title: Clinical and cytokine responses to house dust mite sublingual immunotherapy.
abstract: BACKGROUND
  Cytokine responses accompanying sublingual immunotherapy (SLIT) responder phenotypes have not previously been reported.
  
  
  OBJECTIVE
  To investigate clinical and cytokine responses of house dust mite (HDM) sensitive patients with allergic rhinitis receiving HDM SLIT or placebo for 2 years.
  
  
  METHODS
  Sixty adults were randomized to receive SLIT or placebo. Clinical symptoms were measured using the Total 5 Symptom Score (TSS5) and Juniper Rhinitis Quality of Life Questionnaire. HDM specific IgE, IgG, skin prick tests, and HDM-stimulated release of interleukin (IL) 5 and interferon γ (IFN-γ) in peripheral blood mononuclear cells was studied at 0, 6, 12, and 24 months and IL-13, IL-4, and IL-10 at 0 and 24 months.
  
  
  RESULTS
  A total of 32 of 39 SLIT and 16 of 21 placebo patients completed the study. There was significant clinical improvement in both the SLIT and placebo groups. Median T5SS decreased from 14.75 to 5.25 in the SLIT group (P < .001) and 12.7 to 6.0 in the placebo group (P = .003). The median quality-of-life score also decreased in the SLIT group (P < .001) and the placebo group (P < .001). A subgroup analysis of patients found a 60% or greater improvement (on the T5SS and the Juniper Rhinitis Quality of Life Questionnaire) in the good responders group and a 30% to 59% improvement or no improvement in the intermediate responders group. This subgroup analysis also found more good responders in the SLIT group (47%) compared with the placebo group (25%; P = .07). Significant decreases in the IL-5/IFN-γ (P < .001), IL-13/IFN-γ (P < .001), and IL-4/IFN-γ (P = .03) ratios were found in the combined good clinical improvement group at 24 months.
  
  
  CONCLUSIONS
  A good clinical response (≥60% improvement in both TSS5 and quality of life) is associated with significant decreases in IL-5, IL-13, and IL-4 relative to IFN-γ during 2 years of SLIT therapy for HDMs.
authors: Allergy Diagnostic and Clinical Research Unit, University of Cape Town Lung Institute, Cape Town, South Africa. Electronic address: Paul.Potter@uct.ac.za.
authors: Paul C
authors: PC
authors: Potter
authors: Allergy Diagnostic and Clinical Research Unit, University of Cape Town Lung Institute, Cape Town, South Africa.
authors: Sheila
authors: S
authors: Baker
authors: Allergy Diagnostic and Clinical Research Unit, University of Cape Town Lung Institute, Cape Town, South Africa.
authors: Bartha
authors: B
authors: Fenemore
authors: Division of Immunology, National Health Laboratory Service and Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa.
authors: Barbara
authors: B
authors: Nurse
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D039741:Antigens, Dermatophagoides / Q000276:immunology / Q000627:therapeutic use*; D060829:Arthropod Proteins / Q000276:immunology / Q000627:therapeutic use*; D002478:Cells, Cultured; D003546:Cysteine Endopeptidases / Q000276:immunology / Q000627:therapeutic use*; D016207:Cytokines / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D039981:Pyroglyphidae / Q000276:immunology*; D011788:Quality of Life; D065631:Rhinitis, Allergic / Q000276:immunology* / Q000628:therapy*; D013019:South Africa; D063729:Sublingual Immunotherapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D039741:Antigens, Dermatophagoides; D060829:Arthropod Proteins; D016207:Cytokines; D003546:Cysteine Endopeptidases; C451162:Dermatophagoides pteronyssinus antigen p 1