Clinical and immunologic effects of H1 antihistamine preventive medication during honeybee venom immunotherapy.
BACKGROUND
H1 antihistamines increase safety during allergen-specific immunotherapy and might influence the outcome because of immunoregulatory effects.


OBJECTIVE
We sought to analyze the influence of 5 mg of levocetirizine (LC) on the safety, efficacy, and immunologic effects of ultrarush honeybee venom immunotherapy (BVIT).


METHODS
In a double-blind, placebo-controlled study 54 patients with honeybee venom allergy received LC or placebo from 2 days before BVIT to day 21. Side effects during dose increase and systemic allergic reactions (SARs) to a sting challenge after 120 days were analyzed. Allergen-specific immune response was investigated in skin, serum, and allergen-stimulated T-cell cultures.


RESULTS
Side effects were significantly more frequent in patients receiving placebo. Four patients receiving placebo dropped out because of side effects. SARs to the sting challenge occurred in 8 patients (6 in the LC group and 2 in the placebo group). Seven SARs were only cutaneous, and 1 in the placebo group was also respiratory. Difference of SARs caused by the sting challenge was insignificant. Specific IgG levels increased significantly in both groups. Major allergen phospholipase A(2)-stimulated T cells from both groups showed a slightly decreased proliferation. The decrease in IFN-gamma and IL-13 levels with placebo was not prominent with LC, whereas IL-10 levels showed a significant increase in the LC group only. Decreased histamine receptor (HR)1/HR2 ratio in allergen-specific T cells on day 21 in the placebo group was prevented by LC.


CONCLUSIONS
LC reduces side effects during dose increase without influencing the efficacy of BVIT. LC modulates the natural course of allergen-specific immune response and affects the expression of HRs and cytokine production by allergen-specific T cells.
Medizinische Klinik, Spital Ziegler, Bern, Switzerland. ulrich.mueller@spitalnetzbern.ch
Ulrich R
UR
Müller
Marek
M
Jutel
Andrea
A
Reimers
Judith
J
Zumkehr
Clarissa
C
Huber
Carola
C
Kriegel
Urs
U
Steiner
Gabrielle
G
Haeberli
Mübeccel
M
Akdis
Arthur
A
Helbling
Benno
B
Schnyder
Kurt
K
Blaser
Cezmi
C
Akdis
D000293:Adolescent; D000328:Adult; D001514:Bee Venoms / Q000009:adverse effects / Q000276:immunology; D017332:Cetirizine / Q000276:immunology* / Q000627:therapeutic use; D003888:Desensitization, Immunologic / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D006634:Histamine H1 Antagonists / Q000276:immunology* / Q000627:therapeutic use; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
D001514:Bee Venoms; D006634:Histamine H1 Antagonists; C472067:levocetirizine; D017332:Cetirizine