Role of sublingual immunotherapy and probiotics in clinical improvements of childhood asthma
Keywords:
asthma allergy, sublingual immunotherapy, probiotics, medication score, symptom score, FEV1 reversibility
Abstract
Background Sublingual immunotherapy (SLIT) is an effectivesecondary prevention to improve natural course of asthma. Its
efficacy is limited to allergic asthma caused by inhalant allergen.
Recent studies showed that probiotic as immunomodulator
decreases inflammatory process induced by food allergy. No suf-
ficient clinical evidence reported about the efficacy of combination
sublingual immunotherapy and probiotics or probiotics only in
clinical improvement of childhood asthma.
Objective To investigate the role of SLIT and probiotic on clinical
parameters of childhood asthma (FEVl reversibility, medication
score, and symptom score).
Methods A randomized single blind clinical trial was conducted
on 6-17 year-old asthmatic children sensitive to food and aero-
allergens. Subjects were allocated to Group A receiving SLIT,
Group B receiving probiotics and SLIT, Group C receiving probiot-
ics only. All parameters were evaluated in week 0 untill4.
Results FEVl reversibility improved in all groups. Medication
score and symptom score was also decreased in all groups. The
most marked decrease of FEVl reversibility and symptom score
were found in probiotics group. Statistical analysis revealed
that the difference of each parameter between groups were not
significant.
Conclusion Combination of SLIT and probiotics and probiot-
ics are only similarly effective to improve clinical symptoms as
childhood asthma. Hence, information about probiotics as im-
munomodulator was proved to be an excellent alternative therapy
for childhood asthma has been obtained.
References
1. Bousquet J, Lockey R, Mailing HJ. World Health Organization
Position Paper: Allergen immunotherapy- therapeutical vac-
cines for allergic diseases. Allergy 1998;53 Suppl 44:20-7.
2. Rautava S, Kalliomaki M, lsolauri E. Probiotics during preg-
nancy and breast-feeding might confer immunomodulatory
protection against atopic disease in the infant. J Allergy Clin
lmmunol 2002;109:119-21.
3. lsolauri E, Arvola T, Siitas Y. Probiotics in the management
of atopic eczema. Clin Exp Allergy 2000;30: 1604-10.
4. Barish L. Allergic rhinitis: Systemic inflammation and
implications for management. J Allergy Clin lmmunol
2003; 112:1021-31.
5. Barreiro Tl, Perillo I. An approach to interpreting spirometry.
6. Bousquet J, Scheimann P, Guinnepain MT. Sublingual swal-
Am Fam Phys 2004;69 Suppl5:1107-14.
low immunotherapy (SLIT) in patients with asthma due to
house dust mites: a double blind placebo controlled study.
Allergy 1999;54:249-60.
7. Sheffer AL. International consensus report on the diagnosis
nad management of asthma. Eur Respir J 1992;5:601-41.
8. Petty TL, Weinmann GG. Building a national strategy for
the prevention and management of and research in chronic
obstructive pulmonary disease. National Heart, Lung and
Blood Institute Workshop Summary. Bethesda, Maryland.
JAMA 1995;277:246-53.
9. Malet A, Valero A, Lluch-Pereza M, Pedemonteb C, de Ia
Torre F. Sublingual immunotherapy with a Dermatophagoides
pteronyssinus extract in mass units: assessment of efficacy,
safety and degree of compliance. Allergy lmmunol Clin
2000; 15:145-50.
10. Silvestri M, Spallarossa D, Battistini E, Sabatini F, Pecora
S, Parmiani S, et al. Changes in inflammatory and clinical
parameters and in bronchial hyper reactivity in asthmatic
children sensitized to house dust mites following sub-
lingual immunotherapy. J Invest Allergol Clin lmmunol
2002;12:52-9.
11. DiRienzo V, Marcucci F, Puccinelli P, Parmiani S, Frati F,
Sensi L, Canonica GW, Passalacqua G. Long-lasting effect
of sublingual immunotherapy in children with asthma due
to house dust mite: a 10-year prospective study. Clin Exp
Allergy 2003;33 Suppl 2:206-10.
12. Rosenfeldt V, Benfeldt E, Nielsen SO, Michaelsen KF,
Jeppesen DL, Valerius NH, Paerregaard A. Effect of probi-
otic Lactobacillus strains in children with atopic dermatitis.
J Allergy Clin Immunol 2004; 111:389-95.
13. Viljanen M, Kuitunen M, Haahtela T, Juntunen-Backman K,
Korpela R, Savilahti E. Probiotic efects on faecal infammatory
markers and on faecal lgA in food allergic atopic eczema/dermatitis
syndrome infants. Pediatr Allergy lmmunol2005; 16:65-71.
