Background and Objectives: Allergy to house dust mite is one of the most common causes of allergic rhinitis (AR) in China. We sought to compare the efficacy and safety of a 6-week cluster schedule of specific immunotherapy with that of a 14-week conventional schedule for the treatment of subjects with persistent AR. Methods: The trial was a prospective and randomized study involving 96 patients with persistent AR, aged 14–60 years, who were allergic to Dermatophagoides pteronyssinus. While 48 patients were randomly assigned to the cluster schedule reaching the maintenance dose within 6 weeks, the other 48 were randomly assigned to the conventional schedule reaching the maintenance dose within 14 weeks. Eighty-nine patients completed a 1-year treatment course. While kinetic changes in clinical efficacy and adverse reactions were observed during the treatment, quality of life, cutaneous reactivity and serum-specific immunoglobulin E to Dermatophagoides pteronyssinus were measured before and after treatment. Results: The cluster schedule reduced the time to reach the maintenance dose by 57% and caused mild systemic adverse reactions after 1.0% of injections (6.7% of patients), with no differences in comparison with the conventional schedule. Cluster specific immunotherapy led to decreases in clinical symptoms and earlier use of medication than did the conventional schedule. Similar improvements in quality of life and reduced cutaneous reactivity without significant changes in specific immunoglobulin E were observed in both groups after 1 year. Conclusions: The cluster schedule is a safe alternative to the conventional schedule with the advantage of achieving clinical effectiveness sooner.

Keywords:
Allergic rhinitis, Cluster immunotherapy, Conventional immunotherapy
1.
Bousquet J, van Cauwenberge P, Bachert C, et al: Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol 2001;108(suppl 5):S147–S334.
2.
Sly RM: Changing prevalence of allergic rhinitis and asthma. Ann Allergy Asthma Immunol 1999;82:233–248.
3.
Sly RM: Epidemiology of allergic rhinitis. Clin Rev Allergy Immunol 2002;22:67–103.
4.
Linneberg A: Changes in atopy over 25 years: allergy epidemic has spread to old age. BMJ 2005;331:352.
5.
Law M, Morris JK, Wald N, et al: Changes in atopy over a quarter of a century, based on cross-sectional data at three time periods. BMJ 2005;330:1187–1188.
6.
Bachert C, van Cauwenberge P, Olbrecht J, et al: Prevalence, classification and perception of allergic and nonallergic rhinitis in Belgium. Allergy 2006;61:693–698.
7.
Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema. ISAAC: The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Lancet 1998;351:1225–1232.
8.
Zhao T, Wang HJ, Chen Y, et al: Prevalence of childhood asthma, allergic rhinitis and eczema in Urumqi and Beijing. J Paediatr Child Health 2000;36:128–133.
9.
Sporik R, Holgate ST, Platts-Mills TA, et al: Exposure to house-dust mite allergen (Der p I) and the development of asthma in childhood. A prospective study. N Engl J Med 1990;323:502–507.
10.
Bousquet J, Lockey R, Malling HJ: Allergen immunotherapy: therapeutic vaccines for allergic diseases. A WHO position paper. J Allergy Clin Immunol 1998;102:558–562.
11.
Malling HJ: Immunotherapy as an effective tool in allergy treatment. Allergy 1998;53:461–472.
12.
Varney VA, Tabbah K, Mavroleon G, et al: Usefulness of specific immunotherapy in patients with severe perennial allergic rhinitis induced by house dust mite: a double-blind, randomized, placebo-controlled trial. Clin Exp Allergy 2003;33:1076–1082.
13.
Tabar AI, Fernandez-Tavora L, Alonso R, et al: Tolerance of a cluster schedule with a house dust mite extract quantified in mass units: multicenter study. J Investig Allergol Clin Immunol 2004;14:193–197.
14.
Garcia-Robaina JC, Sanchez I, de la Torre F, et al: Successful management of mite-allergic asthma with modified extracts of Dermatophagoides pteronyssinus and Dermatophagoides farinae in a double-blind, placebo- controlled study. J Allergy Clin Immunol 2006;118:1026–1032.
15.
Frew AJ, Powell RJ, Corrigan CJ, et al: Efficacy and safety of specific immunotherapy with SQ allergen extract in treatment-resistant seasonal allergic rhinoconjunctivitis. J Allergy Clin Immunol 2006;117:319–325.
16.
Calderon MA, Alves B, Jacobson M, et al: Allergen injection immunotherapy for seasonal allergic rhinitis. Cochrane Database Syst Rev 2007:CD001936.
17.
Dursun AB, Sin BA, Oner F, et al: The safety of allergen immunotherapy (IT) in Turkey. J Investig Allergol Clin Immunol 2006;16:123–128.
18.
Serrano P, Algorta J, Martinez A, et al: Prospective safety study of immunotherapy administered in a cluster schedule. J Investig Allergol Clin Immunol 2004;14:312–319.
19.
Tabar AI, Echechipia S, Garcia BE, et al: Double-blind comparative study of cluster and conventional immunotherapy schedules with Dermatophagoides pteronyssinus. J Allergy Clin Immunol 2005;116:109–118.
20.
Position paper: immunotherapy. (EAACI) The European Academy of Allergology and Clinical Immunology. Allergy 1993;48(suppl 14):7–35.
21.
Colas C, Monzon S, Venturini M, et al: Double-blind, placebo-controlled study with a modified therapeutic vaccine of Salsola kali (Russian thistle) administered through use of a cluster schedule. J Allergy Clin Immunol 2006;117:810–816.
22.
Juniper EF, Thompson AK, Ferrie PJ, et al: Validation of the standardized version of the Rhinoconjunctivitis Quality of Life Questionnaire. J Allergy Clin Immunol 1999;104:364–369.
23.
Abramson MJ, Puy RM, Weiner JM: Allergen immunotherapy for asthma. Cochrane Database Syst Rev 2003:CD001186.
24.
Cox L: Accelerated immunotherapy schedules: review of efficacy and safety. Ann Allergy Asthma Immunol 2006;97:126–137.
25.
Alvarez-Cuesta E, Bousquet J, Canonica GW, et al: Standards for practical allergen-specific immunotherapy. Allergy 2006;61(suppl 82):1–20.
26.
Greineder DK: Risk management in allergen immunotherapy. J Allergy Clin Immunol 1996;98:S330–S334.
27.
Nielsen L, Johnsen CR, Mosbech H, et al: Antihistamine premedication in specific cluster immunotherapy: a double-blind, placebo-controlled study. J Allergy Clin Immunol 1996;97:1207–1213.
28.
Casale TB, Busse WW, Kline JN, et al: Omalizumab pretreatment decreases acute reactions after rush immunotherapy for ragweed-induced seasonal allergic rhinitis. J Allergy Clin Immunol 2006;117:134–140.
29.
Ewbank PA, Murray J, Sanders K, et al: A double-blind, placebo-controlled immunotherapy dose-response study with standardized cat extract. J Allergy Clin Immunol 2003;111:155–161.
30.
Durham SR, Till SJ: Immunologic changes associated with allergen immunotherapy. J Allergy Clin Immunol 1998;102:157–164.
31.
Nanda A, O’Connor M, Anand M, et al: Dose dependence and time course of the immunologic response to administration of standardized cat allergen extract. J Allergy Clin Immunol 2004;114:1339–1344.
32.
Lent AM, Harbeck R, Strand M, et al: Immunologic response to administration of standardized dog allergen extract at differing doses. J Allergy Clin Immunol 2006;118:1249–1256.
© 2008 S. Karger AG, Basel
2008
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.