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Background: Efficacy of sublingual immunotherapies (SLIT) is mostly demonstrated during or immediately after the therapy, but little is reported about long-term efficacy. Patients and Methods: 121 phone interviews were performed to analyze the state of patients after SLIT. All patients were children who were treated in two centers in Germany. Questionnaires were developed and standardized with respect to statistical and social rules. 19 questions were designed to elucidate the subjective estimation of allergic symptoms (conjunctivitis, rhinitis, asthma, atopic dermatitis), duration of therapy (> 2 years), duration of preexisting allergy, type of allergen, symptomatical medication, age, gender and others before starting SLIT, immediately after SLIT and 1 to 6 years after having finished the therapy. All interviews were conducted with the patients’ mothers. Due to ethical considerations, for this period of up to 9 years after initiation of treatment, formation of a placebo control group was impossible. Results: In summary, the general state of health improved significantly in 93% of all patients during therapy. This was similar for all single symptoms. During the period after therapy, 84% of patients did not feel any worsening of their state and 15% reported a very slight return of symptoms. At the same time, no patient felt worse than before initiating SLIT, and 8% felt similar to the state before. Results were equal 1, 3 and 5 years after termination of SLIT. Conclusion: In comparison to the expectable allergic march, which implicates a high risk of intensifying symptoms in untreated patients, SLIT treated patients improved and demonstrated a long-lasting clinical effect (5 years) of the therapy. Rates of improvements are higher than spontaneous remissions (age dependently, 5 – 25%) as reported in previous studies.

Several allergen-specific plasma proteins, such as IgE and IgG subclasses, are commonly used for the evaluation of grade of allergy. In the present investigation, we compared the concentration of various nonspecific plasma proteins, mostly known as inflammation markers, in an allergic and a healthy population. Plasma from 130 children with single inhalation allergies to grass pollen, birch pollen, or house dust mites as well as from 42 healthy children was obtained during the symptom-free period. Patients showed symptoms including allergic rhinitis, dermatitis, and asthma with one single radioallergosorbent test (RAST) class 3 or higher. Plasma concentrations of soluble intercellular adhesion molecule-1(sICAM-1), soluble interleukin-2 receptor(sIL-2R), sE-selectin, and soluble vascular cell adhesion molecule-1 (1sVCAM-1) were analyzed by enzyme linked immunosorbent assay (ELISA) technique. Concentrations of sICAM-1 and sE-selectin were significantly increased in all patients compared to controls. In the single allergen groups, sICAM-1 elevation was significant in the grass and mite groups, but not in the birch group; while sE-selection increase was significant in the birch and mite groups, but not in the grass group. The elevation of sIL-2R in the allergic patients was obvious in each single allergen group, but not significant. No difference was observed in sVCAM-1 expression. In two groups of patients with mean age of 9.5 years versus 17.5 years, the analyzed parameters were not age dependent. The increased proteins may be useful as additional markers for efficacy and follow-up investigations of allergy therapies.

The interaction of the CD154 molecule (CD40 ligand, gp39) on activated T-cells with the CD40 antigen on B-cells seems to play a key role in immunoglobulin class switching. We aimed to compare the capacity of intracellular CD154 expression after nonspecific stimulation with phorbol-12-myristate-13-acetate and ionomycin on separated T-cells from allergic patients and healthy donors. We analyzed blood from 104 patients allergic to grass pollen, house dust mites or birch pollen, and from 44 healthy donors. Lymphocytes were isolated using a density gradient and B-cells were extracted by magnet-activated cell separation (MACS) using anti-CD19 microbeads. Cells were nonspecifically stimulated for 5 h, permeabilized and stained with anti-CD154 for fluorescence-activated cell sorter analysis. It was found that stimulation induced a 1.4% increase of intracellular CD154+ T-cells; a 4.6% increase of mean channel fluorescence of all T-cells from healthy donors; a 6.1% increase in intracellular CD154+ T-cells; and a 28.1% increase of mean channel fluorescence of all T-cells from allergic patients. The data demonstrated an elevated capability of B-cell independent CD154 synthesis in T-cells from allergic patients when compared to healthy individuals. It is possible that the enhanced IgE production of B-cells from allergic patients might be partly due to the phenomena described.