Polysensitized Group Research Articles

Efficacy and safety of house dust mite subcutaneous immunotherapy in polysensitized children with allergic asthma

IntroductionThe aim of this study was to compare the efficacy and safety of 3 years of HDM subcutaneous immunotherapy (HDM-SCIT) in allergic asthma (AA) children with mono- and polysensitized. MethodsThis was a retrospective observational study, 51 AA children (aged 4–14 years) who had completed 3 years of standardized HDM-SCIT were enrolled in. Based on skin prick tests (SPT) and allergen-specific IgE antibody (sIgE) test results, children were classified into two groups: the monosensitized group (n = 31) and the polysensitized group (n = 20). Total asthma symptoms score (TASS), total medication score (TMS), visual analog scale (VAS) scores, fractional exhaled nitric oxide (FeNO), lung function parameters, and adverse reactions were evaluated before treatment and at 6 months, 1, 2, 3 years of HDM-SCIT. ResultsIn terms of effectiveness, compared to baseline, TASS, TMS, VAS, FeNO and lung function parameters were significantly improved in both groups after 3 years of HDM-SCIT (all P < 0.05). The comparison between the two groups showed that efficacy indicators were no statistically significant difference at follow-up time points (all P > 0.05) except PEF%pred at 6 months (P = 0.048). In terms of security, the number of adverse reactions in both groups also no statistical difference between the two groups (all P > 0.05). ConclusionThis study confirmed that no significant difference was observed in the clinical efficacy and safety of HDM-SCIT between mono-and polysensitized children with allergic asthma.

Effects of Aeroallergen Sensitization on Symptom Severity, Pulmonary Function, and Bronchodilator Response in Children With Bronchial Asthma

Background: Allergen sensitization, symptom severity, pulmonary function test, and bronchodilator response are important in the diagnosis and treatment of asthma. However, the relationship between these factors remains unclear. Objective: The objective of this study was to investigate the relationship between aeroallergen sensitization and asthma severity, pulmonary function, and bronchodilator response among pediatric patients with bronchial asthma. Methods: This was a prospective study where 155 pediatric patients aged 7–18 years old with bronchial asthma were recruited from Outpatient Clinics. Patients who met the inclusion criteria proceeded with spirometry and aeroallergen skin prick test. Results: There was a significant degree of sensitization, wherein 100% of the patients had sensitization to one or more aeroallergens. Among these children, 106 (68%) were polysensitized. The polysensitized group had more severe and persistent asthma severity profile (p&lt;0.001) and worse pulmonary function (p&lt;0.001). The frequency of abnormal pre-bronchodilator lung function of the polysensitized group was higher than the monosensitized group (p&lt;0.001). A positive bronchodilator response was higher among polysensitized children as compared to monosensitized children (p&lt;0.001). Sensitization to Dermatophagoides farinae, Dermatophagoides pteronyssinus and dog correlated with impairment of both the large airways and distal small airways while sensitization to cat, cockroach, and horse correlated only with impairment of the large airways (p&lt;0.05). Patients sensitized to D. farinae, D. pteronyssinus, cat and dog had significant bronchodilator response (p&lt;0.05). Conclusion: Polysensitized asthmatic children had a more persistent and severe asthma profile, worse pulmonary function, and higher bronchodilator reversibility compared to the monosensitized group.

A Retrospective Cohort Study of Sublingual Immunotherapy with Standardized Dermatophagoides farinae Drops for Allergic Rhinitis.

