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A follow-up study of immunotherapy-treated birch-allergic patients: effect on the expression of chemokines in the nasal mucosa


Sabina Rak, Asthma and Allergy Research Group, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden.


Background Specific immunotherapy (SIT) is the only treatment producing lasting clinical improvement in patients with allergy. We investigated the long-term effect of SIT treatment on the expression of chemokines: eotaxin, RANTES (regulated upon activation, normal T cell expressed and secreted) and thymus and activation-regulated chemokine (TARC), and their receptors CCR3 and CCR4 in biopsies of nasal mucosa from birch-allergic individuals.

Methods Sixteen patients who completed a 3-year treatment programme 3–5 years ago, and 12 untreated, matched controls were included in the study. Patients recorded symptoms and use of rescue medication before and during the pollen season. Nasal mucosa samples obtained before and during the season were stained for eosinophil and mast cell markers and for eotaxin, RANTES, TARC, CCR3 and CCR4.

Results During the pollen season, rhinoconjunctivitis symptoms increased in both SIT and control groups (P=0.001 and 0.002, respectively). However, SIT patients had 37% fewer symptoms than controls. Medication use increased in both groups (P=0.002) during the season but the SIT group used 28% less than the controls (P=0.02). The number of eosinophils in the nasal mucosa increased in the control group (P=0.01) and the difference between the groups was significant during the season (P=0.01). No seasonal increase in the numbers of mast cells was seen, but during the pollen season, more (P=0.02) AA+ cells were found in the controls than in the SIT group. The number of eotaxin+ and RANTES+ cells increased in the control group (P=0.01 and 0.03, respectively) and the difference between groups during the season was significant (P=0.01 and 0.01, respectively). The TARC+ cell numbers were lower in the SIT group during the season (P=0.003). The CCR3+ cells increased only in the control group during the pollen season and remained unchanged in SIT patients, while CCR4+ cell numbers increased in both the control (P=0.03) and SIT (P=0.02) groups.

Conclusion This study confirmed that decreased numbers of eosinophils in the nasal mucosa is a long-lasting effect of birch SIT. SIT also prevented seasonal rises in the number of cells expressing the chemokines eotaxin and RANTES.