Clinico-immunologic Study on Immunotherapy with Mixed and Single Insect Allergens
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Immunotherapy (IT) is practiced mainly with mixed and single allergen vaccines. But studies are rare with mixed allergen preparations.
The objective of this study is to study mix and single insect allergen IT in patients of allergic rhinitis and asthma.
We performed a double-blind placebo-controlled trial of mix and single allergen IT for 1 year in 99 patients of asthma or rhinitis or both. There were two groups, (1) active allergen IT (n = 61) with three subgroups single insect extract (cockroach, housefly, or mosquito) and mix allergen IT (two or three insect extracts) and (2) placebo (n = 38). Clinical (skin reactivity, airway reactivity, and symptom score) and immunological (IgE/IgG4 and IgG1/IgG4 ratio) parameters were assessed at baseline and after 1 year of IT.
Eighty-five patients completed 1 year of IT. The active allergen IT group patients showed a significant improvement compared to baseline values (p < 0.05) and placebo group patients (p < 0.05) with regard to symptom scores, FEV1 values, and immunological parameters (IgG4). No significant difference was found between mixed and single IT group patients for changes in clinical and immunological parameters. Positive correlation was observed between increase in IgG4 and clinical improvement. The changes in above parameters in placebo group were nonsignificant after 1 year of treatment.
IT with two to three mix extract from the same allergen group is effective for insect hypersensitivity.
- Smith TS, Hogan MB, Welch JE, Corder WT, Wilson NW. Modern prevalence of insect sensitization in rural asthma and allergic rhinitis patients. Allergy Asthma Proc. 2005;26:356–60.
- Baldo BA, Panzani RC. Detection of IgE antibodies to a wide range of insect species in subjects with suspected inhalant allergies to insects. Int Arch Allergy Appl Immunol. 1988;85:278–87. CrossRef
- Gupta S, Jain S, Chaudhry S, Agarwal MK. Role of insects as inhalant allergens in bronchial asthma with special reference to the clinical characteristics of patients. Clinical and Experimental Allergy. 1990;20:519–24. doi:10.1111/j.1365-2222.1990.tb03144.x. CrossRef
- Kausar MA, Vijayan VK, Bansal SK, Menon BK, Vermani M, Agarwal MK. Mosquitoes as sources of inhalant allergens: clinicoimmunologic and biochemical studies. J Allergy Clin Immunol. 2007;120:1219–21. doi:10.1016/j.jaci.2007.07.017. CrossRef
- Srivastava D, Singh BP, Sudha VT, Arora N, Gaur SN. Immunotherapy with mosquito (Culex quinquefasciatus) extract: a double-blind, placebo-controlled study. Annals of Allergy, Asthma & Immunology. 2007;99:273–80.
- Gore JC, Schal C. Cockroach allergen biology and mitigation in the indoor environment. Annual Review of Entomology. 2007;52:439–63. doi:10.1146/annurev.ento.52.110405.091313. CrossRef
- Alonso A, Albonico JF, Mouchian K, Scavini LM, Iraneta SG, Pionetti CH. Immunological changes during cockroach immunotherapy. J Investig Allergol Clin Immunol. 1999;9:299–304.
- Chaudhry S, Jhamb S, Chauhan USP, Gaur SN, Agarwal HC, Agarwal MK. Shared and specific allergenic and antigenic components in the two sexes of American cockroach Periplaneta americana. Clinical and Experimental Allergy. 1990;20:59–65. doi:10.1111/j.1365-2222.1990.tb02776.x. CrossRef
- Agarwal MK, Gupta S, Chawla S, Bansal SK, Vijayan VK. Cross-reacting and unique allergenic and antigenic components in insect extracts used for the diagnosis and immunotherapy of patients suffering with respiratory allergy. In: Sharma PU, Singh BP, Rao DN, et al., editors. Trends clinical biochemistry laboratory medicine. New Delhi: Association of Clinical Biochemists of India; 2003. p. 314–24.
- Gaur SN, Gupta K, Rajpal S, Singh AB, Rohatgi A. Prevalence of bronchial asthma and allergic rhinitis among urban and rural adult population of Delhi. Indian J Allergy Asthma Immunol. 2006;20:90–7.
- Aggarwal AN, Chaudhry K, Chhabra SK, D'Souza GA, Gupta D, Jindal SK, et al. Prevalence and risk factors for bronchial asthma in Indian adults: a multicentre study. Indian Journal of Chest Diseases and Allied Sciences. 2006;48:13–22.
