Sublingual immunotherapy with Dermatophagoides monomeric allergoid down-regulates allergen-specific immunoglobulin E and increases both interferon-gamma- and interleukin-10-production.
BACKGROUND
The clinical efficacy and safety of sublingual immunotherapy (SLIT) for aeroallergens has been demonstrated in several trials, whereas the immunological changes induced by this treatment, which may account for the clinical improvement, are still unclear.


OBJECTIVE
To investigate the effects of a successful SLIT on the in vitro allergen-driven T cell response and cytokine secretion as well as on the serum levels of chemokines and of IgE, IgG1 and IgG4 antibodies (Abs).


METHODS
Twenty-five Dermatophagoides pteronyssinus (Dp)-sensitive patients with perennial rhinitic and/or rhinitic and asthmatic symptoms were randomized into two groups (13 untreated (UT) and 12 SLIT-treated) for a 1 year and half study. The proliferative response of peripheral blood mononuclear cell (PBMC) to purified Der p1 allergen, their cytokines (IFN-gamma, IL-4, IL-10 and TGF-beta) production and serum levels of chemokines associated with T helper type 1 (Th1) (CXCL10) or T helper type 2 (Th2) (CCL22) responses and of Dp-specific IgE, IgG1 and IgG4 Abs were evaluated before and after 6 months of treatment.


RESULTS
SLIT induced a significant reduction of symptom medication scores after 6, 12 and 18 months of treatment in comparison with UT patients. SLIT-treated patients showed a significant decrease in serum levels of DP-specific IgE Abs, whereas total IgE, and specific IgG1 and IgG4 Abs remained unchanged. The proliferative response of allergen-specific T cells to Der p1 in vitro after 6 months of treatment was reduced, while no effect was observed on T cell proliferation to recall antigen (streptokinase). Moreover, Der p1-driven IFN-gamma and IL-10 were significantly increased in culture supernatants of PBMC from 6 month-treated patients in comparison with those detected at the beginning of therapy.


CONCLUSIONS
These data suggest that the allergen-driven enhancement of IL-10- and IFN-gamma-producing T cells precedes and associates with SLIT-induced down-regulation of specific IgE, thus providing a rationale to explain the clinical benefit of SLIT in allergic patients.
Cosmi
L
L
Center of Research, Transfer, High Education 'DENOthe', University of Florence, Firenze, Italy.
Santarlasci
V
V
Angeli
R
R
Liotta
F
F
Maggi
L
L
Frosali
F
F
Rossi
O
O
Falagiani
P
P
Riva
G
G
Romagnani
S
S
Annunziato
F
F
Maggi
E
E
D000286:Administration, Sublingual; D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000276:immunology; D000080384:Allergoids; D039741:Antigens, Dermatophagoides / Q000276:immunology*; D060829:Arthropod Proteins; D001249:Asthma / Q000276:immunology / Q000628:therapy; D049109:Cell Proliferation; D002478:Cells, Cultured; D003546:Cysteine Endopeptidases; D040002:Dermatophagoides pteronyssinus / Q000276:immunology; D003888:Desensitization, Immunologic / Q000379:methods*; D015536:Down-Regulation / Q000276:immunology; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000096:biosynthesis* / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007371:Interferon-gamma / Q000096:biosynthesis; D016753:Interleukin-10 / Q000096:biosynthesis; D008297:Male; D010936:Plant Extracts / Q000276:immunology* / Q000627:therapeutic use; D012221:Rhinitis, Allergic, Perennial / Q000276:immunology* / Q000628:therapy; D012720:Severity of Illness Index; D018417:Th1 Cells / Q000276:immunology; D018418:Th2 Cells / Q000276:immunology; D016896:Treatment Outcome
D000485:Allergens; D000080384:Allergoids; D039741:Antigens, Dermatophagoides; D060829:Arthropod Proteins; D007074:Immunoglobulin G; D010936:Plant Extracts; D016753:Interleukin-10; D007073:Immunoglobulin E; D007371:Interferon-gamma; D003546:Cysteine Endopeptidases; C451162:Dermatophagoides pteronyssinus antigen p 1