Clinical and immunologic effects of H1 antihistamine preventive medication during honeybee venom immunotherapy

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:122

Article

Mueller, Ulrich R.¹  Jutel, Marek^2,3  Zumkehr, Judith²  Akdis, Muebeccel²  Schnyder, Benno⁴  Blaser, Kurt²  Akdis, Cezmi² 

[1] Spital Ziegler, Dept Med, Med Klin, Bern, Switzerland

[2] Swiss Inst Allergy & Asthma Res, CH-7270 Davos, Switzerland

[3] Wroclaw Med Univ, Dept Clin Immunol, Wroclaw, Poland

[4] Univ Bern, Div Allergol, Clin Rheumatol & Clin Immunol Allergol, Bern, Switzerland

关键词: Venom immunotherapy;    antihistamine preventive medication;    T cells;    cytokines;    histamine receptors;   

DOI  :  10.1016/j.jaci.2008.08.007

来源: Elsevier

【 摘 要 】

Background: H1 antihistamines increase safety during allergen-specific immunotherapy and might influence the outcome because of immunoregulatory effects. Objective: We sought to analyze the influence of 5 mg of levocetirizine (LC) on the safety, efficacy, and immunologic effects of ultrarush honeybee venom immunotherapy (BVIT). Method: In a double-blind, placebo-controlled study 54 patients with honeybee venom allergy received LC or placebo from 2 days before BVIT to day 21. Side effects during dose increase and systemic allergic reactions (SARs) to a sting challenge after 120 days were analyzed. Allergen-specific immune response was investigated in skin, serum, and allergen-stimulated T-cell cultures. Results: Side effects were significantly more frequent in patients receiving placebo. Four patients receiving placebo dropped out because of side effects. SARs to the sting challenge occurred in 8 patients (6 in the LC group and 2 in the placebo group). Seven SARs were only cutaneous, and I in the placebo group was also respiratory. Difference of SARs caused by the sting challenge was insignificant. Specific IgG levels increased significantly in both groups. Major allergen phospholipase A(2)-stimulated T cells from both groups showed a slightly decreased proliferation. The decrease in IFN-gamma and IL-13 levels with placebo was not prominent with LC, whereas IL-10 levels showed a significant increase in the LC group only. Decreased histamine receptor (HR)1/HR2 ratio in allergen-specific T cells on day 21 in the placebo group was prevented by LC. Conclusions: LC reduces side effects during dose increase without influencing the efficacy of BVIT. LC modulates the natural course of allergen-specific immune response and affects the expression of HRs and cytokine production by allergen-specific T cells. (J Allergy Clin Immunol 2008;122:1001-7.)

【 授权许可】

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