Allergen Sensitization Changes And Clinical Effect Of Asthmatic Children With Standard House Dust Mite Specific Immunotherapy

PARTⅠALLERGEN SENSITIZATION CHANGES OF ASTHMATIC CHILDREN WITH STANDARD HOUSE DUST MITE EXTRACT SPECIFIC IMMUNOTHERAPYObjective This study was aimed to analyze the allergen sensitization changes of Skin Prick Tests (SPT) in Children with asthma,sensitized to House Dust Mite (HDM) or HDM in combination with other allergens and accepted standard HDM Specific Immunotherapy (SIT), research the effect of children with asthma by standard HDM SIT from allergen sensitization.Methods 140 cases were made a definite diagnosis as childhood asthma , SPT, at least one of the mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis ) manifested skin index (SI)"≥+++", were recruited for this study. SIT with standard dust mite extract , provided by denish ALK—ABELLO corporation. The cases were divided into 2 groups according to clinical investigation time: 6 months group (93 cases) and 12 months group (78 cases), 31cases were rechecked SPT after 6 months and 12 months among the total. 13 standard allergens liquor for SPT (provided by denish ALK—ABELLO corporation )were used for measuring the change of skin diameter and atopy numbers (Dermatophagoides pteronyssinus, Dermatophagoides farinae , Blomia tropicalis,Blattella germanica , American cockroach, mould mixⅠ, mould mixⅣ, Cat hair , Dog hair , PollenⅣ, PollenⅠ, Mugwort , Ambrosia artemisifolia) before SIT,after 6 months of SIT and 12 months of SIT,to compare the SPT allergen sensitization results of prior- treatment and post-treatment.Results Of the all 140 cases, 72.86% (103/140) was HDM-monosensitized, 62.85% ( 88/140 ) was sensitized to HDM in combination with other allergens. SPT was rechecked in 93 of these cases which treated by SIT for 6 months, and compared with the pre-SIT results, the SPT wheal diameters of all allergens were significantly decreased (p<0.0001), except cat hair (p>0.05) and pollen (p>0.05), and in 78 cases with 12-month SIT treatment, the SPT wheal diameters of all allergens were significantly decreased (p<0.0001), cockroach (P<0.005) and pollen(P<0.005).After 6-month or 12-month standard HDM SIT treatment, more than 70% of theses children sensitized to HDM in combination with other allergens were desensitized to the other allergens.After 6-month or 12-month of HDM SIT treatment, there were 84.95% and 87.18% showed no new sensitization. Conclusion SPT allergen sensitization results could be well improved by the treatment of standard HDM SIT after 6 months and 12 months, the effectiveness of which is time and dose-dependent. It is implied that possible intrinsic correlations among three mites or other allergens and children with multi-allergen sensitization could be desensitisized by a single allergen extraction SIT ; HDM SIT has the potential to prevent the onset of new sensitizations in children with rhinitis and/or asthma after 6 months or 12 months. PARTⅡCLINICAL EFFECT AND COMPLIANCE OF ASTHMATIC CHILDREN WITH STANDARD HOUSE DUST MITE SPECIFIC IMMUNOTHERAPYObjective This study was aimed to compare the difference in clinical effects of asthmatic children between 3 years of therapy and less than 3 years of therapy ,To evaluate the related influencing factors with the compliance of therapy in the course of SIT, research the appropriate maintenance time of standard HDM SIT and provide some strategies to promote the compliance of SIT.Method To collect and phone follow-up visit 67 cases (25 cases discontinued among the total) were made a definite diagnosis as childhood asthma, Skin Prick Tests and at least one of the mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis ) manifested skin index"≥+++", were recruited for this study. SIT with standard dust mite extract from June to December in 2005. The time of observation was defined 3 years. The subjects were divided into 2 groups according to the time of therapy: 3 years of SIT group (finished SIT group), 42 cases and less than 3 years of SIT group (unfinished SIT group), 25 cases. To phone and record the attack frequency of asthma and the emergency treatment frequency of asthma and the transfusion days of asthma in the year of prior-treatment and post-treatment in 2 groups, respectively. Whether inhaled medicine according to medical orders. To phone the parents of asthmatic children about subjective evaluation of SIT after 3 years. Control degree of asthma was evaluated by doctor after 3 years according to the information of asthmatic attacks and Medication. To phone the parents of unfinished SIT group in order to evaluate the reason of discontinued treatment.Results No significant difference was found about the attack frequency of asthma, the emergency treatment frequency of asthma and the transfusion days of asthma between the 2 groups in the year of pre-SIT(P>0.05). However, after 3 years therapy, the attack frequency of asthma, the emergency treatment frequency of asthma and the transfusion days of asthma were significantly improved in both 2 groups, compared with the pre-SIT. Moreover, significant difference was found between the 2 groups (P<0.005); Inhaled medicine of 3 years of SIT were more regulation than less than 3 years of SIT, and significant difference was found between the 2 groups after 3 years (P<0.005); Subjective evaluation of therapeutic effect of SIT was no significant difference between the 2 groups, objective evaluation of asthmatic control was significant difference between the 2 groups (P<0.05). Subjective evaluation of therapeutic effect of SIT was no significant difference between the 2 groups when except regulating medicine, but the difference of the control degree of asthma was between significance or not (P<0.067); The major influencing factors with the compliance of therapy during SIT were discontinued treatment when symptoms were improved and suspicion of therapeutic efficacy, account for 36% and 32%, respectively.Conclusion The improvements of clinical symptoms of asthmatic children in 3 years of SIT group were superior to those in less than 3 years of s SIT group, thus the former can more effectively control asthma; Taken relative measures such as healthy education might promote the compliance of asthmatic children with SIT, which have positive effects to asthma control.