Dust mite allergy studies

Specific immunotherapy is a very powerful tool which is currently underutilized in the treatment of allergies. Sublingual immunotherapy (SLIT) has many advantages over subcutaneous immunotherapy (SCIT), and has been well proven to work for many pollens and dust mites. Multiple studies have shown SLIT improves symptoms and reduces the reliance on medications. Sublingual treatment has been studied in Europe and is endorsed by the World Health Organization Committee on Immunotherapy as a viable alternative to SCIT. 

Olsen O, Larsen K, Jacobsan L, Svendsen U A 1-year, placebo-controlled, double-blind house-dust-mite immunotherapy study in asthmatic adults. Allergy 1997 52 853-859. 

The efficacy of subcutaneous SIT has been clearly shown in a metaanalysis of 43 double-blind placebo-controlled trials in allergic rhinitis as well as another meta-analysis of 16 double-blind placebo-controlled studies in asthma patients [13]. The mean clinical improvement was 45% reduction in symptoms and medication compared with placebo in rhinitis and 40% in asthma patients, which exceeds the effects of drug therapy. A recent meta-analysis also confirmed that asthma responds favorably to SIT [14], However, recently it could also be demonstrated that SIT is effective in patients with house dust mite allergy, allergic rhinitis and asthma [15]. Immunotherapy in these patients not only reduced rhinitis and asthma symptoms as well as rescue medication, but also had an impact on bronchial hyperreactivity over the 3-year follow-up period. 

Secondary intervention studies are few. A study in Japan [240(Ib)] identified infants at high risk of house dust mite allergy and asthma postnatally, on the basis of early manifestations of atopy (i.e. eczema and food allergy). Children were enrolled during the 1st year of life and randomised to house dust mite prevention which resulted in a substantial reduction in house dust mite allergen levels. At the 1-year follow-up, children in the active treatment group had lower levels of IgE antibody, prevalence of positive skin prick test responses to house dust mite, and lower incidence of wheezing episodes. Follow-up is awaited. 

Winton HL, Wan H, Cannell MB, Gruenert DC, Thompson PJ, Garrod DR, Stewart GA, Robinson C (1998) Cell lines of pulmonary and non-pulmonary origin as tools to study the effects of house dust mite proteinases on the regulation of epithelial permeability. Clin Exp Allergy 28 1273-1285. 

Werfel T, Breuer K, Rueff F, Przybilla B, Worm M, Grewe M, Ruzicka T, Brehler R, Wolf H, Schnitker J, Kapp A Usefulness of specific immunotherapy in patients with atopic dermatitis and allergic sensitization to house dust mites a multicentre, randomized, dose-response study. Allergy 2006 61 202-205. 

Bussmann C, Maintz L, Hart J, Allam JP, Vrtala S, Chen KW, Bieber T, Thomas WR, Valenta R, Zuberbier T, Sager A, Novak N Clinical improvement and immunological changes in atopic dermatitis patients undergoing subcutaneous immunotherapy with a house dust mite allergoid a pilot study. Clin Exp Allergy 2007 37 1277-1285. 

Guilloux, L., Vuitton, D. A., Delbourg, M., Lagier, A., Adessi, B., Marchand, C. R., and Ville, G. (1998). Cross-reactivity between terrestrial snails (Helix species) and house-dust mite (Dermatophagoides pteronyssinus). 11. In vitro study. Allergy 53,151-158. 

Bousquet J, Scheinmann P, Guinnepain MT, Perrin-Fayolle M, Sauvaget J, Tonnel AB, Pauli G, Caillaud D, Dubost R, Leynadier F, Vervloet D, Herman D, Galvain S, Andre C Sublingual-swallow immunotherapy (SLIT) in patients with asthma due to house-dust mites A double blind placebo-controlled study. Allergy 1999 54/3 249-260. 

Guez S, Vatrinet C, Fadel R, Andre C House dust mite SLIT in perennial rhinitis A double blind placebo controlled study. Allergy 2000 55 369-375. 

Hirsch T, Sahn M, Leupold W Double-blind placebo-controlled study of sublingual immunotherapy with house dust mite extract (D.pt.) in children. Pediatr Allergy Immunol 1997 8 21-27. Bahceciler NN, Isik U, Barlan IB, Basaran MM Efficacy of sublingual immunotherapy in children with asthma and rhinitis A double-blind, placebo-controlled study. Pediatr Pulmonol... 

Hirsch TH, Sahn M, Leupold W Double-blind placebo-controlled study of sublingual immunotherapy with house dust mite extract (D.pt.) in children. Pediatr Allergy Immunol 1997 8 21-27. 

La Rosa M, Ranno C, Andre C, Carat F, Tosca MA, Canonica GW Double-blind placebo-controlled evaluation of sublingual swallow immunotherapy with standardized Parietaria judaica extract in children with allergic rhinoconjunctivitis. J Allergy Clin Immunol 1999 104 425 432. Guez S, Vatrinet C, Fadel R, Andre C House dust mite sublingual swallow immunotherapy in perennial rhinitis A double-blind placebo-controlled study. Allergy 2000 55 369-375. 

To date, the APT with foods is not well standardized and different methods in preparing the test materials are likely to cause controversial results. Most studies with foods have been performed with cow s milk, hen s egg, and wheat. The fresh foods should be preferred over commercial extracts for testing. The APT with foods like cow s milk or hen s egg has been studied in infants and children since food allergy plays a role especially in this age group, whereas aeroallergens (house dust mite) have been studied more intensively in adults (Turnjamaa et al., 2006). 

Lau S, llli S, Sommerfeld C, Niggemann B, Bergmann R, von Mutius E, Wahn U (2000) Early exposure to house-dust mite and cat allergens and development of childhood asthma A cohort study. Multicentre Allergy Study Group. Lancet, 356(9239) 1392-1397. 

Pajno GB, Barberio G, De Luca F, Morabito L, Parmiani S Prevention of new sensitizations in asthmatic children monosensitized to house dust mite by specific immunotherapy. A six-year follow-up study. Clin Exp Allergy 2001 31 1392-1397. (Ila)... 

The effectiveness of immunotherapy for seasonal allergic rhinitis appears to be better than that seen with perennial rhinitis, in part because it is more difficult to determine which allergen is responsible for perennial symptoms, and it is more due to multiple sensitizations. Effectiveness has been shown in a number of clinical studies using a variety of pollen extracts, even in patients with severe disease resistant to pharmacotherapy." " Specific immunotherapy for house dust mites has had good results in appropriately selected patients, while several studies have described marked improvement in patients with allergy to cats. Data indicate that in some patients 3 years of immunotherapy may be sufficient to give lasting benefit." ... 

Klaewsongkram J, Ruxrangtham K, Wannakrairot P, et al. Eosinophil count in nasal mucosa is more suitable than the number of ICAM-1-positive nasal epithelial cells to evaluate the severity of house dust mite-sensitive allergic rhinitis A clinical correlation study. Int Arch Allergy Immunol 2003 132 68-75. 

---