To evaluate the efficacy and safety of sublingual immunotherapy (SLIT) with standardized Dermatophagoides farinae (Df) drops in monosensitized and polysensitized patients with allergic rhinitis (AR) and to analyze the adverse events (AEs). A retrospective analysis was performed using data for 68 patients with AR who received SLIT. The patients were divided into a monosensitized group (36 cases) and a polysensitized group (32 cases) based on serum-specific IgE test results. In the two groups of patients, total nasal symptoms score (TNSS), total medication score (TMS), visual analog scale (VAS) score, and AEs before treatment and at 1, 3, 6, and 12months of treatment were evaluated. Compared with that before treatment, the TNSS, TMS, and VAS score in the monosensitized and polysensitized groups all decreased significantly at 3, 6, and 12months of SLIT (all P < 0.05). There were no significant differences in treatment efficacy indicators between the two groups at all treatment time points (all P > 0.05). In terms of safety, compared with 1month after initiating SLIT, the incidence of AEs in the monosensitized and polysensitized groups at 6 and 12months of treatment significantly decreased (all P < 0.05). There was a statistically significant decrease in the incidence of AEs in both groups at 6months compared with 3months of treatment (χ2 = 1.92 and 5.85, respectively, all P < 0.05). The difference in incidence of AEs between the monosensitized and polysensitized groups was not statistically significant at any treatment time point (all P > 0.05). AEs in all patients were local mild reactions; no serious AEs were found. SLIT with standardized Df drops has similar efficacy and safety for monosensitized and polysensitized patients with AR. AEs mostly occurred during the first 3months of SLIT in both the monosensitized and polysensitized groups, and the incidence of AEs gradually decreased as the course of treatment extended.

Analysis of the immunoglobin E molecular sensitization profile in children with allergic asthma and predictive factors for the efficacy of allergy immunotherapy.

BackgroundAs the incidence of allergic asthma in children increases, the immunoglobin E (IgE) molecular sensitization profile of allergic asthma remains underreported while the level of total IgE (tIgE) and sIgE/tIgE have not been studied as predictors of efficacy of allergen immunotherapy (AIT) for allergic asthma, specifically in children.MethodsStarting from August 2018 to March 2019 in the Respiratory Department of the Children’s Hospital of Chongqing Medical University, asthmatic children, with positive skin prick tests to Der p or Der f, were enrolled in this study. Total IgE, allergen serum-specific IgE (sIgE) of Der p, Der f, Blomia tropicalis (Blo t), cat dander, dog dander, egg white, milk, cockroach, shrimp, and crab, along with Der p allergen components, Der p1 and Der p2, were measured by ImmunoCAP™ assay.ResultsA total of 142 children with allergic asthma were enrolled, all of whom showed positive IgE for Der p, Der p1, Der p2, and Der f; meanwhile, the positive rates of Blo t, cat dander, dog dander, egg white, milk, cockroach, shrimp, and crab were 91.84%, 10.96%, 7.32%, 9.15%, 11.58%, 17.03%, 18.90%, and 18.28% respectively. A significantly high correlation was found between total IgE and the sIgE of Der f, Der p, Der p 1, and Der p 2. Asthmatic children with a family history of allergy displayed higher total IgE and unknown IgE levels than those patients without a family history of allergy. The ratios of Der f sIgE/tIgE and Der p sIgE/tIgE were higher in the negative family history of allergy group than in the positive family history of allergy group. Furthermore, total IgE and unknown IgE were higher in the polysensitized group than in the in monosensitized group. The ratios of Der f sIgE/tIgE and Der p sIgE/tIgE were higher in the monosensitized group than in the polysensitized group.ConclusionsFrom this study, we noticed that dust mites are the main cause of asthma in children investigated. Our findings indicate patients with no family history of allergy and monosensitized patients have a higher ratio of sIgE/tIgE, and those patients may benefit more from AIT.

