Detection Of Allergens In Children With Allergic Rhinitis In Qingdao And Its Clinical Efficacy And Mechanism Of Sublingual Immunotherapy

Objective Allergic rhinitis is a common airway disease with regional variability inprevalence and sensitization profiles. This study aim at doing evaluate the sensitization profiles of allergic rhinitis children in Qingdao, and to evaluate the short-term efficacy of sublingual immunotherapy(SLIT) in children with allergic rhinitis(AR) and examine the changes of immunological parameters; and to evaluate the efficacy of sublingual immunotherapy(SLIT) with Dermatophagoides farinae drops on children with allergic rhinitis.Methods From January 2003 to December 2014, 2841 children with allergic rhinitis were enrolled to evaluate the sensitization profiles indicated by skin prick test against a panel of allergens. Of them, 1500 children were between 3 to 5 years old and 1341 children were between 6 to 12 years old. For the evaluation of short-term clinical efficacy, 42 patients with house dust mites-sensitized AR aged from 6 to 11 years old were enrolled for SLIT with sublingual allergen drop, Chanllergen. Clinical efficacy was evaluated by nasal symptom score before and after SLIT treatment for 6 months. In 13 patients with extremely significant improvement, expression of mi R-146 a, Foxp3 m RNA in peripheral blood mononuclear cells(PBMC) and serum IL-10 and IL-5 level were separately determined by RT-PCR and ELISA before and after treatment for 6 months. For the evaluation of efficacy, 110 house dust mites-sensitized AR children were subdivided into the SLIT group(60 children) and control group(50 children). Patients in SLIT group have received 2-year Challenge immunotherapy and combined with symptomatic medication, and patients in drug group only received symptomatic medication. After 2-year treatment, total nasal symptom scores(TNSS) and total medication scores(TMS) have been evaluated.Results The SPT results of 2841 children showed:(1) The main inhaled allergens were Dermatophagoides pteronyssinu(69.3%), Dermatophagoides farinae(66.2%), and Penicillium notatum(38.9%); The main food allergens were mussels(39.2%), carp(36.5%) and shrimp(36.3%).(2) In the younger group, the main inhaled allergens were Dermatophagoides pteronyssinu(67.53%), Dermatophagoides farina(62.47%), and Penicillium notatum(36.40%); In the elder group, the main inhaled allergens were Dermatophagoides pteronyssinu(71.96%), Dermatophagoides farina(70.84%) and Penicillium notatum(41.98%); The positive rate difference between Dermatophagoides farina, Dermatophagoides pteronyssinu, Penicillium notatum, Aspergillus fumigatus, Summer and fall flowers, ragweed, latex, gramineae was statistically significant(P < 0.05).(3) In the younger group, the main food allergens were mussels(39.60%), carp(34.33%), and shrimp(34.13%); In the elder group, the main food allergens were carp(39%), mussels(38.70%) and shrimp(38.63%). The positive rate difference between shrimp, carp, eel and sea crab was statistically significant(P < 0.05).(4) The positive rate difference between sex groups of various inhalant was Penicillium notatum, ragweed and food allergens as milk have significant difference(P<0.05).(5)The sensitization of Dermatophagoides pteronyssinu and Dermatophagoides farinae occurs together and the positive rate is 60%, which is associated with the positive sensitization of one or more other allergens was 56.7%. The positive intensity of Dermatophagoides pteronyssinu was higher than that of Dermatophagoides farina, which has significant difference(P<0.05).(6)The positive rate of dust mite was higher in 6-12 years group than that of younger group(P<0.05); The positive rate of dust mite was higher in male children group than that of female children group(P < 0.05). After 6 months of SLIT, all AR children have significant improvement in nasal symptom scores. The total nasal symptom scores were significantly decreased compared with the baseline values(P<0.01). After treatment, 33 patients met the criteria of extremely significant improvement. In 13 AR children with extremely significant improvement, expression of mi R-146 a, Foxp3 m RNA in peripheral blood mononuclear cells(PBMC) and serum IL-10 level were significantly increased compared with the baseline values(P<0.01), and expression of mi R-146 a significantly correlated with expression of Foxp3 m RNA(mi R-146 a vs Foxp3, r=0.66, P<0.01). After 2-year treatment, TMS and TNSS in SLIT group have decreased significantly compared with control group(P<0.01). Among them, 41 of 60 patients in SLIT group have discontinued symptomatic medication(68.33%), however, 8 of 50 patients in control group have discontinued symptomatic medication use(16.00%), both with significant difference(P<0.05).Conclusions Dermatophagoides pteronyssinu and Dermatophagoides farinae were the most prevalent allergens in AR children in Qingdao. The sensitization of Dermatophagoides pteronyssinu and Dermatophagoides farinae usually occurred together, and often accompanied by one or more other positive allergens. The AR children are more sensitive to aeroallergens with age, especially in male children. Therefore, according to the dust mite allergen, performing allergen specific immunotherapy may lead to better control on AR children. For short-term clinical efficacy, SLIT with Dermatophagoides farinae drops(Challenge) is a safe and effective treatment for AR patients in China, and the clinical efficacy might be associated with modulation of mi R-146 a and Treg cells. For long-term clinical efficacy, SLIT with Dermatophagoides farinae drops combined medical manegement, has significantly improved efficacy compared with symptomatic medication alone.