Effects of BCG Vaccination Prior to Specific Immunotherapy on IL-4/IFN-γ Ratio and AR Total Symptom Score in Persistent Allergic Rhinitis (Efek vaksinasi BCG pre imunoterapi spesifik terhadap rasio IL-4/IFN-γ dan skor gejala total rinitis pada rinitis alergi persisten)

Abstract

Background: Allergic disease including allergic rhinitis (AR) is dominated by Th2 responses with increased production of IL-4 and inhibition of IFN- production. BCG vaccination induced IL-12 production which promotes Th0 to Th1 shift and stimulates IFN- production. The aim of this study is to determine whether BCG vaccination prior specific immunotherapy (SIT) could increase initial phase of SIT responses measured by decreasing IL-4/IFN- ratio’s and AR total symptom score (TSS). Method: This study was carried out by a randomized controlled trial. A total of 84 patients with moderate to severe persistent AR were randomized and assigned into 4 treatment groups (BCG solvent, BCG vaccination, SIT, and BCG vaccination prior SIT). A subcutaneous SIT was given using mixed house dust mite extract (D pteronyssinus and D farinae, 50/50), while BCG vaccination was given by intracutaneous injection. Clinical symptoms and concentrations of IL-4 and IFN-γ were measured by PHA stimulated fresh whole blood culture, before and after 8 weeks of SIT. Result: There were no significance difference between the concentrations of IL-4 and IFN-γ, and their ratio in all four groups. However, there is a significant lower IL-4/IFN- ratio in the group with pretreatment of BCG than SIT (p=0.024), while during the initial phase, AR symptoms in patients who received BCG prior SIT is significantly lower than SIT (p=0.027). Conclusion: This study demonstrates that BCG vaccination prior to SIT treatment could increase initial phase of SIT responses in persistent allergic rhinitis without additional adverse effects.