Effect of sublingual immunotherapy on patients with allergic rhinitis

Objective:Study the efficacy of sublingual immunotherapy （SLIT） for monosensitized and polysensitized allergic rhinitis patients of different severity. Method:According to the results of intradermal experiments, 186 patients with AR who were treated with standardized dust mites SLIT for 2 years. These patients have been divided into mild monosensitized group and mild polysensitized group, moderate monosensitized group and moderate polysensitized group, severe monosensitized group and severe polysensitized group. Statistics and analysis of total nasal symptom score （TNSS）, total medication score （TMS） , visual analog scale （VAS） about before and after SLIT treatment. Result:Before SLIT treatment and after 2 years, the TNSS: Mild monosensitized group （5. 58±1. 68）（0. 58±0. 75）, mild polysensitized group（5. 34±1. 49）（0. 93±0. 75）;moderate monosensitized group （4. 68±1. 55）（0. 32±0. 63）, moderate polysensitized group（6. 26±1. 46）（0. 61±0. 67）,which have showed a statistically significant difference（P<0.05）,between the two groups have no significant difference （P>0.05）. Severe monosensitized group（6. 26±0. 73）（1. 16±1. 13）, severe polysensitized group（6. 49±1. 04）（1. 89±1. 07）, which have showed a statistically significant difference（P<0.05）, between the two groups have a statistically significant difference（P<0.05）. The VAS:Mild monosensitized group （6. 09±1. 23）（1. 52±1. 25）, mild polysensitized group（6. 21±0. 90）（1. 97±1. 18）,moderate monosensitized group（6. 12±0. 53）（1. 16±1. 03）, moderate polysensitized group（6. 65±1. 08）（1. 65±0. 98）,which have showed a statistically significant difference（P<0.05）,between the two groups have no significant difference （P>0.05）. Severe monosensitized group（6. 26±0. 73）（1. 16±1. 13）, severe polysensitized group（6. 49±1. 04）（1. 89±1. 07）, which have showed a statistically significant difference（P<0.05）, between the two groups have a statistically significant difference（P<0.05）. The TMS:These have showed a statistically significant difference（P<0.05）with same group,between all groups have no significant difference （P>0.05）. Conclusion:Dust mites under the SLIT are effective for monosensitized and polysensitized allergic patients. For patients with severe polysensitized , it is necessary to extend the treatment time （>2 years）.

Clinical characteristics of allergic rhinitis and nonallergic rhinitis in Korean children

Purpose: Recently, the prevalence of allergic rhinitis (AR) in Korean children has been increased. The aim of this study was to investi gate the clinical characteristics of rhinitis and to compare clinical parameters between AR and nonallergic rhinitis (NAR) in children. Methods: We retrospectively reviewed the medical records of 1,034 children under 18 years of age who visited Korea University Anam Hospital for rhinitis symptoms from January 2008 to December 2017. Clinical data, including clinical features, comorbidities, blood test results, allergen sensitization profile, and pulmonary function test parameters, were collected. Results: Among the 1,034 children with rhinitis, 737 (71.3%) were AR and 297 (28.7%) were NAR. The prevalence of AR gradually in creased with age. The median levels of eosinophil count (4.1%), serum total IgE (204.4 IU/L), eosinophil cationic protein (ECP) con centration (17.9 μg/L), and fractional exhaled nitric oxide (FeNO) (22.0 ppb) were significantly higher in children with AR than in those with NAR. The sensitization rate to the inhalant allergens increased with age; however, food allergen sensitization rate tended to decrease. Median levels of eosinophil count, total IgE, ECP, and FeNO were significantly higher in the poly-sensitized group than in the mono-sensitized and nonsensitized groups. Conclusion: More than 70% of Korean children who have rhinitis symptoms are AR. Children with AR more likely to have higher lev els of FeNO and bronchial asthma. Poly-sensitized children showed increased rates of atopic dermatitis and bronchial asthma. (Allergy Asthma Respir Dis 2020;8:20-29)

Efficacy and safety of sublingual dust mite drops in children with mono- or polysensitized allergic rhinitis.

To explore the efficacy and safety of sublingual house dust mite (HDM) drops in children with mono- or polysensitized allergic rhinitis. We conducted a retrospective cohort study of 65 children with monosensitized AR and 118 children with polysensitized AR who were scheduled for sublingual administration of HDM drops from January 2015 to June 2016. Interleukin (IL)-2, IL-4, and IL-17α, transforming growth factor-β1 (TGF-β1), specific immunoglobulin E (IgE), and specific IgG4 were detected by ELISA. The efficacies were assessed using symptoms score and medication score. All the outcomes were measured 1 month before the study and 1 month after the end of the 2-year treatment. The total nasal symptoms score (TNSS) decreased significantly from 11.27 (9.81 ± 12.73) at baseline to 3.48(1.98 ± 4.98) at the end of sublingual treatment for the monosensitized AP group (t = 30.00, P < 0.01), and from 11.54(10.04 ± 13.04) to 3.56 (2.00 ± 5.16) for the polysensitized AR group (t = 40.05, P < 0.01), respectively. IL-2 and TGF-β1 increased significantly after treatment in contrast with before treatment in both the monosensitized group and the polysensitized group (both P < 0.01). In contrast, IL-4 and IL-17α decreased significantly after treatment compared with the baseline in both groups (both P < 0.01). Sublingual HDM drops were generally safe and well tolerant in both groups. This study confirmed the efficacy and safety of sublingual AIT in both monosensitized and polysensitized AR patients (Chinese children).