- Jindal SK. Bronchial asthma: the Indian scene. Curr Opin Pulm Med. 2007;13:8–12. doi:10.1097/MCP.0b013e32800ffd09. CrossRef
- Viswanathan R, Prasad M, Thakur AK, Sinha SP, Prakash N, Mody RK. Epidemiology of asthma in an urban population; a random morbidity survey. J Indian Med Assoc. 1966;46:480–3.
- Ariano R, Berto P, Tracci D, Incorvaia C, Frati F. Pharmacoeconomics of allergen immunotherapy compared with symptomatic drug treatment in patients with allergic rhinitis and asthma. Allergy Asthma Proc. 2006;27:159–63.
- Huggins JL, Looney RJ. Allergen immunotherapy. American Family Physician. 2004;70:689–96.
- Maestrelli P, Zanolla L, Pozzan M, Fabbri LM, Regione V. Effect of specific immunotherapy added to pharmacologic treatment and allergen avoidance in asthmatic patients allergic to house dust mite. J Allergy Clin Immunol. 2004;113:643–9. doi:10.1016/j.jaci.2003.12.586. CrossRef
- Wachholz PA, Soni NK, Till SJ, Durham SR. Inhibition of allergen-IgE binding to B cells by IgG antibodies after grass pollen immunotherapy. J Allergy Clin Immunol. 2003;112:915–22. doi:10.1016/S0091-6749(03)02022-0. CrossRef
- Jutel M, Akdis M, Blaser K, Akdis CA. Mechanisms of allergen specific immunotherapy—T-cell tolerance and more. Allergy. 2006;61:796–807. doi:10.1111/j.1398-9995.2006.01175.x. CrossRef
- Karmakar PR, Das A, Chatterjee BP. Placebo-controlled immunotherapy with Cocos nucifera pollen extract. International Archives of Allergy and Immunology. 1994;103:194–201. CrossRef
- Sheikh WA. Immunotherapy vs. inhaled budesonide in bronchial asthma: an open, parallel, comparative trial. Clin Exp Allergy. 1997;27:1279–84. doi:10.1111/j.1365-2222.1997.tb01172.x. CrossRef
- Gaur SN, Gupta S. Clinical response of immunotherapy in cases of nasobronchial allergy. Indian J Allergy Appl Immunol. 1996;10:65–8.
- Adkinson NF Jr, Eggleston PA, Eney D, Goldstein EO, Schuberth KC, Bacon JR, et al. A controlled trial of immunotherapy for asthma in allergic children. N Engl J Med. 1997;336:324–31. doi:10.1056/NEJM199701303360502. CrossRef
- Guidelines for Methacholine and Exercise Challenge Testing —1999. Am J Respir Crit Care Med. 2000;161:309–29.
- Bousquet J, Van Cauwenberge P, Khaltaev N, Aria Workshop Group, World Health Organization. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol. 2001;108:S147–334. doi:10.1067/mai.2001.118891. CrossRef
- Bousquet J, Lockey R, Malling HJ. Allergen immunotherapy: therapeutic vaccines for allergic diseases. A WHO position paper. J Allergy Clin Immunol. 1998;102:558–62. doi:10.1016/S0091-6749(98)70271-4. CrossRef
- Thangam Sudha V, Arora N, Sridhara S, Gaur SN, Singh BP. Biopotency and identification of allergenic proteins in Periplaneta americana extract for clinical applications. Biologicals. 2007;35:131–7. doi:10.1016/j.biologicals.2006.07.004. CrossRef
- Dhyani A, Arora N, Gaur SN, Jain VK, Sridhara S, Singh BP. Analysis of IgE binding proteins of Mesquite (Prosopis juliflora) pollen and cross-reactivity with predominant tree pollens. Immunobiology. 2006;211:733–40. doi:10.1016/j.imbio.2006.03.003. CrossRef
- Singh AK, Mehta AK, Sridhara S, Gaur SN, Singh BP, Sarma PU, et al. Allergenicity assessment of transgenic mustard (Brassica juncea) expressing bacterial cod A gene. Allergy. 2006;61:491–7. doi:10.1111/j.1398-9995.2006.01049.x. CrossRef
- Malling HJ, Weeke B. Position paper: Immunotherapy (EAACI) The European Academy of Allergology and Clinical Immunology. Allergy. 1993;48:7–35.
