Skip to main content Skip to main navigation menu Skip to site footer

The build-up phase outcome of subcutaneous immunotherapy for pediatric allergic asthma: A retrospective cohort study from Surabaya, Indonesia

  • Anang Endaryanto ,


Background: Subcutaneous immunotherapy (SCIT) is an established recommended treatment for allergic asthma. SCIT provides symptomatic relief, and it is potentially curative. Its build-up phase represents vital information to improve patient compliance and treatment outcomes.

Aim: This study aims to assess the build-up phase outcomes of subcutaneous immunotherapy (SCIT) for pediatric allergic asthma.

Methods: The retrospective cohort study comprised 65 children with allergic asthma due to house dust mites at the end of initial build-up phase of SCIT (3 months) from 2009 until 2012 at one hospital in Surabaya, Indonesia. Pre-SCIT clinical evaluation included skin prick tests for Der p 1 and Der f 1, eosinophil counts test, and the reversibility of forced expiratory volume in a second. The serum level of IFN-γ (TH1), IL-4 (TH2), TGF-β (Tregs), and IL-17 (TH17) were measured via enzyme-linked immunosorbent assays (ELISA) at the end of the initial build-up phase of SCIT.

Results: Of the 65 samples, 48 (73.8%) exhibited significant improvement after three months, including 37 (56.9%) partially controlled asthma as against 11 (16.9%) controlled one, respectively. Eosinophil counts, IL-4, and IL-17 levels were higher among subjects who did not have an improvement, whereas they showed lower IFN-γ levels and smaller wheal diameters for either Der p 1 or Der f 1. Total IgE and TGF-β levels were not significantly different according to the asthma refinement.

Conclusion: At the end of the build-up phase, SCIT facilitated improvement in most subjects with allergic asthma, and the outcome was associated with eosinophil counts, wheal diameters for Der p 1 and Der f 1, as well as IFN-γ, IL-4, and IL-17 levels.