Long-Term Efficacy of Sublingual Mite Immunotherapy in Monosensitized and Polysensitized Children with Allergic Rhinitis: A 7-Year Prospective Study

Background: Several foreign studies have shown long-term efficacy of sublingual immunotherapy (SLIT), but data on the long-term efficacy of SLIT in China are still lacking. Objective: We aimed to prospectively evaluate the long-term efficacy of a 2-year SLIT with Dermatophagoides farinae(D. farinae) drops in mono- and polysensitized children with allergic rhinitis (AR). Methods: Eighty house dust mite (HDM)-sensitized children (aged 4–11 years) with AR were enrolled in this prospective study. There were 40 children in both the monosensitized (to HDM only) and polysensitized groups. Both groups were treated with standardized SLIT (D. farinae drops) for 2 years, combined with pharmacotherapy according to their individual requirements, and were followed up for 7 years. A combined symptom and medication score (CSMS) was assessed and compared between the 2 groups during and after SLIT. Safety was evaluated based on adverse events (AEs). Results: There were 31 (77.5%) monosensitized and 29 (72.5%) polysensitized children who completed the study. After 2-year SLIT, the CSMS of 2 groups significantly decreased compared to baseline. The improvement persisted during the first 5 years at each visit, with a significant difference (all p < 0.01). In the monosensitized group, the CSMS significantly increased during the 6th and the 7th year compared to year 2 (both p < 0.05). Meanwhile, the polysensitized group showed a significant worsening of CSMS from the 5th to the 7th year (all p < 0.05). Furthermore, there was a statistical difference between the 2 groups in the 5th year of the study (p < 0.05). No severe AEs were reported. Conclusions: The study confirmed the long-term effects which lasted for 7 years after 2-year SLIT in mono- and polysensitized children. Compared with the polysensitized children, the monosensitized children noted a more sustained benefit.

Immunologic modification in mono- and poly-sensitized patients after sublingual immunotherapy.

To compare immunologic modification and treatment outcomes after 2 years of sublingual immunotherapy (SLIT) with house dust mite extracts (HDM) between monosensitized and polysensitized patients with allergic rhinitis. Retrospective cohort study. Among the patients who were prospectively enrolled in the SLIT cohort study, patients with allergic rhinitis who were sensitized to HDM and treated with SLIT for at least 2 years were studied. All participants underwent serologic tests at baseline and after SLIT to evaluate changes in immunologic parameters. The total nasal symptom score (TNSS) was measured before and after SLIT, and effective and less effective responder groups were categorized depending on whether patients had a TNSS reduction of 50%, as compared with baseline. The increase in Dermatophagoides pteronyssinus and Dermatophagoides farinae specific immunoglobulin G4 levels was significantly higher in monosensitized patients than in polysensitized patients (P = .020 and P = .005, respectively). The TNSS significantly improved after SLIT in both the monosensitized and polysensitized groups (P < .001 in both groups). However, the difference in the changes in TNSS from baseline was not significant between the two groups (P = .374). This study demonstrated different immunologic modifications after SLIT between monosensitized and polysensitized patients. However, patients in the polysensitized group who were treated with single-allergen SLIT experienced clinical improvement in TNSS that was comparable with that in the monosensitized group despite demonstrating different immunologic changes. 2b Laryngoscope, 129:E170-E177, 2019.

