舌下含服免疫治疗对变应性鼻炎患儿的临床疗效

目的 探讨粉尘螨滴剂舌下含服特异性免疫治疗（sublingual immunotherapy，SLIT）对变应性鼻炎（allergic rhinitis，AR）患儿血清sIgG4、IL-10和IL-33表达水平的作用，并对SLIT的临床疗效进行评估。方法 在2016年2月-2016年8月，宁波市医疗中心李惠利医院入组了70例AR患儿，将这些患儿随机分为SLIT试验组（SLIT配合对症药物）和药物对照组（仅对症药物），每组各35例患儿。分别在治疗前、治疗半年、治疗1年、治疗2年时，通过酶联免疫吸附法测定血清sIgG4、IL-10和IL-33的表达水平，同时对患儿的总鼻部症状评分（total nasal symptoms score，TNSS）和总用药评分（total medication score，TMS）进行评估。结果 经过2年的治疗后，与药物对照组相比，SLIT试验组的TNSS评分和TMS评分显著降低（P<0.01）。与治疗前相比，AR患儿经过2年的免疫治疗后，SLIT组的sIgG4和IL-10的水平显著上升（P<0.05），而IL-33的水平显著下降（P<0.05）。2年治疗后药物对照组的sIgG4、IL-10和IL-33的水平都未发生明显的改变。2年治疗结束时2组的sIgG4、IL-10和IL-33水平存在明显的差异（P<0.05）。结论 标准化粉尘螨滴剂SLIT对尘螨引起的儿童AR具有疗效，并且血清sIgG4、IL-10和IL-33表达水平的变化可能作为评估SLIT疗效的指标。     

Sublingual immunotherapy reduces soluble HLA-G and HLA-A,-B,-C serum levels in patients with allergic rhinitis

Allergic rhinitis (AR) is characterized by Th2 polarized immune response. Soluble HLA (sHLA) molecules play an immunomodulatory activity. Specific immunotherapy is the only causal treatment for AR. So far no study investigated the effect of sublingual immunotherapy (SLIT) on sHLA molecules.The aim of the study was to evaluate sHLA-G and sHLA-A,-B,-C serum levels in AR patients with pollen allergy before and after a pre-seasonal course of SLIT. Forty AR patients with pollen allergy were enrolled and they assumed a pre-seasonal SLIT course for 3 months. Serum sHLA-G and sHLA-A,-B,-C and IFN-γ and IL-4 levels were determined by ELISA method at baseline and 3 months after the end of the SLIT course. Symptoms severity was assessed by a Visual Analogue Scale.Both sHLA-G and sHLA-A,-B,-C levels significantly diminished (p < 0.0001 for both) after SLIT. Moreover, there was a highly significant relationship between the serum levels of these two soluble molecules (r = 0.84). Significant relationship between symptoms evaluated by VAS and change of sHLA molecules was also evidenced (r = 0.60 and 0.63). Serum cytokines were not affected by SLIT.Therefore, this preliminary study provides the first evidence that both sHLA-G and sHLA-A,-B,-C levels are significantly reduced by SLIT in AR patients with pollen allergy. Therefore, the clinical implication of this study is that these soluble molecules might be interpreted as biomarker of response to SLIT.     

TGF-β and IL-17 serum levels and specific immunotherapy

Two new T cell subsets may be involved in allergic rhinitis (AR) pathogenesis: Th17 and T regulatory cells, mainly producing IL-17 and TGF-β respectively. Successful Sublingual Immunotherapy (SLIT) induces relevant immunological changes, thus the aim of this study was to evaluate serum IL-17 and TGF-β levels in AR patients treated with SLIT for 2 years. Patients' blood samples were collected before initiating SLIT (baseline), three months after the end of the first pre-seasonal SLIT course, and at the end of the second pre-seasonal course. IL-17 was detectable only in the most severe allergic patients. SLIT significantly induced an increase in serum TGF-β levels. There was moreover a significant relationship between TGF-β and symptom severity and drug use at the end of the study. Therefore, this study provides clinically relevant evidence that two pre-seasonal SLIT courses may significantly affect serum TGF-β levels.     

