Endobronchial provocation test with the Dermatophagoides pteronyssinus antigen and histamine in specific immunotherapy in children with atopic bronchial asthma

Introduction. The diagnosis of atopic bronchial asthma, established on the basis of medical history, skin tests results, and the determination of total and specific IgE concentrations, can be complemented, especially in cases of multifactorial allergy, by an endobronchial provocation test with a specific antigen. This test can also be useful in monitoring specific immunotherapy. Aim of the study. The aim of the study was to assess the usefulness of endobronchial provocation tests with the acarid antigen of Dermatophagoides pteronnyssinus (specific test) and a histamine (non-specific test) in monitoring allergen immunotherapy in children with atopic bronchial asthma. Materials and methods. Twenty four patients of both sexes, aged from 9 to 18, were included in the study. Atopic bronchial asthma was diagnosed on the basis of medical history, skin prick tests results and both total and specific IgE concentrations. The diagnosis was confirmed with an endobronchial provocation test with the Dermatophagoides pteronyssinus antigen, performed according to Rayan with the Siergiejko modification. Ten children were qualified for immunotherapy with the acarid antigens with Novo Helisen Depot vaccine and 14 children with the Phostal vaccine. Provocation tests with histamine and acarid antigen were performed before immunotherapy (as the baseline) and after the one-year treatment. Results. In most patients no significant decrease in bronchial reactivity to specific antigen was demonstrated after 1-year treatment, the differences not achieving statistical significance. In some cases the bronchial reactivity to histamine significantly decreased, as compared with baseline values, but the mean value for the whole study group remained unchanged. Conclusion. Immunotherapy with a specific allergen, of one year's duration, only resulted in decreased specific and non-specific bronchial reactivity in some patients.