J. 2012; 5:S212–S217. PMID: 23268481.

2. Bauchau V, Durham SR. Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J. 2004; 24:758–764. PMID: 15516669.

3. Wheatley LM, Togias A. Clinical practice. Allergic rhinitis. N Engl J Med. 2015; 372:456–463. PMID: 25629743.

4. Lee KS, Yum HY, Sheen YH, Park YM, Lee YJ, Choi BS, et al. Comorbidities and phenotypes of rhinitis in Korean children and adolescents: a cross-sectional, multicenter study. Allergy Asthma Immunol Res. 2017; 9:70–78. PMID: 27826964.

5. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008; 63(Suppl 86):8–160. PMID: 18331513.

6. Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, et al. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol. 2011; 127:S1–S55. PMID: 21122901.

7. Jutel M, Kosowska A, Smolinska S. Allergen immunotherapy: past, present, and future. Allergy Asthma Immunol Res. 2016; 8:191–197. PMID: 26922928.

8. Akdis M, Akdis CA. Mechanisms of allergen-specific immunotherapy: multiple suppressor factors at work in immune tolerance to allergens. J Allergy Clin Immunol. 2014; 133:621–631. PMID: 24581429.

9. Durham SR, Penagos M. Sublingual or subcutaneous immunotherapy for allergic rhinitis? J Allergy Clin Immunol. 2016; 137:339–349. PMID: 26853126.

10. Jutel M, Agache I, Bonini S, Burks AW, Calderon M, Canonica W, et al. International consensus on allergy immunotherapy. J Allergy Clin Immunol. 2015; 136:556–568. PMID: 26162571.

11. Schmitt J, Schwarz K, Stadler E, Wüstenberg EG. Allergy immunotherapy for allergic rhinitis effectively prevents asthma: results from a large retrospective cohort study. J Allergy Clin Immunol. 2015; 136:1511–1516. PMID: 26371838.

12. Bodtger U, Linneberg A. Remission of allergic rhinitis: an 8-year observational study. J Allergy Clin Immunol. 2004; 114:1384–1388. PMID: 15577841.

13. Rottem M, Egbarya A. Subcutaneous immunotherapy in Northern Israel: efficacy and safety. Isr Med Assoc J. 2014; 16:539–543. PMID: 25351009.

14. Wang H, Lin X, Hao C, Zhang C, Sun B, Zheng J, et al. A double-blind, placebo-controlled study of house dust mite immunotherapy in Chinese asthmatic patients. Allergy. 2006; 61:191–197. PMID: 16409195.

15. Asero R. Efficacy of injection immunotherapy with ragweed and birch pollen in elderly patients. Int Arch Allergy Immunol. 2004; 135:332–335. PMID: 15564775.

16. Qi S, Chen H, Huang N, Li W, Liu G, Wang Y, et al. Early intervention improves clinical responses to house dust mite immunotherapy in allergic rhinitis patients. Int Arch Allergy Immunol. 2016; 171:234–240. PMID: 28049194.

17. Howarth P, Malling HJ, Molimard M, Devillier P. Analysis of allergen immunotherapy studies shows increased clinical efficacy in highly symptomatic patients. Allergy. 2012; 67:321–327. PMID: 22142377.

18. Ciprandi G, Tosca MA, Silvestri M. The practical role of serum allergen-specific IgE as potential biomarker for predicting responder to allergen immunotherapy. Expert Rev Clin Immunol. 2014; 10:321–324. PMID: 24450987.

19. Ciprandi G, Silvestri M. Serum specific IgE: a biomarker of response to allergen immunotherapy. J Investig Allergol Clin Immunol. 2014; 24:35–39.

20. Tosca M, Silvestri M, Accogli A, Rossi GA, Ciprandi G. Serum-specific IgE and allergen immunotherapy in allergic children. Immunotherapy. 2014; 6:29–33. PMID: 24341881.

21. Olivieri M, Heinrich J, Schlünssen V, Antó JM, Forsberg B, Janson C, et al. The risk of respiratory symptoms on allergen exposure increases with increasing specific IgE levels. Allergy. 2016; 71:859–868. PMID: 26764559.

22. Corsico AG, De Amici M, Ronzoni V, Giunta V, Mennitti MC, Viscardi A, et al. Allergen-specific immunoglobulin E and allergic rhinitis severity. Allergy Rhinol (Providence). 2017; 8:1–4. PMID: 28381320.

23. Di Lorenzo G, Mansueto P, Pacor ML, Rizzo M, Castello F, Martinelli N, et al. Evaluation of serum s-IgE/total IgE ratio in predicting clinical response to allergen-specific immunotherapy. J Allergy Clin Immunol. 2009; 123:1103–1110. 1110.e1–1110.e4. PMID: 19356792.

24. Bousquet PJ, Castelli C, Daures JP, Heinrich J, Hooper R, Sunyer J, et al. Assessment of allergen sensitization in a general population-based survey (European Community Respiratory Health Survey I). Ann Epidemiol. 2010; 20:797–803. PMID: 20702109.

25. Passalacqua G. The use of single versus multiple antigens in specific allergen immunotherapy for allergic rhinitis: review of the evidence. Curr Opin Allergy Clin Immunol. 2014; 14:20–24. PMID: 24362238.