title: Immunologic alterations and efficacy of subcutaneous immunotherapy with Dermatophagoides pteronyssinus in monosensitized and polysensitized patients.
abstract: BACKGROUND
  There is a continuing debate about whether monoallergen subcutaneous immunotherapy (SCIT) is able to modulate immune and clinical responses toward main causal allergen in polysensitized patients.
  
  
  OBJECTIVE
  To investigate short-term immunologic changes and clinical effectiveness of SCIT with Dermatophagoides pteronyssinus in monosensitized and polysensitized patients who have rhinitis with or without asthma.
  
  
  METHODS
  Nineteen monosensitized and 24 polysensitized patients participated in this prospective, self-placebo-controlled, interventional study. Cluster immunotherapy with D pteronyssinus was administered after 2 months of placebo in both groups. Immunologic parameters, including CD203c expression on basophils after allergen stimulation, total IgE, specific IgE, and specific IgG4, were evaluated at baseline, after placebo, and after immunotherapy. Clinical effectiveness was assessed using monthly symptom-medication scores, visual analog scale, quality-of-life questionnaire, and nasal allergen provocation test.
  
  
  RESULTS
  At baseline, polysensitized patients had higher CD203c expression on basophils than monosensitized patients (P = .007). Activated basophils expressing CD203c, total IgE, and specific IgG4 were significantly increased after immunotherapy compared with baseline and placebo in the polysensitized group (P < .025). After immunotherapy, specific IgE and D pteronyssinus-induced CD203c expression were significantly higher in polysensitized than monosensitized patients (P < .05). The total symptom scores and the Mini Rhinoconjunctivitis Quality of Life Questionnaire scores in polysensitized patients and the visual analog scale scores in both groups were lower after immunotherapy compared with baseline and placebo (P < .025). Titrated nasal allergen provocation test with D pteronyssinus increased after immunotherapy in the monosensitized group (P < .05).
  
  
  CONCLUSIONS
  This study indicates that monosensitized and polysensitized patients have distinct humoral response and basophil behavior to SCIT. However, a single-allergen immunotherapy corresponding to the most clinically troublesome allergy in polysensitized patients can lead to early clinical efficacy comparable to that seen in monosensitized patients.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01795846.
authors.affiliation: Division of Immunology and Allergic Diseases, Department of Chest Diseases, Ankara University, School of Medicine, Ankara, Turkey.
authors.forename: Sadan
authors.initials: S
authors.lastname: Soyyigit
authors.affiliation: Department of Pediatric Immunology and Allergy, Ankara University, School of Medicine, Ankara, Turkey.
authors.forename: Deniz
authors.initials: D
authors.lastname: Guloglu
authors.affiliation: Department of Pediatric Immunology and Allergy, Ankara University, School of Medicine, Ankara, Turkey.
authors.forename: Aydan
authors.initials: A
authors.lastname: Ikinciogullari
authors.affiliation: Division of Immunology and Allergic Diseases, Department of Chest Diseases, Ankara University, School of Medicine, Ankara, Turkey.
authors.forename: Derya
authors.initials: D
authors.lastname: Secil
authors.affiliation: Department of Biostatistics, Ankara University, School of Medicine, Ankara, Turkey.
authors.forename: Derya
authors.initials: D
authors.lastname: Oztuna
authors.affiliation: Division of Immunology and Allergic Diseases, Department of Chest Diseases, Ankara University, School of Medicine, Ankara, Turkey.
authors.forename: Dilsad
authors.initials: D
authors.lastname: Mungan
authors.affiliation: Division of Immunology and Allergic Diseases, Department of Chest Diseases, Ankara University, School of Medicine, Ankara, Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Misirligil
authors.affiliation: Division of Immunology and Allergic Diseases, Department of Chest Diseases, Ankara University, School of Medicine, Ankara, Turkey. Electronic address: bsin@medicine.ankara.edu.tr.
authors.forename: Betul Ayse
authors.initials: BA
authors.lastname: Sin
mesh_terms: D000328:Adult; D000818:Animals; D039741:Antigens, Dermatophagoides / Q000008:administration & dosage / Q000276:immunology*; D001249:Asthma / Q000150:complications / Q000276:immunology; D001491:Basophils / Q000276:immunology / Q000378:metabolism; D001985:Bronchial Provocation Tests; D040002:Dermatophagoides pteronyssinus / Q000276:immunology*; D003888:Desensitization, Immunologic / Q000379:methods; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D007279:Injections, Subcutaneous; D008297:Male; D009299:Nasal Provocation Tests; D011788:Quality of Life; D065631:Rhinitis, Allergic / Q000150:complications / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy*; D013147:Spirometry; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D039741:Antigens, Dermatophagoides; D007074:Immunoglobulin G; D007073:Immunoglobulin E