Vitamin D as an adjunct to subcutaneous allergen immunotherapy in asthmatic children sensitized to house dust mite

Authors

  • S. Baris,

    Corresponding author
    1. Division of Pediatric Allergy and Immunology, Research and Training Hospital, Marmara University, Istanbul, Turkey
    • Correspondence

      Dr. Safa Baris, Division of Pediatric Allergy and Immunology, Research and Training Hospital, Marmara University, Mimar Sinan Cad. No: 41, 34890 Istanbul, Turkey.

      Tel.: +90-0216-657-06-06

      Fax: +90-0216-657-06-95

      E-mail: safabaris@hotmail.com

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  • A. Kiykim,

    1. Division of Pediatric Allergy and Immunology, Research and Training Hospital, Marmara University, Istanbul, Turkey
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  • A. Ozen,

    1. Division of Pediatric Allergy and Immunology, Research and Training Hospital, Marmara University, Istanbul, Turkey
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  • A. Tulunay,

    1. Division of Immunology, Research and Training Hospital, Marmara University, Istanbul, Turkey
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  • E. Karakoc-Aydiner,

    1. Division of Pediatric Allergy and Immunology, Research and Training Hospital, Marmara University, Istanbul, Turkey
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  • I. B. Barlan

    1. Division of Pediatric Allergy and Immunology, Research and Training Hospital, Marmara University, Istanbul, Turkey
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  • Edited by: Hans-Uwe Simon

Abstract

Background

We aimed to investigate the efficacy, safety, and T regulatory cell response of vitamin D as an adjunct to allergen-specific immunotherapy (IT).

Methods

Fifty children with asthma and receiving pharmacotherapy were randomized into three groups as: subcutaneous IT (SCIT) along with vitamin D supplementation (650 U/day; n: 17), SCIT alone (n: 15), and pharmacotherapy alone (n: 18). All patients were evaluated at baseline, 6th and 12th months for scorings of symptoms and medication, skin prick testing, total IgE, specific IgE, and Der p 1-specific IgG4. In addition, D. pteronyssinus-induced CD4+CD25+FOXP3+T regulatory cell percentage, intracellular Foxp3 expression, and peripheral blood mononuclear cell IL-10 and TGF-β responses were assessed.

Results

In the SCIT + vitamin D and SCIT alone groups, total asthma symptom score (TASS), total symptom score (TSS), and total medication scores (TMS) were significantly lower than pharmacotherapy group at the end of 1 year. While the comparison of delta values (Δ 6th and Δ 12th month − baseline) of those scores revealed no significant differences between the two IT groups, TASS at the 6th month was lower in the SCIT + vitamin D group compared with others. There was a significant and positive trend in the levels of Der p 1-specific IgG4 in both IT groups throughout the study period. Whereas the levels of Der p 1-induced IL-10 and TGF-β were similar between IT groups, the mean fluorescence intensity of Foxp3 was highest in the SCIT + vitamin D group compared with others at the 12th month. The rate of discontinuation of inhaled corticosteroid (ICS) was 6/17 in SCIT + vitamin D, 3/15 in SCIT, and 0/18 in the pharmacotherapy group (P = 0.02).

Conclusion

Both SCIT groups fared better than pharmacotherapy alone at the end of 1 year. Although the clinical and immunologic outcomes were mostly similar between the two IT groups, some favorable outcomes of vitamin D warrant further investigation in more selected populations with varying doses as adjunct to IT.

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