House Dust Mite Allergic Rhinitis Research Articles

Standardized quality (SQ) house dust mite sublingual immunotherapy tablet (ALK) reduces inhaled corticosteroid use while maintaining asthma control: A randomized, double-blind, placebo-controlled trial

Investigations meeting current standards are limited for the effect of house dust mite (HDM) allergy immunotherapy in asthmatic patients. This trial investigated the efficacy and safety of a standardized quality (SQ; allergen standardization method proprietary to the trial sponsor) HDM SLIT-tablet (ALK, Hørsholm, Denmark) in adults and adolescents with HDM respiratory allergic disease. This publication reports the results of the endpoints related to asthma. Six hundred four subjects 14 years or older with HDM allergic rhinitis and mild-to-moderate asthma were randomized 1:1:1:1 to double-blind daily treatment with one of 3 active doses (1, 3, or 6 SQ-HDM) or placebo. Their use of inhaled corticosteroid (ICS) was standardized and adjusted at baseline and the end of treatment to the lowest dose providing asthma control. The primary end point was a reduction in ICS dose from the individual subject's baseline dose after 1 year of treatment. The primary analysis revealed a mean difference between 6 SQ-HDM and placebo in the reduction in daily ICS dose of 81 μg (P = .004). Relative mean and median reductions were 42% and 50% for 6 SQ-HDM and 15% and 25% for placebo, respectively. No statistically significant differences were observed for the other assessed asthma parameters, reflecting the intended controlled status of the trial subjects. The most common adverse events were local reactions in the mouth. The rate and severity of adverse events were higher for 3 and 6 SQ-HDM than for 1 SQ-HDM and placebo. Efficacy in mild-to-moderate asthma of 6 SQ-HDM relative to placebo was demonstrated by a moderate statistically significant reduction in the ICS dose required to maintain asthma control. All active doses were well tolerated.

Longer treatment duration with SLIT leads to higher patient satisfaction and clinical improvement. Outcomes of the SAMITES study

Background Sublingual immunotherapy (SLIT) is considered as a valid alternative in treatment of patients suffering house dust mite (HDM) allergic rhinitis. No evaluation of the patients’ satisfaction on treatment and its relationship with clinical improvement and compliance was previously described. Methods

Allied health – 3008. Comparison of anti-allergic effect of pneumococcal conjugated vaccine and pneumococcal polysaccharide vaccine in a murine model of house dust mite allergic rhinitis

The T-bet m RNA level was lower in the PV and PCV group than Der f group (p< 0.05). The IL-13, GATA-3 mRNA level and serum Der f-specific IgE and eosinophil were lower in the PV and PCV group than Der f group (p< 0.05). Foxp3 mRNA expression in the PV and PCV group was elevated compared to the Der f group (p < 0.05). In flow cytometry, the PV group (p < 0.05) and the PCV group (p < 0.05) had higher percentages of CD4+ CD25+Foxp3+ T cells than the Der f group. In the PV group, the percentage of these cells was higher than that in the PCV group. (p=0.00). Conclusions These results suggest that the pneumococcal polysaccharide vaccines will suppress the allergen-specific Th2 response and enhanced the induction of regulatory T cells in a model of allergic rhinitis. And the process to work regulatory T cell can be different between the PV and PCV group.

The Decreased CD4+CD25+ FoxP3+ T Cells in Nonstimulated Allergic Rhinitis Patients Sensitized to House Dust Mites

Objective. Regulatory (CD4+CD25+) T cells have been shown to play an important role in the development of allergic diseases. This study aims to investigate CD4+CD25+ T cells, Forkhead box P3 (FoxP3+ cells), and T-helper 1/T-helper 2 (Th1/Th2) cytokines in newly diagnosed allergic rhinitis (AR) patients. Methods. Altogether, 10 subjects with AR and 12 age-matched nonallergic healthy subjects were included in this study. CD4+CD25+ T cells, FoxP3+ T cells in peripheral blood mononuclear cells (PBMCs) were evaluated by flow cytometry, and the Th1/Th2 cytokine levels were determined by cytometric bead array immunoassay in both PBMC supernatants and nasal lavage fluids. Results. The percentage of CD4+CD25+ T cells were significantly higher, whereas the percentage of FoxP3+ cells were lower in AR patients compared with healthy subjects. In PBMC culture supernatants, interleukin-10 (IL-10) levels were significantly lower (p = .012), whereas IL-4, IL-5, and tumor necrosis factor-α (TNF-α) levels in nasal lavage fluids were higher in AR patients compared with healthy subjects (p = .026, p = .015, p = .03, respectively). Conclusions. Our findings indicate that decrease in CD4+CD25+FoxP3+ T cell fraction and diminished levels of IL-10 are noteworthy without allergen stimulation in house dust mite AR patients.