Soluble serum HLA-G and HLA-A, -B, -C molecules in patients with seasonal allergic rhinitis exposed to pollens

BackgroundAllergic rhinitis (AR) is characterized by a Th2 polarized immune response and soluble HLA (sHLA) molecules play an immunomodulatory role in this response. Previously, it has been reported that these molecules are increased in sera of patients with pollen-induced allergic rhinitis studied outside the pollen season. To date, however, no study has investigated there in AR patients during the pollen season.ObjectiveThe aim of this study was to evaluate serum sHLA-G and sHLA-A, -B, -C levels in both AR patients and healthy controls.Methods60 symptomatic allergic patients were enrolled. A group of 50 healthy subjects was included as a control. Serum sHLA-G and sHLA-A, -B, -C levels were determined by an immunoenzymatic method. Allergy severity was assessed by VAS for symptoms and drug use.ResultsAllergic patients had significantly higher levels of both sHLA-G (p < 0.001) and sHLA-A, -B, -C (p = 0.001) than normal controls. In addition, there was a very strong correlation between sHLA-G levels and clinical severity.ConclusionThe present study confirms evidence that serum sHLA-G and sHLA-A, -B, -C molecules are significantly increased in patients with pollen-induced AR also during the pollen season. Moreover, sHLA-G might be considered as a biomarker for assessing clinical severity.     

Two year sublingual immunotherapy affects serum leptin

BackgroundIt has been demonstrated that serum leptin is elevated in females with allergic rhinitis. Recently, it has been reported that one course of sublingual immunotherapy (SLIT) does not affect serum leptin levels.ObjectiveThe aim of this study was to evaluate the serum leptin levels in a cohort of patients with pollen-induced allergic rhinitis, before and after two pre-seasonal SLIT courses.MethodsForty-one patients (22 males and 19 females, median age 39 years) with AR, due to pollen allergy, and 34 healthy subjects (16 males and 18 females, median age 43 years) were included in the study. Blood sampling for assessing serum leptin was performed in all subjects before and after the second SLIT course.ResultsAll patients were responders to SLIT. Serum leptin was significantly increased only in males (p = 0.0056) after the second SLIT course.ConclusionThis preliminary study shows that at least two pre-seasonal SLIT courses were required to induce significant modifications in serum leptin levels, but it occurred only in males. Some hypotheses might be outlined, including a leptin protective effect, however further studies must clarify this issue.     

Sublingual immunotherapy may affect serum neopterin: Preliminary findings

Background

Neopterin is a protein produced by monocytes/macrophages. It has been considered a biomarker of immune activation in several disorders. However, there are few studies in allergic rhinitis (AR).This study evaluated the serum neopterin levels in patients with pollen-induced AR or treated with sublingual immunotherapy (SLIT) and in healthy subjects.

Methods

146 subjects (70 males, median age 30.5 years): 56 with moderate–severe persistent AR, 40 with AR and successfully treated with 2 year SLIT, and 50 healthy controls were consecutively evaluated outside the pollen season. A skin prick test and blood sampling for assessing serum neopterin levels were performed in all subjects.

Results

SLIT-treated patients had lower neopterin levels than untreated patients and healthy subjects (respectively p = 0.012 and p = 0.0001).

Conclusions

Neopterin is a biomarker for immune activation, SLIT may affect serum neopterin probably as a consequence of Treg response to SLIT.     

Carry-over effect on IFN-gamma production induced by allergen-specific immunotherapy

BackgroundAllergic rhinitis is characterized by Th2 polarization and defective IFN-γ production. Specific immunotherapy determines an allergen-specific clinical improvement.Aim of the studyIt was to evaluate whether a course of pre-seasonal SLIT with pollen allergen extract might affect the in vitro IFN-γ production using Dermatophagoides farinae (Df) allergen as stimulus, in patients presenting with rhinitis due to pollen allergy.MethodsThirty-nine AR patients with pollen allergy were included in the study. They assumed pre-seasonal SLIT for 3 months. IFN-γ-specific producing cells were assessed by cytokine ELISPOT before and 3 months after the SLIT course end.ResultsSLIT provided a significant increase of both pollen-induced and Df-induced IFN-gamma production (p < 0.001).ConclusionsThe present study provides evidence that though the defective IFN-γ production is allergen-specific in allergic subjects, the SLIT increasing effects on IFN-γ may be non-specific.     

