Comparison of short-term effects between subcutaneous and sublingual immunotherapies in children with house dust mite-sensitized allergic rhinitis and asthma

Eun Lee; Min-Ju Kim; Song-I Yang; Jinho Yu; Soo-Jong Hong

doi:10.4168/aard.2015.3.3.180

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Lee, Kim, Yang, Yu, and Hong: Comparison of short-term effects between subcutaneous and sublingual immunotherapies in children with house dust mite-sensitized allergic rhinitis and asthma

Original Article

Allergy, Asthma & Respiratory Disease 2015; 3(3): 180-186.

Published online: 29 May 2015

DOI: https://doi.org/10.4168/aard.2015.3.3.180

Comparison of short-term effects between subcutaneous and sublingual immunotherapies in children with house dust mite-sensitized allergic rhinitis and asthma

Eun Lee^1,², Min-Ju Kim¹, Song-I Yang^1,², Jinho Yu¹, Soo-Jong Hong^1,²

¹Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, Unversity of Ulsan College of Medicine, Seoul, Korea.

²Research Center for Standardization of Allergic Diseases, Asan Medical Center, Unversity of Ulsan College of Medicine, Seoul, Korea.

Correspondence to: Soo-Jong Hong. Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3379, Fax: +82-2-473-3725, sjhong@amc.seoul.kr

Received 27 December 2014 Revised 21 April 2015 Accepted 27 April 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Purpose

There have been several studies on comparisons of efficacy between subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) in children with house dust mite (HDM)-sensitized allergic rhinitis (AR), without consistent results. This study was conducted to compare short-term effects between SCIT and SLIT in Korean children with HDM-sensitized AR.

Methods

Fifty-three children (mean age, 11.15±2.82 years) with HDM-sensitized AR and with/without asthma (SCIT group, n=33; SLIT group, n=20) were enrolled. Clinical symptom scores and skin prick test results were assessed before, and after 3, 6, and 12 months of immunotherapy. Blood tests, including eosinophils, total serum IgE, and HDM-specific IgE, and adenosine 5'-monophosphate, and methacholine bronchial challenge tests were performed before and after 12 months of immunotherapy.

Results

In the SCIT group, the symptom scores improved after 3 months compared to those before immunotherapy, whereas they improved after 6 months in the SLIT group. Significant decreases in skin reactivity to HDM were observed after 3 months only in the SCIT group. Decreases in total eosinophil counts and improvements in methacholine bronchial provocation tests were observed after 12 months of immunotherapy only in the SCIT group. No difference in severe adverse reactions was noted in either group.

Conclusion

The results of this study suggest that SCIT may have more rapid effects on clinical symptoms and skin reactivity in children with AR, compared to SLIT.

Keywords: Allergic rhinitis, Child, Dermatophagoides farinae, Dermatophagoides pteronyssinus, Immunotherapy

Figures and Tables

Table 1

General characteristics of study population

Characteristic	SLIT	SCIT	P-value
No. of subjects	20	33
Sex			1.000
Male/female	16/4	26/7	1.000
Age (yr)	10.20 ± 3.25	11.73 ± 2.39	0.055
Skin prick test
Der f mean wheal	6.96 ± 2.87	7.89±4.64	0.420
Der p mean wheal	8.41 ±3.16	7.74±2.87	0.429
Asthma	13	24	0.553
Symptom scores, initial
AR	17.27 ± 2.69	15.85±4.56	0.243
Asthma	17.80 ± 4.60	18.85±6.00	0.720
IMT compliance (%)	82.00 ± 12.64	100.00±0	< 0.001
Adverse effects
Local reaction	1 (oral itching sensation)	23 (injection site swelling, itching)	< 0.001
Systemic reaction	1 (systemic urticaria)	6 (dyspnea, systemic urticaria)	0.233
New sensitization			0.217
No/yes	16/4	30/3	0.217

Values are presented as number or mean± standard deviation. Categorical variables were analyzed using chi-square test or Fisher exact test, as appropriate.

SLIT, sublingual immunotherapy; SCIT, subcutaneous immunotherapy; Der f, Dermatophagoides farinae; Der p, Dermatophagoides pteronyssinus; AR, allergic rhinitis;IMT, immunotherapy.

