Immunotherapy and probiotic treatment for allergic rhinitis in children

  • Sumadiono Sumadiono Department of Child Health, Universitas Gadjah Mada Medical School/Dr. Sardjito Hospital, Yogyakarta, Central Java
  • Cahya Dewi Satria Department of Child Health, Universitas Gadjah Mada Medical School/Dr. Sardjito Hospital, Yogyakarta, Central Java
  • Nurul Mardhiah Department of Child Health, Universitas Gadjah Mada Medical School/Dr. Sardjito Hospital, Yogyakarta, Central Java
  • Grace Iva Susanti Department of Child Health, Universitas Gadjah Mada Medical School/Dr. Sardjito Hospital, Yogyakarta, Central Java
Keywords: allergic rhinitis; immunotherapy; probiotics


Background Allergic rhinitis is a global health problem that is increasing in prevalence. Many kinds of therapy have been tried, such as antihistamines, probiotics, and immunotherapy. Immunotherapy may restore the patient’s normal immunity against the specific allergen, while probiotics may modify the natural course of allergy.

Objective To evaluate probiotics and immunotherapy for improving clinical symptoms of allergic rhinitis.

Methods This randomized controlled trial (RCT) involved 64 patients, aged 3-18 years, and diagnosed with persistent allergic rhinitis in the Department of Child Health, Sardjito General Hospital from April 2016 until May 2017. Patients were randomly allocated into three therapy groups: group A (standard therapy/cetirizine only), group B (standard and probiotic therapy), and group C (standard therapy and immunotherapy). Clinical symptoms of allergic rhinitis including sneezing, rhinorrhea, and itchy nose, were evaluated for 7 weeks and classified as improved or not improved. The significance of the data was analyzed using proportion test.

Results Sixty-four patients completed 7 weeks of therapy, 15 subjects in group A, 26 in group B, and 23 in group C. Group C showed significantly more improvement of sneezing and rhinorrhea compared to both group A (Z=5.71; Z=7.57, respectively) and group B (Z=2.82; Z=6.90, respectively). However, itchy nose was not significantly improved in group C compared to group B (Z=0.50), but was significantly improved in group C compared to group A (Z=10.91). Group B had significant improvement of sneezing, rhinorrhea, and itchy nose compared to group A (Z=3.81, Z=2.86, and Z=10.91, respectively).

Conclusion The combined standard-immunotherapy group has significantly superior improvement compared to the combined standard-probiotic group and the standard therapy group, in terms of sneezing and rhinorrhea in children with persistent allergic rhinitis.


Mir E, Panjabi C, Shah A. Impact of allergic rhinitis in school going children. Asia Pac Allergy. 2012;2:93.

Cantani A. Allergic rhinitis. In: Heilmann U, editor. Pediatric allergy, asthma and immunology. Berlin-Heidelberg: Springer-Verlag; 2008. p. 875-910.

von Mutius E. Epidemiology of allergic diseases. In: Leung D, editor. Pediatric allergy: principles and practice. 2nd ed. Edinburgh: Elsevier; 2010 p. 1-8.

Dina F, Satria CD, Sumadiono. Karakteristik klinis dan sensitisasi alergen pada anak dengan rinitis alergi di Yogyakarta [thesis]. [Yogyakarta]: Fakultas Kedokteran Universitas Gadjah Mada; 2016.

Raulf M, Bergmann KC, Kull S, Sander I, Hilger C, Bruning T, et al. Mites and other indoor allergens - from exposure to sensitization and treatment. Allergo J Int. 2015; 24: 68-80.

Deo SS, Mistry KJ, Kakade AM, Niphadkar PV. Role played by Th2 type cytokines in IgE mediated allergy and asthma. Lung India. 2010;27:66-71.

Recto MT, Gabriel MT, Kulthanan K, Tantilipikorn P, Aw DC, Lee TH, et al. Selecting optimal second-generation antihistamines for allergic rhinitis and urticaria in Asia. Clin Mol Allergy. 2017;15:19.

Hardy H, Harris J, Lyon E, Beal J, Foey AD. Probiotics, prebiotics and immunomodulation of gut mucosal defences: homeostasis and immunopathology. Nutrients. 2013;29:1869-912.

