Immunotherapy with standardized extract of Dermatophagoides pteronyssinus in bronchial asthma: a dose‐titration study

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Abstract
According to the maximum tolerated dose (MTD) achieved, we assessed the changes in clinical and laboratory parameters, induced by specific immunotherapy (SIT), in a group of 43 asthmatic patients sensitized to Dermatophagoides pteronyssinus, over a period of 18 months. A standardized extract (100 Bu/ml; 40 μg/ml of Der p 1; 20 μg/ml of Der p 2) was used. The patients were divided into two groups: the high‐dose immunotherapy (HDI) group (MTD ≥ 4 μg Der p 1) and the conventional immunotherapy (CI) group (MTD D. pteronyssinus (Der p 1 and Der p 2) were measured (ELISA monoclonal antibodies). Safety was monitored according to the EAACI guidelines. The range of the MTD was 0.8‐16 μg of Der p 1. Ninety percent of the patients tolerated a dose of 3.2 μg, but only 18% of the patients reached a maintenance dose of 16 μg. The medians of the accumulated dose were 197 μg of Der p 1 for the HDI group, and 50 μg for the CI group. Conjunctival and cutaneous reactivity was significantly lowered (PPPP<0.01). These results show that a maintenance dose of 3.2 μg Der p 1 (8 BU) can induce pronounced clinical and immunologic changes with an excellent safety profile.