Correlation of Routine Examinations for the Diagnosis of House Dust Mite Allergic Rhinitis

Objective: To evaluate the correlation between the routine diagnostic tests for house dust mite (HDM) sensitization in Chinese allergic rhinitis (AR) patients, including the skin prick test (SPT), serum HDM-specific immunoglobulin E (sIgE) and nasal smear eosinophilia. Methods: The ImmunoCAP assay was employed to detect serum total IgE and sIgE. The SPT and nasal smear eosinophil counts were performed using standard procedures. Results: Of 82 subjects with HDM-related symptoms and positive SPT results, 55 individuals showed an sIgE level equal to or greater than CAP class 1 for both Dermatophagoides pteronyssinus (Der p) and D. farinae (Der f), and 62 individuals demonstrated positive eosinophils in nasal smears. sIgE of Der p and Der f presented a linear correlation, and the level of serum HDM-sIgE was also positively correlated with total IgE. An increasing sIgE level was correlated with higher SPT grades in both Der p and Der f. Meanwhile, the correlation coefficient exhibited an increase in value with aging, and the 31- to 40-year age group demonstrated the highest value for both Der p and Der f. Conclusion: The positive correlation between SPT and sIgE reaction to HDM varied according to the age of patients with AR.

Effects of a Topical Microemulsion in House Dust Mite Allergic Rhinitis

We have previously demonstrated that a topical microemulsion can attenuate symptoms and signs of seasonal allergic rhinitis. This likely reflects that the microemulsion interferes with the interaction between the allergen and the mucosa. Whether or not the finding translates to conditions caused by other inhaled agents such as house dust mite allergen is unknown. Patients with perennial allergic rhinitis caused by house dust mite were subjected to topical microemulsion treatment in a randomized, double-blinded and crossover design with isotonic saline as control. Morning symptoms were monitored, change from baseline was assessed and the treatments were compared. On the first days of the isotonic saline and microemulsion runs, before any treatment was given, total nasal symptoms were scored to 2.8 and 3.1 (range 0-9), respectively. Nasal symptoms were reduced by intervention with the microemulsion: the change from baseline was consistent for the microemulsion and the difference between the microemulsion and isotonic saline reached statistical significance in favour of the former. We conclude that intervention with a microemulsion may reduce symptoms of house dust mite allergic rhinitis at natural allergen exposure. Our findings suggest the possibility that topical microemulsions can be a useful option to reduce nasal mucosal exposure to allergen in perennial allergic rhinitis..

Association Of Ige Serum Concentration, Total Eosinophil Count With Symptom Severity In Children With House Dust Mite Allergic Rhinitis

Association Of Ige Serum Concentration, Total Eosinophil Count With Symptom Severity In Children With House Dust Mite Allergic Rhinitis

Sublingual Immunotherapy with House Dust Extract for House Dust-Mite Allergic Rhinitis in Children

House dust extract is used in conventional immunotherapy for house dust-mite (HDM) allergic rhinitis in Japan. However, an alternative administration route is desired. The aims of the present double blind, placebo-controlled trial were to evaluate the therapeutic efficacy and safety of sublingual immunotherapy (SLIT) with house dust extract in pediatric patients with HDM allergic rhinitis. The study population comprised 31 subjects (21 males and 10 females) aged from 7 to 15 years old. Twenty patients (the active group) received house dust extract and 11 received placebo via sublingual administration. Extract or placebo (1 ml) was administered at 10-fold dilution once weekly for 40 weeks. During the study period, the subjects recorded their daily nasal symptoms and use (dose and frequency) of other medications in a nasal allergy diary. The symptom scores in the active group began to decrease about 24 weeks after initiation of treatment and significant differences between the active and placebo groups were observed after 30 weeks. The average scores for the last four weeks of the study were significantly lower than those for the first four weeks in the active group but not in the placebo group. The only local adverse effect was a bitter taste reported by one patient. There were no other local or systemic adverse effects associated with SLIT. Our results suggest that SLIT with house dust extract for more than 30 weeks is safe and effective treatment for HDM allergic rhinitis in children.