14. Wang MF, Lin HC, Wang YY, Hsu CH. Treatment of peren-
nial allergic rhinitis with lactic acid bacteria. Ped Allergy
Immunol 2004; 15:152-8.
15. Holt PG, McMenamin C. Defence against allergic sensitisa-
tion in healthy lung: the role of inhalation tolerance. Clin
Exp Allergy 1989;19:55-62.
16. Swarbrick T, Stokes CR, Sooth ill JF. Absorption of antigens
after oral immunization and the simultaneous induction of
specific systemic tolerance. Gut 1979;20:121-5.
17. Tari MG, Mancino M, Monti G. Efficacy of sublingual immu-
notherapy in patients with rhinitis and asthma due to house
dust mites. A double-blind study. Allergol Immunopathol
1990;18:277-84.
18. Lilja S, Sundin B, Graff-Lonnevig Y, Hedlin G, Heilborn H,
Norrlind K, et al. Immunotherapy with partially purified
and standardized animal dander extract. Effect of 2 years of
treatmant. J Allergy Clin Immunol 1989;23:3 7-44.
19. La Rosa M, Ratmo C, Andre C, Carat F, Tosca MA, Canonica
GW. Double-blind placebo-controlled evaluation of sublin-
gual-swallow immunotherapy with standardized Parietaria
judaica extract in children with allergic rhinoconjunctivitis.
J Allergy Clin lmmunol1999;104:425-32.
20. Passalacqua G, Albano M, Pronzato C, Riccio A, Falagiani
P, Canonica GW. Nasal immunotherapy to Parietaria: long
term follow up of a double blind study. Clin Exp Allergy
1997;27:904-8.
21. Pajno GB, Morabito L, Barberio G, Parmiani S. Clinical and
immunologic effects oflong-term sublingual immunotherapy
in asthmatic children sensitized to mites: a double-blind,
placebo-controlled study. Allergy 2000;55 Suppl 9:842-9.
22. Hirsch T, Sahn M, Leupold W. Double-blind placebo-con-
trolled study of sublingual immunotherapy with house dust
mite extract (D. pt.) in children. Pediatr Allergy lmmunol
1997;8:21-7.
23. Subrata LA, 2007. Toleransi oral dan regulasi respon imun
sistemik pada anak asma bronkiale yang mendapat imunot-
erapi house dust-mite sublingual, probiotik, atau kombinasi
sublingual dan probiotik. Thesis. 2007. Medical School of
Airlangga University/Dr.Soetomo Hospital Surabaya. Un-
published.
24. Endaryanto A, 2006. Imunoregulasi Th1 dan Th2 melalui
TLR 2 dan 4 oleh Probiotik LOG dan Lactobacillus plantarum
IS-10506 dalam penurunan reaksi alergi. Studi eksperimental
pada mencit coba. Dissertation. 2006. Medical School of
Airlangga University/Dr.Soetomo Hospital Surabaya. Un-
published.
Position Paper: Allergen immunotherapy- therapeutical vac-
cines for allergic diseases. Allergy 1998;53 Suppl 44:20-7.
2. Rautava S, Kalliomaki M, lsolauri E. Probiotics during preg-
nancy and breast-feeding might confer immunomodulatory
protection against atopic disease in the infant. J Allergy Clin
lmmunol 2002;109:119-21.
3. lsolauri E, Arvola T, Siitas Y. Probiotics in the management
of atopic eczema. Clin Exp Allergy 2000;30: 1604-10.
4. Barish L. Allergic rhinitis: Systemic inflammation and
implications for management. J Allergy Clin lmmunol
2003; 112:1021-31.
5. Barreiro Tl, Perillo I. An approach to interpreting spirometry.
6. Bousquet J, Scheimann P, Guinnepain MT. Sublingual swal-
Am Fam Phys 2004;69 Suppl5:1107-14.
low immunotherapy (SLIT) in patients with asthma due to
house dust mites: a double blind placebo controlled study.
Allergy 1999;54:249-60.
7. Sheffer AL. International consensus report on the diagnosis
nad management of asthma. Eur Respir J 1992;5:601-41.
8. Petty TL, Weinmann GG. Building a national strategy for
the prevention and management of and research in chronic
obstructive pulmonary disease. National Heart, Lung and
Blood Institute Workshop Summary. Bethesda, Maryland.
JAMA 1995;277:246-53.
9. Malet A, Valero A, Lluch-Pereza M, Pedemonteb C, de Ia
Torre F. Sublingual immunotherapy with a Dermatophagoides
pteronyssinus extract in mass units: assessment of efficacy,
safety and degree of compliance. Allergy lmmunol Clin
2000; 15:145-50.