Efficacy of sublingual immunotherapy with Dermatophagoides farina drops in monosensitized and polysensitized children with allergic rhinitis and asthma

Objective:To evaluate the efficacy of SLIT with Dermatophagoides farina drops in monosensitized and polysensitized children with allergic rhinitis and asthma.Method:This retrospective analysis chose 124 cases of allergic rhinitis and asthma with 3 years SLIT treatment. According to skin prick test,they were divided into two groups, monosensitized group (48 patients) and polysensitized group (76 patients). Before SLIT and after SLIT for 1 year, 2 year and 3 years, the TNSS, TRMS of rhinitis and DASS, NASS, TAMS, VAS, PEF, FEV1 of asthma were evaluated. Result:The TNSS, TRMS, DASS, NASS, TAMS, VAS, PEF, FEV1 had continuously improved significantly after SLIT for 1 year, 2 year and 3 years in two groups as compared with baseline (P< 0.05). As compared with after SLIT for 1 year, after SLIT for 2 year the TNSS, TRMS, TAMS, VAS of monosensitized group had obviously decrease (q= 3.76, 5.57, 6.02, 5.62, P< 0.05). As compared with after SLIT for 1 year, similarly, after SLIT for 2 year the TNSS, TRMS, TAMS, VAS of polysensitized group had obviously decrease (q= 5.40, 7.16, 7.19, 7.87, P< 0.05). Before SLIT, TRMS and TAMS of polysensitized group were significantly greater than the monosensitized group (Z=3.16, 2.74, P< 0.05). After SLIT for 1 year, 2 years and 3 years, the all evaluation indicators of two groups were not statistically significant (P> 0.05).Conclusion:Sublingual immunotherapy with Dermatophagoides farina drops in monosensitized and polysensitized children with allergic rhinitis and asthma had similar and significant therapeutic effect.

Profils de sensibilisation cutanée aux allergènes respiratoires des patients de la ville de Tétouan (Nord Ouest du Maroc)

The prevalence of respiratory allergies is increasing and is a serious global health problem. The objective of the study was to determine the prevalence of skin sensitization to inhalant allergens in patients consulting for respiratory allergy, to identify the main allergens involved and to evaluate the profile of skin prick-test reactivity related to sex, age and season. This retrospective study included 379 patients consulting during 2009-2012 in three private medical offices of Tetouan. Of the 379 patients, 39.6% were monosensitized and 60.4% polysensitized. The percentages of polysensitized patients were higher in patients exhibiting rhinoconjunctivitis and astma-rhinoconjunctivitis than in subjects with asthma. The prevalence of symptoms according to sex showed no significant difference (P=0.64). Regarding age, a significant difference was observed in the case of rhinoconjunctivitis (P<0.01), while asthma and asthma-rhinoconjunctivitis showed no significant difference. Sensitization to house dust mites was the most frequent followed by grasses, olives and Parietaria. The multiple correspondence analyses (ACM) showed that patients under 20-years of age with asthma and asthma-rhinoconjunctivitis profile are more associated with sensitization to mites during the spring and autumn. The 20-49-year age group was represented mainly by polysensitized patients with rhinoconjunctivitis. Sensitization to mites ranks first in Tetouan followed by the percentage of sensitized patients to grass pollen and olive. The ACM showed that the house dust mite asthma seems to affect more children and adolescents while the 20-49 year age of polysensitized group suffers significantly rhinoconjunctivitis.

Immunologic alterations and efficacy of subcutaneous immunotherapy with Dermatophagoides pteronyssinus in monosensitized and polysensitized patients

BackgroundThere is a continuing debate about whether monoallergen subcutaneous immunotherapy (SCIT) is able to modulate immune and clinical responses toward main causal allergen in polysensitized patients. ObjectiveTo investigate short-term immunologic changes and clinical effectiveness of SCIT with Dermatophagoides pteronyssinus in monosensitized and polysensitized patients who have rhinitis with or without asthma. MethodsNineteen monosensitized and 24 polysensitized patients participated in this prospective, self-placebo-controlled, interventional study. Cluster immunotherapy with D pteronyssinus was administered after 2 months of placebo in both groups. Immunologic parameters, including CD203c expression on basophils after allergen stimulation, total IgE, specific IgE, and specific IgG4, were evaluated at baseline, after placebo, and after immunotherapy. Clinical effectiveness was assessed using monthly symptom-medication scores, visual analog scale, quality-of-life questionnaire, and nasal allergen provocation test. ResultsAt baseline, polysensitized patients had higher CD203c expression on basophils than monosensitized patients (P = .007). Activated basophils expressing CD203c, total IgE, and specific IgG4 were significantly increased after immunotherapy compared with baseline and placebo in the polysensitized group (P < .025). After immunotherapy, specific IgE and D pteronyssinus–induced CD203c expression were significantly higher in polysensitized than monosensitized patients (P < .05). The total symptom scores and the Mini Rhinoconjunctivitis Quality of Life Questionnaire scores in polysensitized patients and the visual analog scale scores in both groups were lower after immunotherapy compared with baseline and placebo (P < .025). Titrated nasal allergen provocation test with D pteronyssinus increased after immunotherapy in the monosensitized group (P < .05). ConclusionThis study indicates that monosensitized and polysensitized patients have distinct humoral response and basophil behavior to SCIT. However, a single-allergen immunotherapy corresponding to the most clinically troublesome allergy in polysensitized patients can lead to early clinical efficacy comparable to that seen in monosensitized patients. Trial Registrationclinicaltrials.gov Identifier: NCT01795846.

