Steroid-sparing effects with allergen-specific immunotherapy in children with asthma: A randomized controlled trial

详细信息    查看全文

• 作者：Stefan Zielen ; Peter Kardos ; Enzo Madonini
• 关键词：Subcutaneous immunotherapy ; allergoid ; house dust mite ; asthma control ; children ; hypoallergenic preparation ; controlled trial ; efficacy ; safety ; Dermatophagoides pteronyssinus
• 刊名：Journal of Allergy and Clinical Immunology
• 出版年：2010
• 出版时间：November 2010
• 年：2010
• 卷：126
• 期：5
• 页码：942-949
• 全文大小：217 K

文摘

Background

Asthma control is now recognized as the main goal of asthma therapy. Guidelines recommend finding the lowest effective dose of inhaled corticosteroids in children with persistent asthma.

Objective

The aim of this study was to investigate the efficacy of an allergen-specific immunotherapy with a high-dose hypoallergenic mite preparation (allergoid) as steroid-sparing agent in children with allergic asthma.

Methods

Sixty-five children with asthma (Global Initiative for Asthma treatment levels II and III; 6-17 years old), after reaching asthma control with inhaled steroids during a 5-month baseline period, were randomized for subcutaneous mite allergoid immunotherapy (SCIT) plus fluticasone propionate (FP) or FP therapy alone for 2 years. During 2 subsequent 5-month winter periods, steroid therapy was adjusted according to predefined dose steps, determining and comparing the changes in FP dosages and the lowest FP dose sufficient to maintain asthma control. Immunologic and functional investigations were also carried out.

Results

Children treated with house dust mite SCIT plus FP were able to significantly reduce the FP dose by more steps (P < .05), compared with the control group on FP alone. The mean daily dose in the immunotherapy group decreased from 330.3 μg in the baseline period to 151.5 μg after 2 treatment years, whereas in the control group the dose decreased from 290.6 μg to 206.3 μg. Compared with the control group, significant improvement was also observed in morning peak expiratory flow (P = .0315). Significantly increased levels of specific IgG₁ (P = .0001) and IgG₄ (P < .0001) were also observed.

Conclusion

Adding a mite allergoid SCIT to pharmacologic treatment is an effective and safe strategy to reduce corticosteroid doses while maintaining disease control in children with mite-induced allergic asthma.