Table 2

Comparison of changes in symptom scores of allergic rhinitis between subcutaneous immunotherapy group and sublingual immunotherapy group

Treatment duration (mo)	Symptom scores (point)				P-value^†
Treatment duration (mo)	SLIT (n=20)	P-value^*	SCIT (n=33)	P-value^*	P-value^†
0	17.27±1.22		15.85±0.78		0.327
3	17.03±1.43	0.868	13.33±0.78	0.002	0.025
6	13.74±1.31	0.009	13.41±0.78	0.002	0.829
12	11.81±1.30	< 0.001	11.80±0.80	< 0.001	0.996

Values are presented as mean± standard error.

SLIT, sublingual immunotherapy; SCIT, subcutaneous immunotherapy.

^*Comparisons between baseline and time point in both immunotherapy groups were analyzed using paired t-test or Wilcoxon signed rank test. ^†Comparisons of symptom scores in allergic rhinitis between SLIT and SCIT groups at each time point were analyzed using Mann-Whitney U-tests.

Table 3

Comparison of changes in skin reactivity within and between subcutaneous immunotherapy group and sublingual immunotherapy group

Treatment duration (mo)	Skin prick test, Der p (A/H ratio)				P-value^†	Skin prick test, Der f (A/H ratio)				P-value^†
Treatment duration (mo)	SLIT (n=20)	P-value^*	SCIT (n=33)	P-value^*	P-value^†	SLIT (n=20)	P-value^*	SCIT (n=33)	P-value^*	P-value^†
0	2.02±0.10		1.99±0.08		0.769	1.80±0.11		1.93±0.08		0.328
3	1.68±0.13	0.014	1.78±0.08	0.015	0.533	1.61±0.12	0.164	1.60±0.07	< 0.001	0.985
6	1.82±0.10	0.077	1.60±0.06	< 0.001	0.057	1.69±0.08	0.385	1.44±0.05	< 0.001	0.014
12	1.75±0.09	0.009	1.45±0.06	< 0.001	0.008	1.64±0.08	0.201	1.46±0.06	< 0.001	0.070

Values are presented as mean± standard error.

Der f, Dermatophagoides farinae; Der p, Dermatophagoides pteronyssinus; A/H ratio, allergen (mm)/histamine (mm) ratio in skin prick test; SLIT, sublingual immunotherapy; SCIT, subcutaneous immunotherapy.

^*Comparisons of values between 0 month and time point were calculated using paired t-test or Wilcoxon signed rank test. ^†Comparisons of differences between 0 months and 12 months in both SLIT and SCIT groups were calculated using t-test or Mann-Whitney test.

Table 4

Comparisons of clinical and laboratory parameters within and between subcutaneous immunotherapy and sublingual immunotherapy groups

Parameter	SLIT (n=20)			SCIT (n=33)			P-value^†
Parameter	0 Month	12 Months	P-value^*	0 Month	12 Months	P-value^*	P-value^†
Serum eosinophils (µL) (n=53)	683.33±412.69	439.17±209.35	0.076	582.31±357.04	392.31±288.96	0.010	0.682
Specific IgE (kUA/L) (n=53)
Der p	36.40±35.39	44.32±35.45	0.249	41.33±30.78	40.09±28.32	0.814	0.310
Der f	60.40±40.72	58.67±36.17	0.773	70.91±32.77	62.41±26.68	0.080	0.399
Total serum IgE (kU/L) (n = 53)	634.28±656.03	593.66±329.35	0.859	517.60±566.90	709.26±815.63	0.050	0.382
Provocation test
AMP PC₂₀ (mg/mL)	36.80±21.72 (n=5)	114.61±167.37 (n=5)	0.686	120.06±117.16 (n=16)	158.88±145.83 (n=16)	0.125	0.869
MCH PC₂₀ (mg/mL)	4.24±2.06 (n=7)	14.22±11.31 (n=7)	0.063	5.93±6.84 (n=26)	11.80±10.01 (n=26)	< 0.001	0.322

Values are presented as mean± standard deviation.

SLIT, sublingual immunotherapy; SCIT, subcutaneous immunotherapy; Der p, Dermatophagoides pteronyssinus; Der f, Dermatophagoides farinae; AMP, adenosine 5'-monophosphate; MCH, methacholine; PC₂₀, provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second.

^*Comparisons of values between 0 month and at 12 months were calculated using paired t-test or Wilcoxon signed rank test. ^†Comparisons of differences in each value between 0 months and 12 months in both SLIT and SCIT groups were calculated using t-test or Mann-Whitney test

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ORCID iDs: Soo-Jong Hong
https://orcid.org/http://orcid.org/0000-0003-1409-2113
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