Efficacy of Sublingual Immunotherapy with Dermatophagoides farinae Extract in Monosensitized and Polysensitized Patients with Allergic Rhinitis: Clinical Observation and Analysis.

Aim. To investigate differences in the efficacy of sublingual immunotherapy with Dermatophagoides farinae drops in monosensitized and polysensitized allergic rhinitis patients. Methods. The patients enrolled in the study were treated for more than one year by sublingual immunotherapy (SLIT) using Dermatophagoides farinae drops and were divided into a monosensitized group (n = 20) and a polysensitized group (n = 30). Total nasal symptom scores of patients before and after SLIT were analyzed to evaluate the curative effect. The phylogenetic tree of dust mite allergens as well as other allergens that were tested by skin prick test was constructed to help the analysis. Results. There was no significant difference in the efficacy of SLIT between dust mite monosensitized and polysensitized patients. Conclusions. Both dust mite monosensitized and polysensitized patients could be cured by SLIT using Dermatophagoides farinae drops. This study provides a reference for the selection of allergens to be used in immunotherapy for polysensitized AR patients.

Mono-allergic and poly-allergic rhinitis patients have comparable numbers of mucosal Foxp3+CD4+ T lymphocytes

Background: We previously found that allergic rhinitis patients with an isolated pollen sensitization responded more strongly to a nasal provocation with grass pollen (GP) than patients who had an additional house dust mite (HDM) sensitization. To elucidate this phenomenon, we investigated the dynamics of Foxp3+CD4+ T lymphocytes in allergic rhinitis patients with distinct allergen sensitizations. Methods: Three groups of allergic rhinitis patients with skin prick test confirmed allergic sensitizations were investigated and compared to 14 healthy controls: 14 subjects with an isolated grass pollen sensitization (Mono-GP); 9 subjects with isolated housedust mite sensitization (Mono-HDM); 29 subjects with grass pollen and house dust mite sensitization (poly-sensitized). Subjects in the Mono-GP group were challenged with grass pollen extract, subjects in the Mono-HDM group were challenged with house dust mite extract, subjects in the poly-sensitized group and the healthy controls were randomly challenged with either grass pollen or house dust mite. Nasal biopsies were taken before and after nasal provocation. We compared the distribution of FoxP3+CD4+ cells in nasal biopsies before and after nasal provocation using immunohistochemistry. Results: There was no difference in the number of FoxP3+CD4+ cells between healthy and the three allergic groups at baseline.Nasal provocation did result in an increase in eosinophils in the three allergic groups, but did not result in a change in the number of FoxP3+CD4+ cells in any of the groups or induced differences between any of the groups. Conclusion: Clinical differences in the response between mono-GP and multiple-sensitized allergic individuals are not related to differences in the number of regulatory T cells in the nasal mucosa.

Efficacy and safety of house dust mite sublingual immunotherapy in monosensitized and polysensitized children with respiratory allergic diseases.

