Mechanism And Clinical Effect Investigation Of Standard Dermatophagoides Pteronyssinus Vaccine Immunotherapy Asthmatic Children

PartⅠCLINICAL EFFECT INVESTIGATION OF STANDARD DERMATOPHAGOIDES PTERONYSSINUS VACCINE IMMUNOTHERAPY ASTHMATIC CHILDRENObjective To investigate the clinical effects and security of standard Dermatophagoides pteronyssinus vaccine specific immunotherapy asthmtic children, focus on research the suitable maintenance dose of standard Dermatophagoides pteronyssinus vaccine in different stage years of age, for expecting better clinical effects while improving security.Methods All the 112 subjects were made a definite diagnosis as childhood astham, Dermatophagoides pteronyssinus skin tests and skin index"++～++++"were required when enrolled into the investigation. The subjects were divided into 3 groups: 5～<8 years SIT group (52 subjects, SIT with standard Dermatophagoides pteronyssinus vaccine of denish ALK-ABELLócorporation,, maintenance dose: 70000 SQ-U), 8～14 years SIT group (52 subjects, SIT with standard Dermatophagoides pteronyssinus vaccine of denish ALK-ABELLócorporation, maintenance dose: 100000 SQ-U), controll group (8 subjects, treated only with medications). Clinical investigation time was 6 months. Observation items: Basic medications and symptoms score, pulmonary function,bronchial provocation test,skin index and atopy numbers of allergens, side effects of SIT. Observation methods: Asthma diary was used for the medications and symptoms scores of everyday; MasterScope children's spirometry was used for the change of basic pulmonary function assessment (index: the percentage of FEVl, PEF, V75, V50, V25 account for predicted value)and PC20 of methacholine; 13 standard allergens liquor for skin prick tests ( provided by denish ALK-ABELLócorporation) were use for the change of skin index and atopy numbers of allergens (Dermatophagoides farinae, Dermatophagoides pteronyssinus, Bromia tropicalis, Canis familiaris , Felis domesticus , Blattella germanica, American cockroach, mould mixⅠ, mould mixⅣ, Artemisia Vulgaris, Ambrosia artemisifolia, PollensⅣ, PollensⅠ, positive control histamine,negative control normal saline); Side effects of SIT were noted by the doctor.Relsults The percentage of FEVl, PEF, V75 account for predicted value and PC20 of methacholine were significantly improved in both 5～<8 years and 8～14 years SIT group after 6 months of SIT (all P<0.01) and no significant difference was found between the 2 groups; Only the percentage of PEF account for predicted value was significantly improved in controll group ( P<0.01), though PC20 of methacholine got a few improvement, the change reached no statistic significance. Skin index of Dermatophagoides pteronyssinus and skin index and atopy numbers of other 10 allergens were significantly decreased in both 5～<8 years and 8～14 years SIT group after 6 months of SIT (all P<0.01), and no significant difference was found between the 2 groups; Additional, skin index of Dermatophagoides farinae was significantly decreased in 5～<8 years SIT group and skin index of Bromia tropicalis was significantly decreased in 8～14 years SIT group , too (P<0.05 , P<0.01 respectively). No significant difference was found about skin index of all the 13 allergens and atopy numbers of other 10 allergens in controll group. The local side effects in 8～14 years SIT group were significant higher than those in 5～<8 years SIT group ( P<0.01),but no significant difference of systemic side effects was found between the 2 groups. All the medications and symptoms score of 3 investigation groups were significantly decreased after 6 months, but no significant difference was found among all the 3 groups.Conclusion Both 70000SQ-U and 100000SQ-U of standard Dermatophagoides pteronyssinus vaccine as the maintenance dose SIT 5～<8 years and 8～14 years asthmatic children, all can decrease the medications and symptoms score , decrease skin index of Dermatophagoides pteronyssinus and other 10 allergens and the atopy numbers of other 10 allergens, improve the basic pulmonary function, decrease airway hyperreactivity after 6 months, furthermore, 70000 SQ-U group can significantly reduce local side effects. The results suggest that 70000SQ-U and 100000SQ-U of standard Dermatophagoides pteronyssinus vaccine can be used as the suitable maintenance dose of SIT in 5～<8 years and 8～14 years asthmtic children, respectively.PartⅡMECHANISM INVESTIGATION OF STANDARD DERMATOPHAGOIDES PTERONYSSINUS VACCINE IMMUNOTHERAPY ASTHMATIC CHILDRENObjective To investigate the influence of the percentage of CD4+CD25+T in peripheral blood, the production of IL-4,IL-10,IFN-γand the proliferation response of PBMCs of asthmtic children , who accepted specific immunotherapy (SIT) with standard Dermatophagoides pteronyssinus vaccine.Methods Both reqirements and treatment plans of the subjects as the same as partⅠ. The percentage of CD4+CD25+T in peripheral blood were determined by FACS Calibur flow cytometry.The production of IL-4, IL-10, IFN-γin supernatant of PBMCs were determined by ELISA. The proliferation response of PBMCs were determined by MTT method, pre and post treatment.Relsults After 6 mo treatment, The production of IL-4 were significantly decreased in 5～<8 years and 8～14 years SIT group (all P<0.05); the production of IL-10 were significantly decreased , too (P<0.01, P<0.05 respectively); No significant change about IFN-γwas found in the 2 groups. The production of IL-4 was significantly decreased in control group (P<0.05), while no significant change about IFN-γ. The percentage of CD4+CD25+T/CD4+CD25-T was significantly decreased in SIT group (P<0.05) , while no significant change about the percentage of CD4+CD25+T. No significant change about the percentage of CD4+CD25+T and CD4+CD25+T/CD4+CD25-T were found in control group. The proliferation response of PBMCs was significantly decreased in control group (P<0.05) while no significant change was found in 5～<8 years and 8～14 years SIT group.Conclusion Standard Dermatophagoides pteronyssinus vaccine SIT Dermatophagoides pteronyssinus allergic asthmtic children can significantly suppression the production levels of Th2-type cytokine, thus bring it's immunotherapy effects.