- Lowell FC, Franklin W. A double-blind study of the effectiveness and specificity of injection therapy in ragweed hay fever. N Engl J Med. 1965;273:675–9.
- Franklin W, Lowell FC. Comparison of two dosages of ragweed extract in the treatment of pollinosis. JAMA. 1967;201:915–7. doi:10.1001/jama.201.12.915. CrossRef
- Johnstone DE, Crump L. Value of hyposensitization therapy for perennial bronchial asthma in children. Pediatrics. 1961;27:39–44.
- Garcia-Robaina JC, Sanchez I, de la Torre F, Fernandez-Caldas E, Casanovas M. Successful management of mite-allergic asthma with modified extracts of Dermatophagoides pteronyssinus and Dermatophagoides farinae in a double-blind, placebo-controlled study. J Allergy Clin Immunol. 2006;118:1026–32. doi:10.1016/j.jaci.2006.07.043. CrossRef
- Abramson MJ, Puy RM, Weiner JM. Allergen immunotherapy for asthma. Cochrane Database Syst Rev. 2003;4:CD001186.
- Lu FM, Chou CC, Chiang BL, Hsieh KH. Immunologic changes during immunotherapy in asthmatic children: increased IL-13 and allergen-specific IgG4 antibody levels. Annals of Allergy, Asthma & Immunology. 1998;80:419–22.
- Pierson-Mullany LK, Jackola D, Blumenthal M, Rosenberg A. Altered allergen binding capacities of Amb a 1-specific IgE and IgG4 from ragweed-sensitive patients receiving immunotherapy. Ann Allergy. 2000;84:241–3.
- Hogan MB. Patterson: Heterogeneity of histamine releasing factors and IgE. Allergy Proceedings. 1993;14:351–5. doi:10.2500/108854193778773958. CrossRef
- Durham SR, Till SJ. Immunologic changes associated with allergen immunotherapy. J Allergy Clin Immunol. 1998;102:157–64. doi:10.1016/S0091-6749(98)70079-X. CrossRef
- Einarsson R, Dreborg S, Hammarström L, Löfkvist T, Smith CI, Svensson G. Monitoring of mite Dermatophagoides farinae allergen-specific IgG and IgG subclass distribution in patients on immunotherapy. Allergy. 1992;47:76–82.
- Iraneta SG, Duschak VG, Rodriguez SM, Seoane MA, Albonico JF, Alonso A. Proteinase and gelatinolytic activities of house dust mite and cockroach extracts. J Investig Allergol Clin Immunol. 1999;9:235–40.
- Hoff M, Karil M, Kastner M, Haustein D, Vieths S. Fusarium culmorum causes strong degradation of pollen allergens in extract mixtures. J Allergy Clin Immunol. 2002;109:96–101. doi:10.1067/mai.2002.120560. CrossRef
- Meier EA, Whisman BA, Rathkopf MM. Effect of imported fire ant extract on the degradation of mountain cedar pollen allergen. Annals of Allergy, Asthma & Immunology. 2006;96:30–2. CrossRef
- Nelson HS, Ikle D, Buckmeier A. Studies of allergen extract stability: The effects of dilution on and mixing. J Allergy Clin Immunol. 1996;98:382–8. doi:10.1016/S0091-6749(96)70162-8. CrossRef
- Kardash TR, Amend KJ, Willamson L. Effect of mixing allergenic extracts containing Helminthosporium, D. farinae and cockroach with perennial rye grass. Ann Allergy. 1993;71:240–6.
- Sudha VT, Srivastava D, Arora N, Gaur SN, Singh BP. Stability of protease-rich periplaneta Americana allergen extract during storage: formulating preservatives to enhance shelf life. J Clin Immunol. 2007;27:294–301. doi:10.1007/s10875-007-9078-y. CrossRef
- Clinico-immunologic Study on Immunotherapy with Mixed and Single Insect Allergens
Journal of Clinical Immunology
Volume 29, Issue 5 , pp 665-673
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Insect allergy
- double-blind placebo-controlled trial
- pulmonary function test
- Industry Sectors
- Author Affiliations
- 1. Institute of Genomics and Integrative Biology, Mall Road, Delhi, 110007, India
- 2. University of Pune, Ganeskhind, Pune, 411007, India
- 3. Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, 110007, India