The Journal of Allergy and Clinical Immunology
Volume 122, Issue 5 , Pages 1001-1007.e4, November 2008

Clinical and immunologic effects of H1 antihistamine preventive medication during honeybee venom immunotherapy

  • Ulrich R. Müller, MD

      Affiliations

    • Medizinische Klinik, Spital Ziegler, Bern, Switzerland
    • Corresponding Author InformationReprint requests: Ulrich R. Müller, MD, Department of Medicine, Spital Ziegler, Morillonstrasse 75-91 Bern, Switzerland.
    • ,
  • Marek Jutel, MD

      Affiliations

    • Swiss Institute for Allergic and Asthma Research (SIAF), Davos, Switzerland
    • Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
    • ,
  • Andrea Reimers, MD

      Affiliations

    • Medizinische Klinik, Spital Ziegler, Bern, Switzerland
    • ,
  • Judith Zumkehr, Sci Tec

      Affiliations

    • Swiss Institute for Allergic and Asthma Research (SIAF), Davos, Switzerland
    • ,
  • Clarissa Huber, MD

      Affiliations

    • Medizinische Klinik, Spital Ziegler, Bern, Switzerland
    • ,
  • Carola Kriegel, MD

      Affiliations

    • Medizinische Klinik, Spital Ziegler, Bern, Switzerland
    • ,
  • Urs Steiner, MD

      Affiliations

    • Medizinische Klinik, Spital Ziegler, Bern, Switzerland
    • ,
  • Gabrielle Haeberli, MD

      Affiliations

    • Medizinische Klinik, Spital Ziegler, Bern, Switzerland
    • ,
  • Mübeccel Akdis, MD, PhD

      Affiliations

    • Swiss Institute for Allergic and Asthma Research (SIAF), Davos, Switzerland
    • ,
  • Arthur Helbling, MD

      Affiliations

    • Medizinische Klinik, Spital Ziegler, Bern, Switzerland
    • ,
  • Benno Schnyder, MD

      Affiliations

    • Division of Allergology, Clinic of Rheumatology and Clinical Immunology/Allergology, University of Bern, Bern, Switzerland
    • ,
  • Kurt Blaser, PhD

      Affiliations

    • Swiss Institute for Allergic and Asthma Research (SIAF), Davos, Switzerland
    • ,
  • Cezmi Akdis, MD

      Affiliations

    • Swiss Institute for Allergic and Asthma Research (SIAF), Davos, Switzerland

Received 28 April 2008; received in revised form 9 July 2008; accepted 11 August 2008. published online 10 October 2008.

Background

H1 antihistamines increase safety during allergen-specific immunotherapy and might influence the outcome because of immunoregulatory effects.

Objective

We sought to analyze the influence of 5 mg of levocetirizine (LC) on the safety, efficacy, and immunologic effects of ultrarush honeybee venom immunotherapy (BVIT).

Method

In a double-blind, placebo-controlled study 54 patients with honeybee venom allergy received LC or placebo from 2 days before BVIT to day 21. Side effects during dose increase and systemic allergic reactions (SARs) to a sting challenge after 120 days were analyzed. Allergen-specific immune response was investigated in skin, serum, and allergen-stimulated T-cell cultures.

Results

Side effects were significantly more frequent in patients receiving placebo. Four patients receiving placebo dropped out because of side effects. SARs to the sting challenge occurred in 8 patients (6 in the LC group and 2 in the placebo group). Seven SARs were only cutaneous, and 1 in the placebo group was also respiratory. Difference of SARs caused by the sting challenge was insignificant. Specific IgG levels increased significantly in both groups. Major allergen phospholipase A2-stimulated T cells from both groups showed a slightly decreased proliferation. The decrease in IFN-γ and IL-13 levels with placebo was not prominent with LC, whereas IL-10 levels showed a significant increase in the LC group only. Decreased histamine receptor (HR)1/HR2 ratio in allergen-specific T cells on day 21 in the placebo group was prevented by LC.

Conclusions

LC reduces side effects during dose increase without influencing the efficacy of BVIT. LC modulates the natural course of allergen-specific immune response and affects the expression of HRs and cytokine production by allergen-specific T cells.

Key words: Venom immunotherapy, antihistamine preventive medication, T cells, cytokines, histamine receptors

Abbreviations used: BV, Honeybee venom, BVIT, Honeybee venom immunotherapy, HR, Histamine receptor, LC, Levocetirizine, PLA, Phospholipase A2, a major allergen of honeybee venom, SAR, Systemic allergic reaction, SE, Side effect, STEPC, Skin test end point concentration, TT, Tetanus toxoid

 

 Supported by Swiss National Science Foundation grant nos. 32.118226 and 32-112306, the Global Allergy and Asthma European Network (GA2LEN), and UCB Pharma AG.

 Disclosure of potential conflict of interest: U. R. Müller has received a research grant from UCB. M. Jutel has served as a clinical investigator for Schering-Plough and AllergoPharma Joachim Ganzer and as an investigator for AllergoPharma Joachim Ganzer. M. Akdis has had research collaboration with Allergopharma, Stallergenes, ALK-Abelló, SARM, and UCB Pharma and has served as Section Board Member for the European Academy of Allergology and Clinical Immunology. C. Akdis has had research collaboration with Allergopharma, Stallergenes, ALK-Abelló, SARM, and UCB Pharma and has served as the Vice President of the European Academy of Allergology and Clinical Immunology and as a committee member for the Global Allergy and Asthma European Network. The rest of the authors have declared that they have no conflict of interest.

PII: S0091-6749(08)01497-8

doi:10.1016/j.jaci.2008.08.007

The Journal of Allergy and Clinical Immunology
Volume 122, Issue 5 , Pages 1001-1007.e4, November 2008

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