The Basic And Clinical Research In Children With Allergic Rhinitis Receiving Specific Immunotherapy

Objective:To research the level of IL-2,IL-4,IL-6,IL-10,TNF and IFN-y in serum the clinical efficacy and of subcutaneous immunotherapy(SCIT) and sublingual immunotherapy(SLIT) with dust mite(DM) extract for childen of moderate or sever persistent allergic rhinitis(AR).Methods:Fifty children who were diagnosed moderate or severe persistent allergic rhinitis were enrolled in this open-label controlled study.All children were caused by dermatophagoides pteronyssinus(DP) and/or dermatophagoides farina(DF),aged from five to forteen years old and had symptom durations from one to eight years. Children were randomly divided into two groups and twenty-five patients in each group.And they were respectively taken subcutaneous immunotherapy or sublingual immunotherapy treatment programs and had the long-term follow-up. Venous bloods were exsanguinated to detect the Thl/Th2cytokines (IL-2, IL-4,IL-6,IL-10,TNF and IFN-y) values with flow cytometry(FCM) before and after one-year course of immunotherapy. Meanwhile,the nasal symptoms(sneezing,rhinorrhea,nasal obstruction, pruritus) and general symptom were evaluated with visual analogue scale(VAS).Result:1. Compared after one-year immunotherapy to before,both two groups significantly increased the scores of IL-2,IL-10and IFN-y,and reduced the scores of IL-4and IL-6in serum which had statistically signinicant difference(t value were7.183,4.084,10.115,-8.662,-3.343;7.226,4.016,10.095,-1.015,-2.170,respectively,all P<0.05). With the reduce of scores of TNF in two groups, the subcutaneous immunotherapy group had statistically difference(t=-2.195,P<0.05) while the other one did not (t=-1.859,P>0.05).2. Except the score of IFN-y in sublingual immunotherapy group which was higher than subcutaneous immunotherapy one(r=2.508,P<0.05), there was no significant difference in the mean score of the cytokines between the two groups before and after treatment(t value were1.347,-1.949,0.025,0.130,-0.026,respectively,all P>0.05)3. After one-year immunotherapy,both groups of subcutaneous and sublingual immunotherapy significantly reduced the individual symptom scores of sneezing,rhinorrhea,nasal obstruction,pruritus and general symptom which had signinicant difference(t value were-18.667,-15.267,-15.544,-11.830,-19.822;-25.103,-22.992,-14.288,-140343,-22.093,respect ively,all P<0.01).4..There was no difference in decreased mean score of the symptoms between the two groups of children before and after treatment(t value were0.147,0.522,1.327,0.695,0.112, respectively,all P>0.05).5. There was no correlation beween the value of cytokines(IL-2, IL-4,IL-6,IL-10,TNF and IFN-y) and the score of general symptom in children before and after one-year course of immunotherapy.Conclusion;1. Specific immunotherapy could significantly improve the serum levels of expression of IL-2and IFN-y (Thl cytokines),and decrease the levels of expression of IL-4and IL-6(Th2cytokines) in children,which regulated the balance of Th1and Th2cells for the goal.2. Immunotherapy with dust mite extract was efficacious to treat children allergic rhinitis.And SLIT had the same clinical efficacy with SCIT. SLIT had simple administration without pain which was expected to replce SCIT in children.