Association of CCL11, CCL24 and CCL26 with primary biliary cholangitis

BackgroundCCL11, CCL24 and CCL26 are potent chemokines for eosinophils. Since there has been no study reporting the association serum CCL11, CCL24 and CCL26 with fibrotic progression of PBC, the aim of this study is to explore the association.MethodsOne hundred and eight PBC patients, 52 patients with chronic hepatitis B (CHB) and 50 healthy controls (HC) were recruited. The sera were detected for CCL11, CCL24 and CCL26 using multiplex immunoassay. Other laboratory indicators were routinely measured. PBC was divided into four stages according to Scheuer's classification.ResultsSerum CCL11, CCL24 and CCL26 levels were significantly higher in PBC patients than those with CHB and HC (P < 0.05). The ROC analyses showed that all of the three CCLs performed well for identification of PBC (all P< or =0.001). The multiple linear regression analysis showed an independent relationship of CCL26 with APRI and FIB-4 in PBC patients, but no relationship of CCL11 and CCL24 with fibrotic indicators. Additionally, serum CCL11 and CCL26 were negatively correlated with histological stage of PBC, while serum CCL24 showed no statistical correlation.ConclusionSerum CCL11, CCL24 and CCL26 are upregulated in PBC. CCL11 and CCL26 are associated with fibrotic progression of PBC, but CCL24 is not.     

Relationships between increased circulating YKL-40, IL-6 and TNF-α levels and phenotypes and disease activity of primary Sjögren's syndrome

BackgroundThere is now no single score or marker useful for evaluating disease activity of primary Sjögren's syndrome (pSS). This study was designed to explore the associations of circulating YKL-40, interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) with systemic activity and phenotypes of pSS.MethodsThis study included 58 pSS patients and 30 healthy controls (HC). The sera were measured by multiplex immunoassay for YKL-40, IL-6 and TNF-α concentrations. The disease activity of pSS patients was evaluated by European league against rheumatism (EULAR) SS disease activity index (ESSDAI). Local severity was assessed in accordance with the Tarpley score.ResultsSerum YKL-40, IL-6 and TNF-α levels significantly elevated in pSS patients compared with those in HC (all P < 0.001). These cytokines correlated with ESSDAI, ESR, CRP, and IgG (all P < 0.05). Serum YKL-40 level correlated markedly with age (r = 0.405, P = 0.002), neutrophil count (r = 0.399, P = 0.002) and neutrophil-to-lymphocyte ratio (NLR) (r = 0.401, P = 0.002), while IL-6 did weakly with NLR (r = 0.296, P = 0.024) and C3 (r = 0.288, 0.036). Serum levels of all three cytokines were substantially lower in patients with eye/mouth dryness vs. those without (all P < 0.05). Additionally, patients with pulmonary, renal involvement or anemia had remarkably higher concentrations of YKL-40 (all P < 0.05), while those with leukocytopenia had lower levels (P = 0.01). Fever or anemia patients showed higher serum concentrations of IL-6 (both P < 0.05), while serum levels of TNF-α were much higher in patients with presence of ANA, anti-SSA or anti-SSB antibodies (All P < 0.05). Serum IL-6 level correlated strongly with YKL-40 (r = 0.452, P < 0.001) and TNF-α (r = 0.743, P < 0.001) in pSS patients. A significant correlation was also found between YKL-40 and TNF-α (r = 0.308, P = 0.022) .ConclusionThe circulating YKL-40, IL-6 and TNF-α levels increase in pSS, and all of them are significantly correlated with indicators (ESSDAI, ESR, CRP, and IgG) for systemic inflammation of pSS. Each cytokine is separately associated with specific pSS phenotype.     

Sublingual desensitization in patients with wasp venom allergy: preliminary results