The efficacy of single-allergen-specific immunotherapy in polysensitized subjects is a matter of debate. This study aimed to investigate the efficacy of house dust mite (HDM) sublingual immunotherapy (SLIT) in monosensitized and polysensitized children. A total of 112 children, aged 4 to 13 years old, with HDM-induced respiratory allergic diseases were allocated to a monosensitized group (n = 56) or a polysensitized group (n = 56). Both groups were treated by standard pharmacotherapy and SLIT with Dermatophagoides farinae (American HDM) extracts for 52 weeks. Symptoms, medications, visual analogue scale (VAS), and presence of adverse events (AEs) were assessed once a month. Skin-prick test (SPT) was done before and after treatment. After treatment, subjects in the polysensitized group who completed the study were further analyzed as subgroup 1 (n = 20) and subgroup 2 (n = 15) according to the number of coexisting allergens. Forty-one subjects in the monosensitized group and 35 subjects in the polysensitized group completed the study. The global clinical parameters had significantly improved after treatment, with no significant difference between the monosensitized and polysensitized group throughout this period (all p > 0.05). The comparison among the monosensitized group, subgroup 1, and subgroup 2 indicated that there was no significant difference in symptoms scores and VAS at each scheduled follow-up visit. There was also no significant difference in total medications score (TMS) in the monosensitized group, subgroup 1, and subgroup 2 after week 24 (all p > 0.05). No severe systemic AEs were reported. No significant difference was observed in the clinical effects of HDM SLIT between polysensitized and monosensitized children with respiratory allergic diseases.

Mono-allergic and poly-allergic rhinitis patients have comparable numbers of mucosal Foxp3+CD4+ T lymphocytes

We previously found that allergic rhinitis patients with an isolated pollen sensitization responded more strongly to a nasal provocation with grass pollen (GP) than patients who had an additional house dust mite (HDM) sensitization. To elucidate this phenomenon, we investigated the dynamics of Foxp3+CD4+ T lymphocytes in allergic rhinitis patients with distinct allergen sensitizations. Three groups of allergic rhinitis patients with skin prick test confirmed allergic sensitizations were investigated and compared to 14 healthy controls: 14 subjects with an isolated grass pollen sensitization (Mono-GP); 9 subjects with isolated housedust mite sensitization (Mono-HDM); 29 subjects with grass pollen and house dust mite sensitization (poly-sensitized). Subjects in the Mono-GP group were challenged with grass pollen extract, subjects in the Mono-HDM group were challenged with house dust mite extract, subjects in the poly-sensitized group and the healthy controls were randomly challenged with either grass pollen or house dust mite. Nasal biopsies were taken before and after nasal provocation. We compared the distribution of FoxP3+CD4+ cells in nasal biopsies before and after nasal provocation using immunohistochemistry. There was no difference in the number of FoxP3+CD4+ cells between healthy and the three allergic groups at baseline.Nasal provocation did result in an increase in eosinophils in the three allergic groups, but did not result in a change in the number of FoxP3+CD4+ cells in any of the groups or induced differences between any of the groups. Clinical differences in the response between mono-GP and multiple-sensitized allergic individuals are not related to differences in the number of regulatory T cells in the nasal mucosa.

Differences of the Clinical Manifestations and Laboratory Tests between Monosensitized and Polysensitized Children: A Single Center Study

Purpose: The objective of this study was to identify differences in the clinical manifestations and allergic indices between monosensitized and polysensitized children. Methods: We reviewed retrospective data from the medical records of patients who had chronic or recurrent respiratory symptoms and visited the pediatric clinic at Chung-Ang University Hospital for an evaluation of allergic diseases from January 2003 to January 2011. The patients were categorized into nonsensitized (n=111), monosensitized (n=149), and polysensitized (n=205) groups according to skin prick tests (as classified by five allergen groups). We compared gender, age, family history, admission history, food sensitization, total immunoglobulin E (IgE), peripheral eosinophil counts, eosinophil cationic protein (ECP) levels, forced expiratory volume in 1 second (FEV1), and methacholine provocation tests among the three groups. Results: The frequency of food sensitivity was highest in the polysensitized group (n=101, 49.3%), followed by the monosensitized (n=8, 5.4%) and nonsensitized groups (n=0) (P<0.001). The FEV1 was significantly lower in the polysensitized group than that in the monosensitized and nonsensitized groups (79.4 ± 20.2% vs. 87.2 ±16.0% vs. 87.6 ± 17.1%, respectively) (P=0.013). The total IgE and ECP levels were significantly higher in the polysensitized patients than those in the other patients (P<0.001 and <0.001, respectively). Differences in gender, age, peripheral eosinophil count, and bronchial hyper-responsiveness were not identified between the monosensitized and polysensitized groups. Conclusion: The polysensitized group showed more frequent food hypersensitivity, lower FEV1 values, and higher allergic indices such as total IgE and ECP, suggesting a different atopic phenotype compared with those in the monosensitized group. (Pediatr Allergy Respir Dis(Korea) 2011;21: 277-284)

