Randomized, Double-Blind, Placebo-Controlled Trial of Vitamin D Supplementation in the Build-up Phase of House Dust Mite-Specific Immunotherapy

Chirawat Chiewchalermsri; Sasipa Sangkanjanavanich; Panitan Pradubpongsa; Wat Mitthamsiri; Nattapon Jaisupa; Sarawut Jindarat; Supranee Buranapraditkun; Alain Jacquet; Atik Sangasapaviliya; Tadech Boonpiyathad

doi:10.4168/aair.2023.15.3.336

Randomized, Double-Blind, Placebo-Controlled Trial of Vitamin D Supplementation in the Build-up Phase of House Dust Mite-Specific Immunotherapy

Allergy Asthma Immunol Res. 2023 May;15(3):336-347. doi: 10.4168/aair.2023.15.3.336. Epub 2023 Jan 2.

Authors

Affiliations

¹ Division of Allergy and Clinical Immunology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand.
² Department of Medicine, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand.
³ Division of Allergy, Immunology and Rheumatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
⁴ Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok, Thailand.
⁵ Center of Excellence in Vaccine Research and Development (Chula Vaccine Research Center, Chula VRC), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁶ Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
⁷ Division of Allergy and Clinical Immunology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand. tadechb@pmk.ac.th.

Abstract

Purpose: Vitamin D (VitD) is an immunomodulatory molecule capable of alleviating allergic symptoms. However, the effectiveness of allergen-specific immunotherapy (AIT) is not commonly evidenced in the early build-up phase. The aim of the study was to determine the potential of VitD supplementation in this treatment phase.

Methods: Thirty-four house dust mite (HDM)-allergic adult patients treated with subcutaneous AIT were randomized to receive VitD2 60,000 IU/week or placebo for 10 weeks and followed up for 10 weeks. The primary endpoints were the symptom-medication score (SMS) and the treatment response rate. The secondary endpoints were eosinophil count and levels of plasma IL-10, Der p 2-specific IgG4, and dysfunctional regulatory T (CRTH2⁺ Treg) cells.

Results: Of 34 patients, 15 in each group completed the study. Patients with VitD deficiency receiving a VitD supplement showed significantly lower mean change SMS than the placebo group in weeks 10 (mean difference -54.54%, P = 0.007) and 20 (mean difference -42.69%, P = 0.04). The percentage of treatment responders reached 78% and 50% in the VitD and placebo groups, respectively, and the effect remained in week 20 (89% and 60%). No significant difference was observed for the tested immunological read-outs, with the exception of the frequency of CRTH2⁺ Treg cells, which was remarkably reduced in the VitD-treated patients. Moreover, improvement in SMS was correlated to the number of CRTH2⁺ Treg cells. Our in vitro experiment indicated that VitD downregulated activation markers, whereas it improved the function of CRTH2⁺ Treg cells.

Conclusions: VitD supplementation in the build-up phase of AIT could relieve symptoms and decrease Treg cell dysfunction, especially in patients with VitD deficiency.

Keywords: Vitamin D; alleric rhinitis; antigens, Dermatophagoides; immunologic desensitization; regulatory T-lymphocytes; treatment outcome.

Abstract

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