The aim of this paper is to assess in an open prospective pilot case-control study the tolerability, safety and efficacy of an ultra-rush sublingual immunotherapy (SLIT) protocol with Vespula venom in wasp allergic patients compared to subcutaneous immunotherapy (SCIT). Forty-one wasp allergic patients were treated with sublingual (SLIT group) or subcutaneous (SCIT group) ultrarush immunotherapy with Vespula venom extract. All patients underwent skin tests and serum specific IgE and IgG4 detection before enrollment and after 6, 12 and 24 months of immunotherapy. The SLIT group consisted of 21 (6 females and 15 males) patients who received increasing doses of Vespula venom (Aquagen, ALK-Abellò) until the final dose of 30 drops of extract in 3 hours, containing 100,000 SQ-U/ml. The maintenance dose was of 10 drops of pure venom extract 3 times a week, for a total dose of 100,000 SQ-U weekly (corresponding to 100 microgram of venom extract). The SCIT group consisted of 20 patients (16 males and 4 females) who were treated with subcutaneous ultrarush immunotherapy with Vespula venom extract (Pharmalgen, Alk-Abellò). Patients received 101.1 microgram of Vespula venom in 3 hours and were treated with 100 microgram of wasp venom monthly. During the ultrarush sublingual treatment 2 patients (9.5%) experienced mild side-effects. Specific IgE and specific IgG to wasp venom did not show any significant modification. Four patients were field-stung by a wasp during the treatment (for a total of 6 stings). Two patients (3 stings), with a previous clinical history of a grade III and IV reaction, did not experience any reaction. One patient, with a previous grade II reaction, showed a large local reaction. The fourth patient, with a previous grade III reaction, was re-stung twice (after 12 and 24 months) with two systemic reactions (SR) (mild throat constriction). During the ultrarush SCIT phase, 3 (15%) patients experienced side-effects: 2 of them showed a large local reaction and 1 had headache and stomach ache. Specific IgE showed a significant (P = 0.001) increase after 6 months of treatment and then returned to baseline levels while specific IgG showed a significant (P = 0.001) increase after 6, 12 and 24 months in comparison with baseline. Nine patients were field-stung during the treatment: 8 of them experienced large local reactions; one patient (11%) experienced an SR (dizziness). Our results, even if in a small number of patients, suggest that in patients with Hymenoptera sting allergy SLIT could be efficacious with a good tolerability profile when compared to SCIT. Larger studies are needed to assess efficacy, safety and tolerability profile of wasp venom SLIT.     

定量检测SLIT2 基因甲基化对高级别宫颈癌前病变的诊断价值

摘要:目的 探讨神经导向因子 2 （SLIT2） 基因甲基化定量检测对于高级别宫颈癌前病变的临床诊断价值。方法 收集 178 例高危型人乳头瘤病毒 （HPV） 感染患者的宫颈脱落细胞, 以组织病理学诊断作为金标准, 分为正常宫颈组 （n=45）、 低级别病变组 （n=50） 和高级别病变组 （n=83）。采用焦磷酸测序法定量检测各样本中 SLIT2 基因的甲基化水平。采用受试者工作特征 （ROC） 曲线确定 SLIT2 基因的甲基化水平对高级别宫颈癌前病变的诊断阈值。结果 正常宫颈组 SLIT2 基因的甲基化水平为 （4.53±1.37） %, 低级别病变组为 （5.81±2.26） %, 高级别病变组为 （11.80± 8.47） %, 组间差异有统计学意义 （F=27.61, P<0.001）; 高级别病变组高于正常宫颈组和低级别病变组 （均 P<0.001）,正常宫颈组和低级别病变组之间差异无统计学意义 （P=0.297）。SLIT2 基因甲基化定量检测诊断高级别宫颈癌前病变的灵敏度为 80.7%, 特异度为 83.2%, 最佳界值为 6.41%。结论 采用焦磷酸测序法定量检测宫颈脱落细胞中 SLIT2 基因甲基化水平能够有效诊断高级别宫颈癌前病变。     

Comparison of peripheral blood B cell subset ratios and B cell-related cytokine levels between ocular and generalized myasthenia gravis

