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

• Published in: Journal of allergy and clinical immunology Vol. 122; no. 5; pp. 1001 - 1007.e4
• Main Authors: Müller, Ulrich R., MD, Jutel, Marek, MD, Reimers, Andrea, MD, Zumkehr, Judith, Sci Tec, Huber, Clarissa, MD, Kriegel, Carola, MD, Steiner, Urs, MD, Haeberli, Gabrielle, MD, Akdis, Mübeccel, MD, PhD, Helbling, Arthur, MD, Schnyder, Benno, MD, Blaser, Kurt, PhD, Akdis, Cezmi, MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.11.2008; Elsevier Limited
• Subjects: Adolescent; Adult; Allergies; Allergy and Immunology; antihistamine preventive medication; Apis mellifera; Bee Venoms - adverse effects; Bee Venoms - immunology; Bees; Blood pressure; Cetirizine - immunology; Cetirizine - therapeutic use; Cytokines; Desensitization, Immunologic - adverse effects; Double-Blind Method; Female; Histamine H1 Antagonists - immunology; Histamine H1 Antagonists - therapeutic use; histamine receptors; Humans; Hypersensitivity - etiology; Hypersensitivity - immunology; Hypersensitivity - prevention & control; Intensive care; Lymphocytes; Male; Middle Aged; Prospective Studies; T cells; Venom; Venom immunotherapy; Young Adult; BVIT; TT; Venom immunotherapy; PLA; SAR; antihistamine preventive medication; HR; T cells; Skin test end point concentration; Systemic allergic reaction; STEPC; SE; BV; Honeybee venom immunotherapy; Phospholipase A 2, a major allergen of honeybee venom; LC; Tetanus toxoid; cytokines; Honeybee venom; Histamine receptor; histamine receptors; Levocetirizine; Side effect
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2008.08.007

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.