10. Silvestri M, Spallarossa D, Battistini E, Sabatini F, Pecora
S, Parmiani S, et al. Changes in inflammatory and clinical
parameters and in bronchial hyper reactivity in asthmatic
children sensitized to house dust mites following sub-
lingual immunotherapy. J Invest Allergol Clin lmmunol
2002;12:52-9.
11. DiRienzo V, Marcucci F, Puccinelli P, Parmiani S, Frati F,
Sensi L, Canonica GW, Passalacqua G. Long-lasting effect
of sublingual immunotherapy in children with asthma due
to house dust mite: a 10-year prospective study. Clin Exp
Allergy 2003;33 Suppl 2:206-10.
12. Rosenfeldt V, Benfeldt E, Nielsen SO, Michaelsen KF,
Jeppesen DL, Valerius NH, Paerregaard A. Effect of probi-
otic Lactobacillus strains in children with atopic dermatitis.
J Allergy Clin Immunol 2004; 111:389-95.
13. Viljanen M, Kuitunen M, Haahtela T, Juntunen-Backman K,
Korpela R, Savilahti E. Probiotic efects on faecal infammatory
markers and on faecal lgA in food allergic atopic eczema/dermatitis
syndrome infants. Pediatr Allergy lmmunol2005; 16:65-71.
14. Wang MF, Lin HC, Wang YY, Hsu CH. Treatment of peren-
nial allergic rhinitis with lactic acid bacteria. Ped Allergy
Immunol 2004; 15:152-8.
15. Holt PG, McMenamin C. Defence against allergic sensitisa-
tion in healthy lung: the role of inhalation tolerance. Clin
Exp Allergy 1989;19:55-62.
16. Swarbrick T, Stokes CR, Sooth ill JF. Absorption of antigens
after oral immunization and the simultaneous induction of
specific systemic tolerance. Gut 1979;20:121-5.
17. Tari MG, Mancino M, Monti G. Efficacy of sublingual immu-
notherapy in patients with rhinitis and asthma due to house
dust mites. A double-blind study. Allergol Immunopathol
1990;18:277-84.
18. Lilja S, Sundin B, Graff-Lonnevig Y, Hedlin G, Heilborn H,
Norrlind K, et al. Immunotherapy with partially purified
and standardized animal dander extract. Effect of 2 years of
treatmant. J Allergy Clin Immunol 1989;23:3 7-44.
19. La Rosa M, Ratmo C, Andre C, Carat F, Tosca MA, Canonica
GW. Double-blind placebo-controlled evaluation of sublin-
gual-swallow immunotherapy with standardized Parietaria
judaica extract in children with allergic rhinoconjunctivitis.
J Allergy Clin lmmunol1999;104:425-32.
20. Passalacqua G, Albano M, Pronzato C, Riccio A, Falagiani
P, Canonica GW. Nasal immunotherapy to Parietaria: long
term follow up of a double blind study. Clin Exp Allergy
1997;27:904-8.
21. Pajno GB, Morabito L, Barberio G, Parmiani S. Clinical and
immunologic effects oflong-term sublingual immunotherapy
in asthmatic children sensitized to mites: a double-blind,
placebo-controlled study. Allergy 2000;55 Suppl 9:842-9.
22. Hirsch T, Sahn M, Leupold W. Double-blind placebo-con-
trolled study of sublingual immunotherapy with house dust
mite extract (D. pt.) in children. Pediatr Allergy lmmunol
1997;8:21-7.
23. Subrata LA, 2007. Toleransi oral dan regulasi respon imun
sistemik pada anak asma bronkiale yang mendapat imunot-
erapi house dust-mite sublingual, probiotik, atau kombinasi
sublingual dan probiotik. Thesis. 2007. Medical School of
Airlangga University/Dr.Soetomo Hospital Surabaya. Un-
published.
24. Endaryanto A, 2006. Imunoregulasi Th1 dan Th2 melalui
TLR 2 dan 4 oleh Probiotik LOG dan Lactobacillus plantarum
IS-10506 dalam penurunan reaksi alergi. Studi eksperimental
pada mencit coba. Dissertation. 2006. Medical School of
Airlangga University/Dr.Soetomo Hospital Surabaya. Un-
published.
Published
2016-09-15
How to Cite
1.
lrmawati M, Endaryanto A, Harsono A. Role of sublingual immunotherapy and probiotics in clinical improvements of childhood asthma. PI [Internet]. 15Sep.2016 [cited 22Nov.2024];48(5):261-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/593
Section
Articles
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
Received 2016-09-11
Accepted 2016-09-11
Published 2016-09-15
Accepted 2016-09-11
Published 2016-09-15
