Three years of specific immunotherapy may be sufficient in house dust mite respiratory allergy

doi:10.1016/j.jaci.2010.10.025

Journal of Allergy and Clinical Immunology

Volume 127, Issue 1, January 2011, Pages 57-63.e3

https://doi.org/10.1016/j.jaci.2010.10.025 Get rights and content

Background

Specific immunotherapy (SIT) duration for respiratory allergy is currently based on individual decisions.

Objective

To evaluate the differences in clinical efficacy of SIT as a result of the duration between the current recommended limits (3-5 years).

Methods

A 5-year prospective, controlled clinical trial of SIT blind until the first year and randomization to a 3-year (IT3) or 5-year (IT5) course was conducted. Of the 239 patients with respiratory allergy caused by D pteronyssinus initially included, 142 completed 3 years of SIT with good compliance. Twenty-seven controls were included at the third year. Efficacy of SIT after 3 (T3) and 5 (T5) years was assessed by using clinical scores, visual analog scales (VASs), rhinitis (RQLQ) and asthma (AQLQ) quality of life questionnaires, skin tests, and serum immunoglobulins.

Results

At T3, significant reductions were observed in rhinitis (44% in IT3 and 50% in IT5; P < .001), asthma (80.9 % in IT3 and 70.9% in IT5; P < .001) scores, VAS (P < .001 in both), RQLQ (P < .001 in both) and AQLQ (P < .001 in both). At T5, the clinical benefit was maintained in both groups, and IT5 patients presented additional decreases (19%; P = .019) in rhinitis scores. At Tf, specific IgG₄ measurements were lower in IT3 (P = .03) without detecting differences in IT5. An increase in asthma score of 133% was the only difference observed in controls.

Conclusion

Clinical improvement is obtained with 3 years of D pteronyssinus SIT. Two additional years of SIT add clinical benefit in rhinitis only.

Section snippets

Study design

This was a 5-year, phase IV, prospective study, double-blind for the first year, in which the initial phase (cluster or conventional) was blind. After the first year, half the patients were randomized¹⁷ to 3 years (IT3) and the other half to 5 years of SIT (IT5). At the third year (T3), a control group receiving pharmacologic treatment exclusively was also included (Fig 1). Patients were evaluated at baseline (T0), after the first year (published data¹⁸), and at the third year (T3) and the

Results

Two hundred thirty-nine patients initiated the study, and at T3, 142 of the 215 patients who completed the first year were still on treatment with good compliance. Seventy patients were told to continue SIT for 2 more years (IT5 group) and 72 were told to cease the treatment (IT3 group) according to a randomized sequence. At this time, the control group was recruited. Forty-nine (IT5) and 62 (IT3) patients came to all scheduled visits. For analysis, we used data from patients who had complete

Discussion

The recommended duration of SIT treatment relies on empiric data and is not well documented. In our opinion, an adequate SIT treatment should guarantee clinical efficacy with significant reduction of the symptoms and medication needs, a good safety profile without unpredictable systemic reactions, and a long-term therapeutic benefit after its completion.

To date, few studies have addressed the identification of the proper duration of SIT treatment needed to fulfill those requirements.³⁴ Some

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: Supported by a research grant from the Regional Government of Navarra.

: Disclosure of potential conflict of interest: S. Martin is an employee of ALK-Abelló and helped in the design and analysis of the study. The rest of the authors have declared that they have no conflict of interest.

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Commemorating 100 years of immunotherapyThree years of specific immunotherapy may be sufficient in house dust mite respiratory allergy

Background

Objective

Methods

Results

Conclusion

Section snippets

Study design

Results

Discussion

Clin Ther

J Allergy Clin Immunol

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Prophylactic inoculation against hay fever

Lancet

Allergen immunotherapy for asthma

Cochrane Database Syst Rev

Allergen injection immunotherapy for seasonal allergic rhinitis

Cochrane Database Syst Rev

Prevention of new sensitizations in asthmatic children monosensitized to house dust mite by specific immunotherapy: a six-year follow-up study

Clin Exp Allergy

Long term clinical efficacy of grass pollen immunotherapy

N Engl J Med

Specific immunotherapy has long-term preventive effect of seasonal and perennial asthma: 10-year follow-up on the PAT study

Allergy

Twelve-year follow-up after discontinuation of preseasonal grass pollen immunotherapy in childhood

Allergy

Allergen immunotherapy: a practice parameter second update

J Allergy Clin Immunol

EAACI, Immunotherapy Task Force. Standards for practical allergen-specific immunotherapy

Allergy

Commemorating 100 years of immunotherapy
Three years of specific immunotherapy may be sufficient in house dust mite respiratory allergy