Safety and Tolerability of House Dust Mite Tablets in Sublingual Immunotherapy

A single-centre, randomised, double-blind, placebo-controlled trial to investigate the safety and tolerability of four different sublingual immunotherapy (SLIT) tablet regimens in house dust mite allergic rhinitis.

Expression of Interleukin-16 in Allergic Rhinitis

Background: Interleukin-16 (IL-16) has been characterized as a chemoattractant for a variety of CD4+ T cells. Several inflammatory diseases, including allergic disorders, have been reported to correlate with IL-16. We first examined the IL-16 expression of serum and mucosal tissue in patients with allergic rhinitis. Methods: Forty-eight patients with a clinical history of house dust mite (HDM) or pollen-sensitive allergic rhinitis were included in this study. Serum IL-16 was analyzed by enzyme-linked immunosorbent assay (ELISA). IL-16 expression of nasal mucosa was detected by immunohistochemistry. Results: IL-16 levels were elevated in the serum of patients with allergic rhinitis compared with normal controls. In particular, serum IL-16 levels in HDM-sensitive patients were higher than those in pollen-sensitive patients. IL-16 was significantly correlated with eosinophils in the peripheral blood of allergic rhinitis patients. Histologically, IL-16 was expressed in infiltrated lymphocytes and nasal gland cells. Conclusions: Our data indicate that one of the sources of elevated serum IL-16 in allergic patients may be gland cells and lymphocytes in allergic nasal mucosa. This IL-16 cytokine may be strongly associated with the developmental mechanism of allergic rhinitis.

Absorption across the nasal airway mucosa in house dust mite perennial allergic rhinitis

House dust mite allergens express protease activity and it has been suggested that this property has pathogenic effects by increasing airway absorption. In accordance, house dust mite allergens may increase mucosal permeability in vitro. The objective of the present study was to examine nasal absorption of desmopressin (1-deamino-8-D-arginine vasopressin) in patients with perennial house dust mite allergic rhinitis and in healthy subjects in vivo. Patients with perennial allergic rhinitis were examined after a 4-week treatment withdrawal period, when symptoms of allergic rhinitis occurred, and healthy subjects were examined together with the patients. Desmopressin (20 microg ml(-1)) was moved into the nasal cavity using a nasal pool-device that contained 15 ml fluid. The fluid was kept in the nasal cavity for 15 min and then recovered. Urine was collected for 24 h after the nasal administration and the urinary excretion of desmopressin was determined as an index of nasal absorption. The urinary excretion of desmopressin was 1148+/-535 pmol 24 h(-1) in patients with perennial house dust mite allergic rhinitis and 1012+/-291 pmol 24 h(-1) in healthy subjects. We conclude that nasal airway absorption of the 1067 Da peptide desmopressin is unaffected in perennial house dust mite allergic rhinitis compared with healthy subjects.

House dust mite avoidance measures for perennial allergic rhinitis.

In developed countries, it is estimated that 15% of the general population suffer from one or more allergic disorders, of which allergic rhinitis is the most common. Perennial rhinitis is most often due to allergy to the house dust mite. In such patients, house dust mite avoidance is logical, but there is considerable uncertainty regarding the efficacy and effectiveness of interventions designed to reduce dust mite exposure. To assess the benefit (and harm) of measures designed to reduce house dust mite exposure in the management of house dust mite sensitive allergic rhinitis. We searched the Cochrane Controlled Trials Register, Central, MEDLINE and EMBASE. No restrictions on the language of publication were employed. The bibliography of each paper and other published reviews were checked for further references. We wrote to first authors of all included trials in an attempt to identify further published and unpublished trials. Randomised controlled trial (with or without blinding), in which house dust mite control measures have been evaluated in comparison with placebo or other dust mite avoidance measures, in patients with clinician diagnosed allergic rhinitis and confirmed allergy to dust mite. Two reviewers independently checked titles and abstracts identified by the searches and full text copies of all papers of potential relevance were considered. Trials were graded for methodological quality using the Cochrane approach. Data extraction was performed in a standardised manner. Meta-analysis was neither possible, nor considered appropriate, because of the heterogeneity of the patient groups studied; a narrative overview of the results is therefore presented. Four trials satisfied the inclusion criteria, all of which were small and of poor quality. Two trials investigated the efficacy of acaricides, a third investigated the role of high-efficiency particulate air (HEPA) filters, whilst a fourth investigated the efficacy of a bedroom environmental control program that comprised use of a barrier mattress cover, fortnightly washing of bed covers, removal of soft furnishings and daily cleaning. Each of the four trials showed the interventions to result in significant reductions in house dust mite load when compared with control. Trial results suggest that the interventions may be effective in reducing some rhinitis symptoms, though it is not possible to provide a reliable summary estimate about the magnitude of such symptom reduction. No serious adverse effects were reported from the interventions. Trials to date have been small and of poor methodological quality making it difficult to offer any definitive recommendations on the role, if any, of house dust mite avoidance measures in the management of house dust mite sensitive perennial allergic rhinitis. The results of these studies suggest that interventions designed to reduce house dust mite exposure in patients with house dust mite allergic perennial rhinitis may be of some benefit in reducing rhinitis symptoms. Data at present is only available for acaricides, HEPA filters and a bedroom-based environmental control program; therefore, if considered appropriate, these should be the interventions of choice.

