Immunotherapy with a standardized Dermatophagoides pteronyssinus extract. I. In vivo and in vitro parameters after a short course of treatment.
Dermatophagoides pteronyssinus (Dp) is the major allergen in allergic asthma in France. Standardized and lyophilized Dp extracts are available, and their effectiveness after a short course of rush immunotherapy was examined in a placebo-controlled, double-blind study. Twenty patients received the Dp standardized extract, and 10 other patients received a placebo extract. Before and 7 weeks after rush immunotherapy, in vivo and in vitro parameters were examined. Bronchial provocation tests performed in a standardized manner demonstrated that a provocative dose causing a 20% fall in FEV1, a 25% fall in maximum mild expiratory flow rate, a 25% fall in maximum flow when 50% of the forced vital capacity has been expired, and a 35% fall in specific airway conductance were significantly (p less than 0.005 to p less than 0.01, Wilcoxon W test) improved in the treated group and remained unchanged in the placebo group. Skin test titration demonstrated that patients placed in the treated group had a significant (p less than 0.001, Wilcoxon W test) decrease of both end point titer and size of the largest wheal. No significant difference was observed in the placebo group. Serum Dp-IgE did not vary significantly in either group. Serum Dp antigen P1-IgG was significantly (p less than 0.001, Wilcoxon W test) increased in the treated group and slightly increased in the placebo-treated group. This study demonstrated that a Dp standardized extract administered by a rush protocol elicits a rapid and significant immune response and leads to a significant protection of the patients.