Abstract
Sublingual Allergen Specific Immunotherapy (SLIT) has been advocated for the treatment for allergies. Controlled studies are difficult to perform in humans due to the variety of allergies, diet, and allergenic exposure. This prospective, randomized, controlled study evaluated clinical and immunological effects of one year of SLIT using an experimental model of atopic dermatitis in dogs. Eighteen Beagles, sensitized to dust mites, timothy grass and ragweed were divided into control (n=6, vehicle) and active (n=12, 3 allergens) groups. Allergen challenge and scoring of clinical signs was done before and at the end of one year of SLIT. Blood was drawn at baseline, 4,8, and 12 months of SLIT and 2 months after stopping SLIT to measure allergen-specific IgE, IL-10, and TGF-beta. After 12 months of SLIT, ANOVA showed significant decrease of clinical scores for both groups (p<.0001) but no significant differences between groups. T tests within each group comparing pre vs. post treatment scores showed statistically significant decrease in the control (p=0.042) and in the SLIT group (p=0.00027). Effect size using Cohen’s d was 1.182 for control and 2.1 for allergen group. Thus, decrease from baseline to post-treatment was nearly twice as large in the allergen as in the control group. Mixed results were found for allergen-specific IgE with significant decrease for dust mites (p=0.0242) and increase for ragweed (p=0.0074) at the end of the study. SLIT induced significant increase of TGF-beta (p=0.03) and IL-10 (p=0.0009) after ragweed stimulation compared to baseline and to the control group. TGF-beta increase abated after SLIT discontinuation results consistent with SLIT induced T regulatory response. Interestingly a significant increase for IL-10 after timothy stimulation was seen for both groups at the end of study (p<.0001).It is concluded that this experimental model is useful to investigate treatments for atopic dermatitis and their immunologic effects.
Highlights
Allergen specific immunotherapy (ASIT) is currently considered the best long term approach to manage environmental allergies in both human and veterinary medicine [1,2,3] when allergen avoidance is not feasible
The degree of erythema and pruritus progressively increased over the course of the allergen challenge as sensitization and before starting the sublingual immunotherapy (SLIT) phase showed no significant differences between the dogs allocated to the allergen (SLIT group) and the ones allocated to the control group (Figure 5A) reassuring that the group allocation was balanced for severity
Analysis of Variance (ANOVA) showed a significant effect of time (p
Summary
Allergen specific immunotherapy (ASIT) is currently considered the best long term approach to manage environmental allergies in both human and veterinary medicine [1,2,3] when allergen avoidance is not feasible. ASIT is indicated for the treatment of allergic rhinitis, allergic asthma and hymenoptera-induced anaphylaxis. In human medicine sublingual immunotherapy (SLIT) has been used with good success for allergic conjunctivitis, rhinitis and asthma [4,5,6]. An advantage of SLIT over the traditional route of subcutaneous injections is the easy administration and the excellent tolerability [7]. SLIT will be more cost-effective over time with increased usage than the traditional subcutaneous injections as it does not require frequent office visits. There have been reports of beneficial effects of ASIT for atopic dermatitis (AD) this approach is not routinely used for patients with only cutaneous disease [8,9,10,11]
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