  1. Moustaki M, Loukou I, Tsabouri S, Douros K. The Role of Sensitization to Allergen in Asthma Prediction and Prevention. Front Pediatr. 2017;5:166. Published 2017 Jul 31. doi:10.3389/fped.2017.00166
  2. Johan El Hakim Siregar, Lily Irsa, Supriatmo, Sjabaroeddin Loebis, Rita Evalina. Association between bronchial asthma in atopic children and their number of siblings. Paediatrica Indonesiana. 2014; 54(5): 289-93
  3. Elliott J, Kelly SE, Johnston A, Skidmore B, Gomes T, Wells GA. Allergen immunotherapy for the treatment of allergic rhinitis and/or asthma: an umbrella review. CMAJ Open. 2017;5(2): 373-385.
  4. EAACI Guidelines. Muraro A, Roberts G, editors. Allergen Immunotherapy Guidelines Part 2: Recommendations; 2017: 1-168. ISBN Number: 978-3-9524815-1-6.
  5. Jutel M, Agache I, Bonini S, Burks AW, Calderon M, Canonica W, Cox L, Demoly P, Frew AJ, et al. International Consensus On (ICON) Allergy Immunotherapy (AIT). J Allergy Clin Immunol. 2015 Sep;136(3):556-68
  6. Purkey T, Smith L M, Ferguson T, Luong B, Reisacher A, Pillsbury WC, Toskala H, Elina. Subcutaneous immunotherapy for allergic rhinitis: An evidence based review of the recent literature with recommendations [Abstract]. International forum of allergy & rhinology. 2013; 3. 10.1002/alr.21141.
  7. Endaryanto, A & Irmawati, M. Enhanced Efficacy of Sublingual Immunotherapy in Childhood Allergic Asthma by Probiotics. Folia Medica Indonesiana 2018; 54 (64). 10.20473/fmi.v54i1.8055.
  8. Jutel M. Allergen-Specific Immunotherapy in Asthma. Curr Treat Options Allergy. 2014;1(2):213-219. Published 2014 Mar 12. DOI:10.1007/s40521-014-0013-1
  9. Incorvaia C, Riario-Sforza GG, Incorvaia S, Frati F. Sublingual immunotherapy in allergic asthma: Current evidence and needs to meet. Ann Thorac Med. 2010;5(3):128-32. [Accessed on March 2019]
  10. Harsono, A. Specific immunotherapy for allergic diseases. Paediatrica Indonesiana 2005; 45 (7-8): 137-44.
  11. Martin H, Taube C. Regulatory T cells and regulation of allergic airway disease. Am J Clin Exp Immunol. 2012;1(2):166-78. Published 2012 Nov 15.
  12. Hankin CS, Cox L, Bronstone A, Wang Z. Allergy immunotherapy: reduced health care costs in adults and children with allergic rhinitis [Abstract]. J Allergy Clin Immunol. 2013 Apr;131(4):1084-91. DOI: 10.1016/j.jaci.2012.12.662.
  13. Penagos M, Eifan AO, Durham SR, Scadding GW. Duration of Allergen Immunotherapy for Long-Term Efficacy in Allergic Rhinoconjunctivitis. Curr Treat Options Allergy. 2018;5(3):275-290.
  14. Akdis CA, Akdis M. Mechanisms of allergen-specific immunotherapy and immune tolerance to allergens. World Allergy Organ J. 2015;8(1):17. Published 2015 May 14. doi:10.1186/s40413-015-0063-2
  15. Rolnick SJ, Pawloski PA, Hedblom BD, Asche SE, Bruzek RJ. Patient characteristics associated with medication adherence. Clin Med Res. 2013;11(2):54-65.
  16. Musa F, Al-Ahmad M, Arifhodzic N, Al-Herz W. Compliance with allergen immunotherapy and factors affecting compliance among patients with respiratory allergies. Hum Vaccin Immunother. 2016;13(3):514-517.
  17. Tsabouri S, Mavroudi A, Feketea G, Guibas GV. Subcutaneous and Sublingual Immunotherapy in Allergic Asthma in Children. Front Pediatr. 2017;5:82. Published 2017 Apr 21. DOI:10.3389/fped.2017.00082
  18. Gelincik A, Demir S, Olgaç M, İşsever H, Khishigsuren B, Özşeker F, Çolakoğlu B, Büyüköztürk S. High adherence to subcutaneous immunotherapy in a real-life study from a large tertiary medical center. Allergy Asthma Proc. 2017 Nov 1;38(6):78-84. DOI: 10.2500/aap.2017.38.4091.
  19. Pajno GB, Bernardini R, Peroni D, et al. Clinical practice recommendations for allergen-specific immunotherapy in children: the Italian consensus report. Ital J Pediatr. 2017;43(1):13. Published 2017 Jan 23. DOI:10.1186/s13052-016-0315-y
  20. Tsabouri, Mavroudi S, Feketea A, Guibas G. Subcutaneous and Sublingual Immunotherapy in Allergic Asthma in Children. Frontiers in Pediatrics 2017; 5. 10.3389/fped.2017.00082.
  21. National Asthma Education and Prevention Program, Third Expert Panel on the Diagnosis and Management of Asthma. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Bethesda (MD): National Heart, Lung, and Blood Institute (US); 2007 Aug. Section 4, Managing Asthma Long Term: Overview. Available from:
  22. Scichilone N, Contino A, Figlioli GB, Paglino G, Bellia V. Patient perspectives in the management of asthma: improving patient outcomes through critical selection of treatment options. Patient Prefer Adherence. 2010;4:17-23. Published 2010 Feb 4.
  23. Braido F. Failure in asthma control: reasons and consequences. Scientifica (Cairo). 2013;2013:549252.
  24. GINA. Difficult-to-Treat & Severe Asthma in Adolescent and Adult Patients. Diagnosis and Management. A GINA Pocket Guide for Health Professionals. Global Initiative for Asthma; 2018.
  25. Yukselen A. Allergen-specific immunotherapy in pediatric allergic asthma. Asia Pac Allergy. 2016;6(3):139-48.
  26. Maggie Pik-Kee Lit. Occupational Asthma [Newsletter]. Hongkong Institute of Allergy. May 2017: 29-30.
  27. Cheng L, Chen J, Fu Q, He S, Li H, Liu Z, Tan G, et al. Chinese Society of Allergy Guidelines for Diagnosis and Treatment of Allergic Rhinitis. Allergy Asthma Immunol Res. 2018 Jul; 10 (4): 300-353. DOI: org/10.4168/aair.2018.10.4.300
  28. Lee JH, Kim S-C, Choi H, Jung C-G, Ban G-Y, Shin YS, et al. Subcutaneous Immunotherapy for Allergic Asthma in a Single Center of Korea: Efficacy, Safety, and Clinical Response Predictors. J Korean Med Sci 2017; 32: 1124-1130. DOI: org/10.3346/jkms.2017.32.7.1124
  29. Taketomi E.A., Silva, D.A.O., Sopelete, M.C., Gervásio, A.M., Alves, R., Sung, S.J. Differential IgE reactivity to Der p 1 and Der p 2 allergens of Dermatophagoides pteronyssinus in mite-sensitized patients. J Investig Allergol Clin Immunol 2006; Vol. 16(2): 104-109
  30. Lee JH, Kim SC, Choi H, Jung CG, Ban GY, Shin YS, Nahm DH, Park HS, Ye YM. A Retrospective Study of Clinical Response Predictors in Subcutaneous Allergen Immunotherapy with House Dust Mites for Allergic Rhinitis. Allergy Asthma Immunol Res. 2018; 10 (1): 18-24. DOI: ORG/10.4168/AAIR.2018.10.1.18
  31. Majori, M, Caminati A, Coradi M, Brianti E, Scarpa S, Pesci A. T-cell cytokine pattern at three time points during specific immunotherapy for mite-sensitive asthma [Abstract]. Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology 2000; 30(3):341-347.
  32. Durham SR, Kay AB, Hamid Q. Changes in Allergic Inflammation Associated with Successful Immunotherapy [Abstract]. Int Arch Allergy Immunol 1995; 107: 282-284. DOI: 10.1159/000237003
  33. Plewako H., Holmberg, K., Oancea, I., Gotlib, T., SamoliÅ„ski, B., Rak, S. A followâ€up study of immunotherapyâ€treated birchâ€allergic patients: effect on the expression of chemokines in the nasal mucosa [Abstract]. Clinical and Experimental Allergy 2008; 38(7): 1124-31. DOI: org/10.1111/j.1365-2222.2008.03005.x
  34. Meiler, F, et al. In vivo switch to IL-10–secreting T regulatory cells in high dose allergen exposure. Journal of Experimental Medicine 205.12 (2008): 2887-2898.
  35. Francis M and Sharon M. Wahl. Dysregulation of IFN-γ Signaling Pathways in the Absence of TGF-β1. J Immunol 2002; 169 (10): 5941-7. DOI:
  36. Martín-Muñoz, M.F., Pineda, F., Muiños, T., Fontan, M., Nevot, S., Bosque, M., Palomo, J.J., Torredemer, A., et al. Changes in IL-10 and specific antibodies associated to successful Dermatophagoides pteronyssinus immunotherapy in children during the first year of treatment [Abstract]. Allergologia et Immunopathologia 2013; 41 (Issue 1): 4-10. DOI: ORG/10.1016/J.ALLER.2011.12.005
  37. Shamji, M. H., Kappen, J. H., Akdis, M., Jensenâ€Jarolim, E., Knol, E. F., Kleineâ€Tebbe, J., Bohle, B., Chaker, A. M., et al. Biomarkers for monitoring clinical efficacy of allergen immunotherapy for allergic rhinoconjunctivitis and allergic asthma: an EAACI Position Paper, Allergy, 2017; 72 (8): 1156-1173.
  38. Fujita H, Soyka MB, Akdis M, Akdis CA. Mechanisms of allergen-specific immunotherapy. Clin Transl Allergy. 2012; 2(1): 2. DOI:10.1186/2045-7022-2-2
  39. Vitaliti G, Pavone P, Guglielmo F, Spataro G, Falsaperla R. The immunomodulatory effect of probiotics beyond atopy: an update [Abstract]. J Asthma. 2014 Apr; 51(3): 320-32. DOI: 10.3109/02770903.2013.862259.
  40. Tosca MA, Licari A, Olcese R, Marseglia G, Sacco O, Ciprandi G. Immunotherapy and Asthma in Children. Front Pediatr. 2018; 6: 231. DOI:10.3389/fped.2018.00231

How to Cite

Endaryanto, A. (2019). The build-up phase outcome of subcutaneous immunotherapy for pediatric allergic asthma: A retrospective cohort study from Surabaya, Indonesia. Bali Medical Journal, 8(1), 341–346.




Search Panel

Anang Endaryanto
Google Scholar
BMJ Journal