Effect of specific immunotherapy in eosinophil cationic protein release after specific nasal provocation

Specific immunotherapy (SIT) is effective in the treatment of allergic rhinitis but its mechanisms of action are still not completely understood, particularly in regard to eosinophil activation mechanisms. The purpose of this research was to study if the inhibition of eosinophil activation, demonstrated through the reduction of eosinophil cationic protein [ECP] release, is involved in the therapeutic actions of specific immunotherapy. We analyzed ECP concentrations in nasal lavage fluid of 21 patients with allergic rhinitis, before and after specific nasal provocation. These results were compared to controls, treated without specific immunotherapy. ECP concentrations in nasal lavage fluid were significantly reduced after two years of specific injectable immunotherapy. These reductions were demonstrated both in pre-provocation [basal] values and after specific nasal provocation. Specific immunotherapy can reduce ECP in nasal lavage fluid of in house dust mite allergic rhinitis patients, both before and after allergen nasal challenge, with significant changes in the kinetic of ECP release, a fact which suggests that specific immunotherapy can influence eosinophil activation or its releasability.

Local production and detection of (specific) IgE in nasal B-cells and plasma cells of allergic rhinitis patients.

Allergic diseases are characterized by allergic complaints in the shock organ and specific immunoglobulin (Ig)E in serum. Literature data indicate that the nasal mucosa itself could produce at least a large part of the specific IgE in allergic rhinitis patients. In order to investigate this hypothesis, nasal mucosal biopsies from the inferior turbinate were taken from symptomatic grass pollen allergic rhinitis patients, symptomatic house dust mite allergic rhinitis patients and nonallergic healthy controls, confirmed by radioallergosorbent test and skin-prick test. Immunohistochemical double-staining was performed for B-cells (CD19) with IgE, plasma cells (CD138) with IgE and plasma cells with biotinylated allergens. Significantly more IgE-positive B-cells and IgE-positive plasma cells were found in the nasal mucosa of allergic patients than in that of nonallergic controls. Double staining with biotinylated allergens and plasma cells showed allergen-positive plasma cells in the nasal mucosa of allergic patients and no allergen-positive plasma cells in the nasal mucosa of nonallergic patients. Blocking experiments using polyclonal antibodies directed against IgE showed a significant reduction in the number of allergen-positive cells in contrast to experiments using polyclonal antibodies directed against IgG, IgA or IgM. This study describes new evidence that specific immunoglobulin E is produced locally in the nasal mucosa in patients with seasonal allergic rhinitis and perennial allergic rhinitis, but not in nonallergic controls.

RAST in Diagnosis and Therapy of Allergic Rhinitis

Skin tests, RAST, nasal provocation tests, and other nasal allergy examinations were performed on 463 patients exhibiting symptoms of allergic rhinitis who were examined at the Department of Otolaryngology of Osaka City University Medical School, and comparisons were made between the RAST scores and the results of the other examinations. A study was also made of the change in grade of the allergic rhinitis and the change of the RAST score resulting from one year of immunotherapy. The rates of agreement for patients with positive skin test and RAST were 60 to 70% for house dust (HD), house dust mites, Japanese cedar, and cocksfoot, and 10 to 35% for common ragweed and the fungus group. The RAST was positive for house dust 1, house dust 2, and Dermatophagoides farinae in 80 to 90% of the patients with house dust or house dust mite allergic rhinitis, and for over 80% of the patients with pollinosis (Japanese cedar or common ragweed). In most cases, the RAST scores were unchanged by one year of specific hyposensitization, and in the cases in which the RAST scores did change, the treatment was ineffective.