title: Immunomodulation during sublingual therapy in allergic children.
abstract: The clinical efficacy of sublingual immunotherapy (SLIT) has been demonstrated, but its mechanism of action is still controversial. The most recent experimental observations suggest that a critical role in the modulation of immune response is sustained by Th2 cytokines, such as interleukin-4 (IL-4), IL-5 and IL-13, by co-stimulatory molecules, such as CD40 on B cells, and by hormones and neuropeptides. To better understand whether SLIT affects immune responses we used a double-blind placebo-controlled design. Eighty-six children with mild asthma due to allergy to Dermatophagoides pteronyssinus (33 of whom also had rhinoconjunctivitis) were randomly assigned SLIT (n = 47) or placebo (n = 39). We assessed symptom scores using diary cards of each patient and determined the expression of CD40 on B cells and the serum concentration of ECP, IL-13, prolactin (PRL) and ACTH at enrolment and after 6 months of therapy. We observed a significant reduction in asthma and rhinitis scores in the immunotherapy group compared with the placebo group, no variation in CD40 and ACTH, but a significant decrease in ECP, IL-13 and PRL after 6 months of therapy (p <0.01). Our results confirm the efficacy and safety of SLIT, and lead us to believe that it could modulate the synthesis of Th2 cytokines, as revealed from the decrease of IL-13. In addition, the reduction of PRL might be a signal of reduced activation of T lymphocytes.
authors.affiliation: Department of Experimental Medicine and Pathology, University 'La Sapienza', Rome, Italy.
authors.forename: Flora
authors.initials: F
authors.lastname: Ippoliti
authors.forename: Wladimiro
authors.initials: W
authors.lastname: De Santis
authors.forename: Anna
authors.initials: A
authors.lastname: Volterrani
authors.forename: Luisa
authors.initials: L
authors.lastname: Lenti
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Canitano
authors.forename: Sandra
authors.initials: S
authors.lastname: Lucarelli
authors.forename: Tullio
authors.initials: T
authors.lastname: Frediani
mesh_terms: D000286:Administration, Sublingual; D000324:Adrenocorticotropic Hormone / Q000096:biosynthesis*; D000485:Allergens / Q000008:administration & dosage / Q000276:immunology; D001249:Asthma / Q000276:immunology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D040002:Dermatophagoides pteronyssinus / Q000276:immunology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007167:Immunotherapy; D018793:Interleukin-13 / Q000096:biosynthesis*; D008297:Male; D011388:Prolactin / Q000096:biosynthesis*; D012221:Rhinitis, Allergic, Perennial / Q000276:immunology / Q000628:therapy*; D012882:Skin Tests
chemical_list: D000485:Allergens; D018793:Interleukin-13; D000324:Adrenocorticotropic Hormone; D011388:Prolactin