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KMID : 0369319940140020215
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Allergy
1994 Volume.14 No. 2 p.215 ~ p.228
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Bronchial Provocation Test is the Most Optimal Termination-Index of Immunotherapy in Extrinsic Bronchial Asthmatics
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Abstract
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Though immunotherapy(IT) is effective treatment modality to extrinsic bronchial asthma and allergic rhinitis, termination and termination index of IT is not clarified yet.
We speculate that if bronchial hyperresponsiveness(BHR) which is the fundamental characteristic pathophysiology of BA disappears with effective IT, termination of IT could be done and objective parameter to measure BHR such as bronchial
provocation
test(BPT) can be the most optimal index of terminating IT.
In this study we measured non-specific and allergen-specific bronchial hyperresponsiveness (NSBHR, SBHR) by BPT with methacholine and house dust mite(HDM), Dermatophagoides farinae(MBPT, HDM-BPT) in 17 house dust mite sensitive asthmatics having
been
placed on IT with aquous extract of house dust and D.f., for more than 3 yrs and experienced symptom-free for more than 1yr, and measured simultaneously symptom score, skin reactivity by prick test, serum specific IgE by RAST.
@ES The results were as follows:
@EN 1) All 17 patients´ symptom score converted negative.
2) Skin reactivity to D.f. decreased significantly(P=0.036), but that of D.p. not significantly(P=015).
3) RAST score of D.p. and D.f. didn´t change significantly.
4) Nine patients´ PC20-Meth. were more than 25mg/ml, 5 patients more than 10mg/ml (12.5-25mg/ml), the rest 3 were less than 5mg/ml(1.5-4.7), so 9 patients´(53%) NSBHR completely disappeared.
5) Six patients were non-responder, another 6 early asthmatic responder, the other 5 were dual asthmatic responder to HDM-BPT, so totally 12 patient(70.6%) lost last asthmatic reaction(LAR).
6) Among 14 patients whose PC20-Meth. were more than 10mg/ml, 12 patients(85.7%) lost late asthmatic response existed between disappearance of LAR and PC20-Meth. more than 10mg/ml(P-0.029).
7) There was no significant correlation between duration of IT and skin reactivity, RAST score disappearance of NSBHR and SBHR respectively in this study subjects having placed on IT more than 3 yrs(P=0.76, 0.90, 0.56, 0.87).
Taken together, We concluded that MBPT and ABPT, both BPTs were the most optimal parameter to decide termination of IT, and suggested it´s desirable to termiante IT that the one who lost LAR and whose PC20-Meth, is more than 10mg/ml., which is
the
non
clinical asthmatic range, among patients who have been treated with IT more than 3yrs and have experienced no asthmatic symptoms for long periods. But further follow-up study shall be needed to watch out recurrence of asthma among them.
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