Peran Terapi Adjuvan Vitamin D3 Terhadap Kadar T Regulator dan Gejala Klinis Penderita Rinitis Alergi Yang Mendapat Imunoterapi Subkutaneus Initial Build Up Dose

Abstract

Imunoterapi spesifik (ITS) merupakan pilihan terapi pada rinitis alergi yang tidak memberikan respons perbaikan klinis dengan medikamentosa. Peran zat adjuvan diduga dapat meningkatkan efektivitas dan efikasi ITS. Penelitian ini bertujuan menganalisis peran adjuvan vitamin D3 pada ITS terhadap percepatan timbulnya respons imun toleran. Penelitian analitik komparatif numerik dua kelompok tidak berpasangan dengan rancangan uji klinis acak terkontrol ganda ini dilakukan di Klinik Rinologi-Alergi THT-KL RSUP dr. Hasan Sadikin Bandung sejak Mei 2016–April 2017. Sampel terdiri atas 18 pasien menerima ITS+kalsitriol dan 18 pasien menerima ITS+plasebo yang memenuhi kriteria penelitian diambil secara consecutive sampling. Dilakukan pemeriksaan jumlah sel Tregulator dengan flowcitometry pada baseline, minggu ke-8 dan 15 dan skor gejala hidung.  Analisis dengan Uji Mann-Whitney, uji Friedman, uji T berpasangan dan analisis Post hoc. Perbandingan kenaikan rerata median jumlah sel Treg kelompok intervensi dengan kontrol pada minggu ke 8 menunjukkan nilai p=0,04, rerata MFI Treg pada kelompok intervensi dengan kontrol nilai p=0,002. Analisis post hoc terhadap MFI Treg menunjukkan peningkatan pada kelompok intervensi dengan p=0,001 pada minggu ke-8. Disimpulkan perubahan di tingkat imunologi mulai terjadi pada minggu ke-8, tetapi perbaikan gejala klinis terlihat setara.

Kata kunci: Imunoterapi spesifik, rinitis alergi, sel t-toleran perifer, sel T-regulator, vitamin D3

Role of Adjuvant Therapy with Vitamin D3 on T-Regulator in Allergic Rhinitis Patient with Subcutaneus Immunotherapy

Allergen-specific immunotherapy (AIT) is a potentially disease-modifying therapy that is useful for the treatment of allergic rhinitis, especially in those who do not response to pharmacotherapy. Currently, the role of adjuvant is expected to increase the clinical efficacy in AIT.  The aim of this study was to analyze the role of vitamin D3 adjuvant in AIT to induce immune tolerance. This was an unpaired comparative analytic research with a randomized controlled trial dstudy conducted at the Rhinology-Allergy Clinic ORL-HNS of Dr. Hasan Sadikin General Hospital Bandung from May 2016 to April 2017. Eighteen subjects with AIT+ calcitriol treatment and 18 subjects with AIT+placebo treatment who met the study criteria were selected through consecutive sampling. All subjects were evaluated for Treg cells using flow citometry at baseline, week 8, and week 15. Nasal symptom score was also evaluated.  Statistical analysis performed in this study included Mann-Whitney test, Friedman test, T-Paired test,and Post hoc analysis. There was a significant different of Treg cells average results between the intervention group and control at week 8 with a p-value of 0.04. The mean delta value on MFI Treg reflected significant differences within intervention group (p=0.002). Post hoc analysis results presented a significant increase in MFI Treg in the intervention group at week 8 (p=0,001). Therefore, immunological changes start in week eight but the improvement of clinical symptoms looks similar.

Key words: Allergic rhinitis, peripheral t-cell tolerance, regulatory t(treg) cell allergen specific immunotherapy, vitamin D3