Sublingual Immunotherapy in Children With Allergic Rhinitis

Study Overview
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Brief Summary
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The purpose of this study is to evaluate the clinical efficacy and mucosal/systemic antibody response changes after SLIT using house dust mite allergen with or without bacterial extracts in mite-allergic children.

Detailed Description
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Patients with allergic rhinitis with or without asthma were selected for a randomized double-blind, placebo-controlled trial and distributed into three groups: DPT (Dpt allergen extract, n=34), DPT+MRB (Dpt allergen plus mixed respiratory bacterial extracts, n=36), and Placebo (n=32). Clinical evaluation and immunological analyses are being carried out before and after 12 and 18 months of treatment, including rhinitis/asthma symptom and medication scores, skin prick test (SPT) to Dpt, and measurements of Dpt-, Der p 1-, Der p 2-specific serum IgE, IgG4, IgG1 and -specific salivary IgA.

Official Title
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Clinical Efficacy and Mucosal/Systemic Antibody Response Changes After Sublingual Immunotherapy in Mite-allergic Children in a Randomized Double-blind, Placebo-controlled Study in Brazil

Conditions
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Allergic Rhinitis

Intervention / Treatment
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* Biological: Mite, Mite and Bacterial or Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinical diagnosis of allergic rhinitis Positive skin test to Dermatophagoides pteronyssinus total extract Positive serum levels of specific IgE to D. pteronyssinus extract Exclusion Criteria: Previous allergen immunotherapy Use of antihistamines 1 week or topical corticosteroid up to 3 weeks prior to skin prick test Long term use of systemic corticosteroid. Airway infection 30 days prior to the selection. Children with severe asthma, malignant, cardiovascular or autoimmune diseases, under chemotherapy or immunosuppressor therapy. Users of cigarette smoke Presence of severe skin lesions

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 15 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: mite allergen drop<br>Children with allergic rhinitis sensitized with dust mites will receive progressive doses of allergen drops comparing those receiving placebo. | Biological: Mite, Mite and Bacterial or Placebo<br>* All treatments were given by sublingual route according to schedule of EAACI, with some modification. Patients received up-dosing sublingual drops once a day, reaching in approximately 3 months a monthly maintenance dose of 36 μg of Der p 1 given three times a week in alternate days for mite, mite and bacterial allergen extract, and no Der p 1 and no bacterial components in the placebo group. Doses were delivered by using vials equipped with a metered-dose dropper, and subjects were instructed to hold the solution under the tongue for 2 min and not to eat or drink for 60 min after the dose. Subjects self-administered the treatment at home. Adjustments in the schedule were made on an individual basis according to standard guidelines for specific immunotherapy<br>* Other names: bacterial allergen extract;|
| Active Comparator: mite plus bacterial extracts<br>Vaccine constituted with mite and bacterial extracts will be compared to placebo. | Biological: Mite, Mite and Bacterial or Placebo<br>* All treatments were given by sublingual route according to schedule of EAACI, with some modification. Patients received up-dosing sublingual drops once a day, reaching in approximately 3 months a monthly maintenance dose of 36 μg of Der p 1 given three times a week in alternate days for mite, mite and bacterial allergen extract, and no Der p 1 and no bacterial components in the placebo group. Doses were delivered by using vials equipped with a metered-dose dropper, and subjects were instructed to hold the solution under the tongue for 2 min and not to eat or drink for 60 min after the dose. Subjects self-administered the treatment at home. Adjustments in the schedule were made on an individual basis according to standard guidelines for specific immunotherapy<br>* Other names: bacterial allergen extract;|
| Placebo Comparator: Placebo<br>Placebo will be constituted by the same solution used to make dilution of the allergen extracts. | Biological: Mite, Mite and Bacterial or Placebo<br>* All treatments were given by sublingual route according to schedule of EAACI, with some modification. Patients received up-dosing sublingual drops once a day, reaching in approximately 3 months a monthly maintenance dose of 36 μg of Der p 1 given three times a week in alternate days for mite, mite and bacterial allergen extract, and no Der p 1 and no bacterial components in the placebo group. Doses were delivered by using vials equipped with a metered-dose dropper, and subjects were instructed to hold the solution under the tongue for 2 min and not to eat or drink for 60 min after the dose. Subjects self-administered the treatment at home. Adjustments in the schedule were made on an individual basis according to standard guidelines for specific immunotherapy<br>* Other names: bacterial allergen extract;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline in Symptom and Medication Scores at 12 months | For clinical evaluation will be used a questionnaire determining the symptom and medication scores. | Baseline and 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline in Specific Antibody Levels. | Measurement of serum specific antibodies (IgE, IgG1, IgG4, and IgA) to Dermatophagoides pteronyssinus total extract, and Der p 1 and Der p 2 allergens. | Baseline, 12 months and 18 Months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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IgA antibody, IgE antibody, IgG1/IgG4 subclasses, Mite allergy, Sublingual immunotherapy, Saliva