Cockroach Immunotherapy Effective in Patients With Allergic Rhinitis, Asthma: Presented at EAACI

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Title: Cockroach Immunotherapy Effective in Patients With Allergic Rhinitis, Asthma: Presented at EAACI
URL: http://www.pslgroup.com/dg/22374E.htm
Doctor's Guide
June 11, 2008

By Chris Berrie

BARCELONA, Spain -- June 11, 2008 -- Immunotherapy with cockroach extract provides effective treatment for patients with allergic rhinitis and asthma, according to a randomised, double-blind, placebo-controlled trial, with placebo cross-over also showing benefit.

The study was presented here on June 9 at the 27th Congress of the European Academy of Allergology and Clinical Immunology (EAACI).

Although the cockroach allergen can be avoided, "Immunotherapy is the treatment that can be effective and alter the natural course of the disease," said Naveen Arora, PhD, Institute of Genomics and Integrative Biology, Delhi, India, and co-investigators.

Researchers aimed to evaluate the effects of allergen immunotherapy with subcutaneous application of standardised Periplaneta americana cockroach extract.

They screened 75 allergic patients by history, skin tests, and specific levels of immunoglobulin (Ig) E. Forty patients (aged 15-40 years) were randomised to receive active treatment with P americana extract subcutaneously, and the placebo group received phosphate buffered saline subcutaneously. After 1 year of treatment, placebo patients were crossed over to active treatment and received injections of P americana extract.

Patient assessments included skin tests, symptom scores, medication-use scores, airway reactivity, levels of IgE, IgG₁, and IgG₄, and cytokine levels. The researchers examined possible correlations of the IgG₄ to IgG₁ ratio with the symptom score.

Symptom scores from baseline to 1 year improved significantly in the active-treatment group (P < .05) but did not change significantly in the placebo group. There was no significant difference in use of rescue medication across treatment groups.

Skin reactivity scores were not significantly different in the 2 groups. However, only active treatment saw no new sensitisations during the study period. Changes in airway reactivity values were significant (P < .05) as compared with baseline values or with the placebo group.

Assessment of immunological parameters demonstrated modifications associated with active treatment. A nonsignificant reduction in IgE level (P = .08) accompanied by a significant increase in IgG₄ level (P < .05) provided a decrease in the IgE to IgG₄ ratio, accompanied by a significant decrease in interleukin-4 levels (P < .05).

Active treatment resulted in a significant positive correlation between the ratio of IgG₄ to IgG₁ and the symptom score (r² = .8931; P < .05), which was not seen with placebo.

Among the 16 placebo patients who completed the crossover year to active treatment there was a significant decrease in symptom score (P < .05), a slight reduction in drug-use score, a nonsignificant reduction in IgE level (P = .092), and a significant increase in IgG₄ level (P < .05).

"The good correlation between immunological and clinical parameters reflects the effectiveness of this immunotherapy," Dr. Arora concluded.

[Presentation title: A Double-Blind, Controlled Study on Cockroach Allergen Immunotherapy: Shift of Placebo Group to Active Group Shows Significant Improvement. Abstract 92]

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