BackgroundThe pathogenesis of myasthenia gravis (MG) depends upon T and B cells, as well as complement and cytokines. The activation of functional subpopulations of T and B cells is the basis of the immune response. However, the activation levels of T and B cell subsets remain unclear in the pathogenesis of MG. Here, we evaluated the proportions of T and B cell subsets and related cytokines in ocular MG (oMG) patients and generalized MG (gMG) patients, and analyzed the potential roles of T and B cell subsets in the pathogenesis of oMG.MethodsIn total, 16 patients with oMG, 31 patients with gMG, and 20 healthy controls (HCs) were included in this study. Peripheral blood mononuclear cells (PBMCs) were separated from venous blood via density centrifugation. The percentages of CD3⁺CD4⁺ T cells, CD3⁺CD8⁺ T cells, CD4⁺CD25⁺CD127^- regulatory T cells (Tregs), CD19⁺CD27⁺CD38^- memory B cells, CD19⁺CD24^hiCD27⁺ regulatory B cells (Bregs), CD19⁺CD38⁺CD138⁺ plasma cells, and CD19⁺CD40⁺ B cells in PBMCs were detected by flow cytometry. The levels of interleukin (IL)-2, IL-4, IL-6, IL-10, IL-17, and interferon (IFN)-γ in serum were detected by enzyme linked immunosorbent assay (ELISA). Differences in T and B cell subsets and related cytokines were compared among the three groups of participants.ResultsThe proportions of CD19⁺CD27⁺CD38^- memory B cells were significantly higher in the oMG and gMG groups than in the HC group (P = 0.004; P < 0.001), whereas the proportion of CD19⁺CD27⁺CD38^- memory B cells was significantly lower in the oMG group than in the gMG group (P < 0.001). Moreover, the proportion of CD19⁺CD24^hiCD27⁺ Bregs was significantly higher in the oMG group than in the gMG and HC groups (P = 0.001). The proportion of CD4⁺CD25⁺CD127^- Tregs was significantly lower in the gMG group than in the oMG and HC groups (P < 0.001). Finally, the level of serum IL-10 was significantly higher in the oMG group than in the gMG and HC groups (P < 0.05). Compared with the HC group, serum IL-2 levels were significantly increased in the oMG and gMG groups (P = 0.016; P = 0.002).DiscussionThe reduced ratios of Tregs and Bregs may contribute to the progression of oMG to gMG, and the increased proportion of memory B cells may be closely related to the progression of oMG. IL-2 and IL-10 are important in the development of oMG.     

ALCAM基因1沉默对胃癌细胞增殖和凋亡的影响及分子机制

目的 探讨活化白细胞黏附分子（ALCAM）基因沉默对胃癌细胞增殖和凋亡的影响,并对其分子机制进行初步研究。方法 将ALCAM 和对照 shRNA转染至胃癌细胞SGC-7901中,建立稳定细胞系,分别采用实时荧光定量（RT-PCR）技术和蛋白免疫印迹法（Western blot）检测转染后SGC-7901细胞中ALCAM mRNA和蛋白水平;采用CCK-8法检测转染后SGC-7901细胞的增殖情况;采用流式细胞术检测转染后SGC-7901细胞凋亡情况。采用胃癌肿瘤模型分析ALCAM基因沉默对肿瘤生长的影响。结果 ALCAM shRNA稳定细胞系ALCAM mRNA（1.01±0.26）和蛋白质的表达水平（1.66±0.23）低于对照 shRNA组细胞ALCAM mRNA（0.12±0.06）和蛋白质水平（0.23±0.09）,差异有统计学意义（P<0.05）。与对照shRNA稳定细胞系比较,ALCAM shRNA 稳定细胞系细胞增殖活性下降（P<0.05）、凋亡水平升高（P<0.05）、荷瘤小鼠肿瘤生长速度减缓（P<0.05）。ALCAM下调并不影响总蛋白激酶B（AKT）和哺乳动物雷帕霉素靶蛋白（mTOR）的表达,而降低了AKT和mTOR磷酸化水平,抑制了mTOR活性,此外,ALCAM蛋白敲低提高了Caspase-3蛋白的表达水平,激活了凋亡信号通路。结论 ALCAM基因沉默能够降低胃癌细胞中ALCAM的表达水平,抑制胃癌细胞的增殖,增加细胞凋亡。     

组胺受体拮抗剂联合白三烯受体拮抗剂治疗过敏性鼻炎的疗效观察

目的 探讨H1组胺受体拮抗剂(H1RAs)联合白三烯受体拮抗剂(LTRAs)治疗过敏性鼻炎(AR)的临床疗效.方法 AR患者84例,采用随机数字表法分为观察组与对照组,各42例.对照组单用H1RAs——盐酸氮卓斯汀治疗,观察组在对照组基础上加用LTRAs——孟鲁司特钠治疗,对比两组的临床疗效,治疗前后评价鼻炎症状评分,检测血清微量元素、嗜酸性粒细胞阳离子蛋白(ECP)、特异性免疫球蛋白E(sIgE)及炎性因子水平.结果 观察组的总有效率为100.00％,显著高于对照组的88.10％(P<0.05);治疗后观察组的鼻炎症状评分显著低于对照组(P<0.05);治疗后观察组的血清sIgE、ECP、白细胞介素(IL)-4、IL-6、IL-8、Cu均显著低于对照组,IL-10、γ-干扰素(INF-γ)、Zn、Mn显著高于对照组(P<0.05).结论 H1RAs联合LTRAs治疗AR能够提高临床疗效、改善鼻炎症状,其机制可能与调节血清微量元素及sIgE、ECP水平、抗炎性反应有关.     

