title: Vitamin D as an adjunct to subcutaneous allergen immunotherapy in asthmatic children sensitized to house dust mite.
abstract: BACKGROUND
  We aimed to investigate the efficacy, safety, and T regulatory cell response of vitamin D as an adjunct to allergen-specific immunotherapy (IT).
  
  
  METHODS
  Fifty children with asthma and receiving pharmacotherapy were randomized into three groups as: subcutaneous IT (SCIT) along with vitamin D supplementation (650 U/day; n: 17), SCIT alone (n: 15), and pharmacotherapy alone (n: 18). All patients were evaluated at baseline, 6th and 12th months for scorings of symptoms and medication, skin prick testing, total IgE, specific IgE, and Der p 1-specific IgG4. In addition, D. pteronyssinus-induced CD4(+) CD25(+) FOXP3(+) T regulatory cell percentage, intracellular Foxp3 expression, and peripheral blood mononuclear cell IL-10 and TGF-β responses were assessed.
  
  
  RESULTS
  In the SCIT + vitamin D and SCIT alone groups, total asthma symptom score (TASS), total symptom score (TSS), and total medication scores (TMS) were significantly lower than pharmacotherapy group at the end of 1 year. While the comparison of delta values (Δ 6th and Δ 12th month - baseline) of those scores revealed no significant differences between the two IT groups, TASS at the 6th month was lower in the SCIT + vitamin D group compared with others. There was a significant and positive trend in the levels of Der p 1-specific IgG4 in both IT groups throughout the study period. Whereas the levels of Der p 1-induced IL-10 and TGF-β were similar between IT groups, the mean fluorescence intensity of Foxp3 was highest in the SCIT + vitamin D group compared with others at the 12th month. The rate of discontinuation of inhaled corticosteroid (ICS) was 6/17 in SCIT + vitamin D, 3/15 in SCIT, and 0/18 in the pharmacotherapy group (P = 0.02).
  
  
  CONCLUSIONS
  Both SCIT groups fared better than pharmacotherapy alone at the end of 1 year. Although the clinical and immunologic outcomes were mostly similar between the two IT groups, some favorable outcomes of vitamin D warrant further investigation in more selected populations with varying doses as adjunct to IT.
authors.affiliation: Division of Pediatric Allergy and Immunology, Research and Training Hospital, Marmara University, Istanbul, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Baris
authors.forename: A
authors.initials: A
authors.lastname: Kiykim
authors.forename: A
authors.initials: A
authors.lastname: Ozen
authors.forename: A
authors.initials: A
authors.lastname: Tulunay
authors.forename: E
authors.initials: E
authors.lastname: Karakoc-Aydiner
authors.forename: I B
authors.initials: IB
authors.lastname: Barlan
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000293:Adolescent; D000818:Animals; D039741:Antigens, Dermatophagoides / Q000008:administration & dosage*; D060829:Arthropod Proteins / Q000008:administration & dosage*; D001249:Asthma / Q000276:immunology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D003546:Cysteine Endopeptidases / Q000008:administration & dosage*; D040002:Dermatophagoides pteronyssinus / Q000276:immunology; D003888:Desensitization, Immunologic / Q000379:methods*; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control*; D008297:Male; D014807:Vitamin D / Q000008:administration & dosage*
chemical_list: D000276:Adjuvants, Immunologic; D039741:Antigens, Dermatophagoides; D060829:Arthropod Proteins; D014807:Vitamin D; D003546:Cysteine Endopeptidases; C451162:Dermatophagoides pteronyssinus antigen p 1
keywords: asthma; children; immunotherapy; regulatory T cells; vitamin D