Kurniati AM, Sunardi D, Sungkar A, Bardosono S, Kartinah NT. Associations of maternal body composition and nutritional intake with fat content of Indonesian mothers' breast milk. Paediatr Indones. 2016;56:298-304.

Leung DYM, Szefler SJ, Bonilla FA, Akdis CA, Sampson HA. Pediatric allergy: principles and practice. 3rd ed. Edinburgh: Elsevier; 2016. p.179. PMid:27539211

Jacobsen L, Wahn U, Bilo MB. Allergen-specific immunotherapy provides immediate, long-term and preventive clinical effects in children and adults: the effects of immunotherapy can be categorised by level of benefit -the centenary of allergen specific subcutaneous immunotherapy. Clin Transl Allergy. 2012;2:8.

Song Y, Long J, Wang T, Xie J, Wang M, Tan G. Long-term efficacy of standardised specific subcutaneous immunotherapy in children with persistent allergic rhinitis due to multiple allergens including house dust mites. J Laryngol Otol. 2018;132:230-235.

El-sayed ZA, El-farghali OG. Allergen-specific immunotherapy in children. Egyptian Journal of Pediatric Allergy and Immunology .2012;10:55-66.

Fattory H, Endharti AT, Barlianto W, Olivianto E, Kusuma HMSC. Efek imunoterapi, probiotik, Nigella sativa terhadap rasio CD4+/CD8+, kadar imunoglobulin E, dan skoring asma. J Kedokt Brawijaya. 2015;28:328-33.

Ratih I, Olivianto E, Barlianto W, Kusuma HMSC. Pengaruh imunoterapi, probiotik dan jinten hitam terhadap CD4+IFNγ CD4 IFN, eosinofil, dan skor asma. J Kedokteran Brawijaya. 2015;28:187-94.

Endaryanto A, Hikmah Z, Harsono A. Use of superoxide dismutase in accelerating symptom relief in asthmatic and house dust mite allergic children receiving house dust mite immunotherapy. Int J Integr Heal Sci. 2015;3:72-8.

Muhyi A, Barlianto W, Kuksuma HMSC. Efek pemberian imunoterapi, probiotik, Nigella sativa terhadap Th17, neutrofil, dan skoring asma. J Kedokt Brawijaya. 2015; 28: 334-9.

Nucifera C, Olivianto E, Barlianto W, Chandra HMS. Jumlah CD4+IL-5+, CD8+IL-5+, dan perbaikan kualitas hidup setelah pemberian probiotik dan Nigella sativa pada anak asma dengan imunoterapi fase rumatan. Sari Pediatri. 2015;16:379-84.

Endaryanto A, Irmawati M. Enhanced efficacy of sublingual immunotherapy in childhood allergic asthma by probiotics. Folia Medica Indonesiana. 2018;54:64-74.

Hansen TK. Skin prick testing skin testing. 2006;58:1-5.

Brożek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic Rhinitis and its impact on Asthma (ARIA) Guidelines - 2016 Revision. J Allergy Clin Immunol. 2017;140: 950-8.

Smith H, White P, Annila I, Poole J, Andre C, Frew A. Randomized controlled trial of high-dose sublingual immunotherapy to treat seasonal allergic Rinitis. Journal of Allergy and Clinical Immunology. 2004;114:831-7.

Palma-Carlos AG, Santos AS, Branco-Ferreira M, Pregal AL, Palma-Carlos ML, Bruno ME, et al. Clinical efï¬cacy and safety of preseasonal sublingual immunotherapy with grass pollen carbamylated allergoid in rhinitic patient. double-blind, placebo-controlled study. Clinical Allergy Immunology Center. CAIC. 2006;34:195–8.

Karakoc-Aydiner E, Eifan AO, Baris S, Gunay E, Akturk H, Akkoc T, et al. Long-term effect of sSublingual and subcutaneous immunotherapy in dust mite-allergic children with asthma/rhinitis: A 3-year prospective randomized controlled trial. J Investig Allergol Clin Immunol. 2015;25:334-42. PMid:26727762

How to Cite
Sumadiono S, Satria C, Mardhiah N, Susanti G. Immunotherapy and probiotic treatment for allergic rhinitis in children. PI [Internet]. 10Dec.2018 [cited 20Jun.2024];58(6):280-. Available from:
Pediatric Allergy Immunology
Received 2018-07-30
Accepted 2018-11-26
Published 2018-12-10