托珠单抗对类风湿关节炎患者疗效、免疫球蛋白及辅助性T细胞水平的影响

目的 观察托珠单抗对类风湿关节炎（RA）患者的疗效,以及对患者免疫球蛋白、辅助性T细胞水平的影响。方法 选择本院收治的RA患者90例,随机分为对照组与观察组,每组45例。对照组患者接受英夫利西单抗联合甲氨蝶呤治疗方案,观察组患者接受托珠单抗联合甲氨蝶呤治疗方案。两组患者均连续治疗6个月。比较两组患者治疗后的临床疗效;分别检测两组患者治疗前后血清中免疫球蛋白、T辅助细胞-1（T helper1,Th1）以及调节性T细胞（T Regulatory,Treg）的水平。结果 治疗后,两组患者晨僵、关节压痛及关节肿胀情况均有所好转,且观察组患者的上述症状情况好转程度明显优于对照组（P<0.05）。两组患者血清中IgG及Th1细胞水平均显著降低,且观察组患者血清中2种细胞水平显著低于对照组（P<0.05）;而两组患者Treg细胞水平均有明显升高,且观察组Treg水平显著高于对照组（P<0.05）。结论 托珠单抗可有效改善RA患者临床症状,改善患者免疫功能紊乱,具有较好的临床疗效。     

Observational study of sublingual specific immunotherapy in persistent and intermittent allergic rhinitis: the EFESO trial

ABSTRACT

Background: Sublingual specific immunotherapy (SLIT) is a valid treatment for allergies. However, there are few data on a large sample size regarding its clinical role in ‘real life’.

Study aim: We performed a multicentre, case-control study to evaluate the effectiveness of SLIT in patients with allergic rhinitis (AR).

Methods: A total of 305 patients with AR were enrolled. Cases (n?=?154) were defined as patients with intermittent (64%) or persistent (36%) AR who were treated daily for at least two consecutive years with specific SLIT. Controls (n?=?151) were defined as age-, sex- and type of allergen-matched AR subjects who were never treated with specific immunotherapy. The main outcomes of the study were the rhinoconjunctivitis symptom score (SS) and the symptomatic medication score (MS). SS and MS were evaluated at the end of the observational period in relation to the peak of relevant pollen season or during the period of maximum allergen exposure in case of non-seasonal allergens.

Results: SS mean (SD) value was 5.1 (3.0) in cases and 9.3 (3.3) in controls (?43%) (?p?=?0.0001). MS mean (SD) value was 2.6 (1.8) and 4.4 (2.6) in the case and control groups, respectively (?41%) (?p?=?0.0001). At the end of the observation period, asthma-related symptoms were present in 8.5% of cases and in 20% in the control group (?p?=?0.01).

Conclusion: The EFficacia nella rinitE allergica di SlitOne (EFESO) trial shows that SLIT treatment in AR is associated with lower SS and MS in comparison with controls. SLIT is also associated with a lower incidence of asthma and new sensitizations. As this was an observational study, our results need to be confirmed in randomized, double-blind, controlled trials.     

Sublingual immunotherapy efficacy in patients with atopic dermatitis and house dust mites sensitivity: a prospective pilot study

ABSTRACT

Background: Specific subcutaneous immunotherapy (SCIT) with house dust mite (HDM) preparation has recently been shown to improve eczema in patients with atopic dermatitis (AD). So far, there is less data regarding efficacy and safety of specific sublingual immunotherapy (SLIT) in patients with AD.

Study aim: To evaluate in an open non-controlled, non-randomized pilot trial the effect of SLIT with HDM allergen extracts preparation (SLITone, ALK Abellò Italy) on SCORAD in adult patients with mild–moderate AD.

