title: Clinico-immunological changes post-immunotherapy with Periplaneta americana.
abstract: BACKGROUND
  Cockroach proteins induce allergies including asthma in predisposed individuals. Well-designed controlled studies are required to show the effect of cockroach immunotherapy (IT). This study is aimed to assess changes in clinical and immunological parameters post-IT with Periplaneta americana extract.
  
  
  METHODS
  A double-blind, placebo-controlled trial of cockroach IT was performed for 1year in 50 patients of asthma, rhinitis or both. The efficacy of IT was assessed by change in skin reactivity and clinical parameters such as symptom/drug score, airway reactivity and immunological parameters namely IgE, IgG1 and IgG4, IL-4 and IFN-γ by enzyme-linked immunosorbent assay and western blotting using patients' sera at baseline and after 1year of treatment.
  
  
  RESULTS
  Immunotherapy with cockroach extract demonstrated significant improvement in clinical parameters of active group patients compared with baseline values and placebo group. Specific IgE levels showed a modest reduction, while IgG4 levels increased significantly in active IT group after 1year. IgE immunoblotting demonstrated reduction in intensity and number of specific bands, whereas IgG4 binding showed more number and distinct bands following IT. Active group patients showed correlation between increase in IgG4/IgG1 ratio and reduction in symptom score post-IT.
  
  
  CONCLUSIONS
  Immunotherapy with cockroach extract improved clinical and immunological status of asthma and rhinitis patients. Clinical improvement in patients after IT is associated with immunological changes.
authors.affiliation: Allergy and Immunology Section, Institute of Genomics and Integrative Biology, CSIR, Delhi, India.
authors.forename: Deepsikha
authors.initials: D
authors.lastname: Srivastava
authors.forename: Shailendra Nath
authors.initials: SN
authors.lastname: Gaur
authors.forename: Naveen
authors.initials: N
authors.lastname: Arora
authors.forename: Bhanu Pratap
authors.initials: BP
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000008:administration & dosage*; D000818:Animals; D001249:Asthma / Q000276:immunology / Q000628:therapy*; D004311:Double-Blind Method; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D015151:Immunoblotting; D007073:Immunoglobulin E / Q000276:immunology; D007074:Immunoglobulin G / Q000276:immunology; D007167:Immunotherapy; D007371:Interferon-gamma / Q000276:immunology; D015847:Interleukin-4 / Q000276:immunology; D008297:Male; D010526:Periplaneta / Q000276:immunology*; D012220:Rhinitis / Q000276:immunology / Q000628:therapy*; D012882:Skin Tests; D055815:Young Adult
chemical_list: D000485:Allergens; D007074:Immunoglobulin G; D015847:Interleukin-4; D007073:Immunoglobulin E; D007371:Interferon-gamma