Susceptibility and reactivity in polysensitized individuals following controlled induction

It is uncertain whether polysensitized patients acquire multiple allergies only because of a high degree of exposure to environmental allergens, or because of being highly susceptible to developing contact allergy. The aim of this study was to investigate and compare susceptibility and reactivity in polysensitized and monosensitized individuals, and in healthy controls. We sensitized 66 adult individuals (21 polysensitized, 22 monosensitized, and 23 healthy controls) with diphenylcyclopropenone and assessed challenge responses with visual scoring and ultrasound. We compared sensitization rates using a chi-square test and logistic regression analyses, and calculated linear regression lines of the elicitation responses for each individual. The mean values of the slopes and the intercepts for each group were used to measure the strength of the elicitation response, and were compared using the Mann-Whitney test. Sensitization ratio was equal in the three groups: 57% for the polysensitized, 59% for the monosensitized, and 65% for the healthy control group. There was a lowered elicitation threshold in the polysensitized group compared with that in the monosensitized and healthy control groups and, although not statistically significant, a stronger elicitation response was observed in the polysensitized group. Increased reactivity was found in the polysensitized group, demonstrated by a lowered elicitation threshold, compared with that in the monosensitized and healthy control groups.

Characterization of the polysensitized patient: a matched case–control study

Polysensitization ( >or= 3 contact allergies) may be regarded as a special entity in patients with contact allergies. However, this group of polysensitized patients is poorly characterized. Filaggrin mutations are associated with atopic eczema and lead to impaired skin barrier which may predispose to contact allergy. Therefore, it is of interest to consider atopic eczema and contact allergies, especially in patients with multiple allergies. To characterize polysensitized patients regarding occurrence, duration and course of dermatitis, and examine potential risk factors for polysensitization, including atopic eczema. A questionnaire case-control study of 562 polysensitized and 1124 single/double-sensitized individuals was performed. The results show that 45% of polysensitized and 31% of single/double-sensitized patients had or had had atopic eczema, and atopic eczema was identified as a risk factor for polysensitization. Patients with leg ulcer constituted only a minor part of the polysensitized group and leg ulcers were not identified as a risk factor for polysensitization in this study. The influence of contact allergies on duration and course of disease diverged between the group of patients with atopic eczema and the group without atopic eczema. Patients with atopic eczema were overrepresented in the group of polysensitized patients and polysensitized patients should be viewed in the light of occurrence or lack of atopic eczema.

Patch test dose-response study: polysensitized individuals do not express lower elicitation thresholds than single/double-sensitized individuals

It is not known if reduced elicitation thresholds are evident among polysensitized individuals when using allergens to which the patients are already sensitized. Reduced elicitation thresholds may be an expression of increased reactivity in this patient group. To examine and compare elicitation dose-response curves and elicitation thresholds in a polysensitized vs. a single/double-sensitized group for allergens to which the test subjects were already sensitized. Fifty-one patients (13 polysensitized and 38 single/double-sensitized) were patch tested with nickel sulphate, methyldibromo glutaronitrile (MDBGN) and p-phenylenediamine (PPD) in dilution series. The ratio between the doses eliciting a response in 50% of patients in the two groups was used as the measure for relative sensitivity. The dose-response curves of the polysensitized group for MDBGN and PPD were shifted to the right, and for nickel sulphate shifted to the left, compared with the single/double-sensitized group. The relative sensitivity for each of the three allergens and a combined relative sensitivity for all three allergens were not significantly different when comparing the polysensitized and single/double-sensitized groups. No increased sensitivity, in the form of distinct elicitation thresholds, could be demonstrated in polysensitized individuals compared with individuals with one or two contact allergies.