Patients and methods: 86 Subjects (53 females and 33 males) between 3 and 60 years of age with AD and IgE-proved (Class > 2) HDM sensitization were enrolled after their informed consent in the trial. Exclusion criteria were severe asthma and treatment with systemic or high potent topical corticosteroids or immunosuppressant agents. Patients were treated with SLIT (Dermatophagoides pteronyssinus and Dermatophagoides farinae extracts: SLITone, ALK-Abellò) for at least 12 months. SCORAD was evaluated at baseline and after 12 months of treatment.

Results: Baseline SCORAD value, mean ± SD, was 43.3 ± 13.7 (range 15–84). After 1 year of SLIT, mean ± SD, SCORAD value was reduced to 23.7 ± 13.3 (range: 0–65) (p = 0.0001; unpaired t-test vs. baseline). This was a 46% reduction in SCORAD in comparison with baseline value. A significant improvement, defined as a SCORAD reduction of > 30%, was observed in 51 out of 86 patients (59%). In 5 patients (5.8%) SCORAD values did not change at the end of the observation period. In 30 patients (35%) the SCORAD reduction after SIT was ≤ 30% in comparison with baseline. Total and specific IgE serum levels were significantly (p = 0.001) reduced after SLIT. No severe adverse events were observed during the trial.

Conclusion: In this open non-controlled trial SLIT with HDM extracts in patients with mild to moderate AD was effective in reducing the SCORAD after 1 year of SLIT treatment. In addition the treatment was very well tolerated. Treatment with SLIT, furthermore, has allowed a gradual and relevant reduction of concomitant therapies with topical corticosteroids or immunosuppressants. Present results require further controlled trials in order to confirm the potential clinical benefit of SLIT in this clinical setting.     

Serum adipsin levels in patients with seasonal allergic rhinitis: Preliminary data

BackgroundSeveral studies have outlined a possible relationship between adipokines and respiratory allergic diseases. However, there are no data about a role for adipsin in allergic rhinitis.ObjectiveThe aim of the study was to evaluate the serum adipsin levels in patients with seasonal allergic rhinitis (SAR), subdivided into two sub-groups: treated or not treated with sublingual immunotherapy (SLIT), and in a group of healthy controls.MethodsThe study included 110 subjects; i) 24 SLIT-treated SAR patients, ii) 62 untreated SAR patients, and iii) 24 normal subjects. All subjects were consecutively evaluated. A skin prick test and blood sampling for assessing serum adipsin levels were performed in all subjects.ResultsSerum adipsin was increased in SAR patients, even though significant only in males. There was also a significant positive association between adipsin and adiponectin.ConclusionThis preliminary study reports that adipsin serum levels may be increased in some SAR patients, but further functional studies should be performed.     

盐酸西替利嗪滴剂联合丙酸氟替卡松吸入气雾剂治疗儿童过敏性鼻 炎合并支气管哮喘疗效观察

目的:观察盐酸西替利嗪滴剂联合丙酸氟替卡松吸入气雾剂治疗过敏性鼻炎(AR)合并支气管哮喘(BA)患儿的疗效及 安全性。方法:选取2020 年1 月-2022 年6 月我院收治的AR 合并BA 患儿84 例,按随机数表法分为联合组与对照组各42 例。 对照组给予丙酸氟替卡松吸入气雾剂吸入治疗,联合组则采用盐酸西替利嗪滴剂联合丙酸氟替卡松吸入气雾剂治疗,比较两组 患儿治疗前后AR 和BA 严重程度评分、肺功能指标[第1 秒用力呼气量(FEV1)、呼气流速(PEF)、用力肺活量(FVC)]、血清酶 学[可溶性细胞间粘附分子-1(sICAM-1)、可溶性血管细胞间粘附分子-1(sVCAM-1)、白细胞介素-4(IL-4)、IL-10]、血清淀粉样 蛋白(SAA)水平及不良反应发生情况。结果:治疗后,联合组AR 与BA 严重程度评分低于对照组,FEV1、PEF 及FVC 水平高于 对照组(P 均<0. 05);两组sICAM-1、sVCAM-1、IL-4、IL-10 及SAA 水平均下降,且联合组均低于对照组( P 均<0. 05);两组患儿 不良反应发生率比较差异无统计学意义(P>0. 05)。结论:采用盐酸西替利嗪滴剂联合丙酸氟替卡松吸入气雾剂治疗AR 合并 BA 患儿,能显著减轻临床症状,有效改善肺功能,调节血清酶学指标与SAA 水平,且不会增加不良反应的发生。