title: Immunotherapy with mosquito (Culex quinquefasciatus) extract: a double-blind, placebo-controlled study.
abstract: BACKGROUND
  Mosquito allergy is well established, but mosquito immunotherapy requires validation using clinical and immunologic variables.
  
  
  OBJECTIVE
  To evaluate the tolerability and efficacy of specific immunotherapy with Culex quinquefasciatus (mosquito) extract.
  
  
  METHODS
  We performed a randomized, double-blind, placebo-controlled trial of immunotherapy for 1 year in 40 patients with asthma, rhinitis, or both. Patients were evaluated by means of intradermal testing, symptom and drug scores, and histamine provocation testing before and after 1 year of immunotherapy. Mosquito specific IgE and IgG subclass antibody responses were evaluated at the basal level and after 1 year.
  
  
  RESULTS
  Patients receiving allergen immunotherapy for 1 year showed a significant improvement compared with baseline and patients receiving placebo regarding skin reactions, symptom scores (rhinitis and asthma), and forced expiratory volume in 1 second. Provocation concentration of histamine that caused a decrease in forced expiratory volume in 1 second of 20% by inhalation was elevated in the group receiving immunotherapy. In the active group serologic analysis showed a slight reduction in IgE levels (P = .02) but a significant elevation in IgG4 levels (P = .001), with a significant decrease in the IgE/IgG4 ratio (P = .001). All these changes in the placebo group were nonsignificant.
  
  
  CONCLUSIONS
  Allergen immunotherapy with mosquito extract was well tolerated, with improvement in symptoms and airway reactivity. Good clinical outcome was associated with increased IgG4 antibody levels.
authors.affiliation: Allergy and Immunology Sections, Institute of Genomics and Integrative Biology, Delhi, India.
authors.forename: Deepsikha
authors.initials: D
authors.lastname: Srivastava
authors.forename: Bhanu P
authors.initials: BP
authors.lastname: Singh
authors.forename: V Thangam
authors.initials: VT
authors.lastname: Sudha
authors.forename: Naveen
authors.initials: N
authors.lastname: Arora
authors.forename: Shailendra N
authors.initials: SN
authors.lastname: Gaur
mesh_terms: D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000276:immunology / Q000627:therapeutic use; D000818:Animals; D001249:Asthma / Q000503:physiopathology / Q000628:therapy*; D001985:Bronchial Provocation Tests; D045424:Complex Mixtures / Q000276:immunology / Q000627:therapeutic use*; D003465:Culex / Q000737:chemistry / Q000276:immunology*; D003888:Desensitization, Immunologic / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D012221:Rhinitis, Allergic, Perennial / Q000503:physiopathology / Q000628:therapy*; D012882:Skin Tests; D016896:Treatment Outcome
chemical_list: D000485:Allergens; D045424:Complex Mixtures; D007074:Immunoglobulin G; D007073:Immunoglobulin E