Study: Allergen Immunotherapy in a 45-year-old Caucasian Male with a 20-year History of HIV with Severe Allergic Rhinitis

Allergen Immunotherapy in a 45-year-old Caucasian male with a 20-year history of HIV with severe allergic rhinitis: monitoring of HIV Viral load and T Cells during Immunotherapy. John Wheeler, MD ,Vanessa Van Stee, M.D., Jonathan Bayuk, D.O. FAAAAI. Baystate Medical Center/Tufts University School of Medicine, Springfield, MA

Background: Allergic Rhinitis can be a severe, limiting condition in as many as 25% of the US population. HIV infection has become a chronic managed disease for many people in the United States. Many people with HIV infection also have allergic rhinitis that does not respond to avoidance of allergens or pharmaceutical intervention. Allergen immunotherapy (IT) may be of great benefit to these patients, but as T-cell modification is known to occur during IT, the risk of HIV disease progression exists monitoring of HIV viral load and CD4 count occur during IT. We present one case of an HIV-infected male on HAART during the first year of IT.

Objective: To report the clinical and serologic results of a 45-year-old man with severe allergic rhinitis and recurrent sinus infections (3-6 a year) in a 20-year history of HIV as he begins and continues on immunotherapy.

Methods: As the patient had failed allergen avoidance measures and pharmacologic interventions, allergen immunotherapy (IT) was recommended. The risks and benefits were explained and after informed consent was obtained, IT was begun. Prior to the initiation of immunotherapy to alternaria, dust mite, dog and eastern tree mix, HIV viral load and B and T cells were measured.

Results: Prior to the initiation of immunotherapy, the patients HIV viral load was undetectable, his CD3+, specific CD3+CD4+ and CD3+CD8+ cells were normal. His immunoglobulins were also measured and were normal. His HIV viral load remained undetectable for the first year. In addition his CD3+, specific CD3+CD4+ and CD3+CD8+ cells remained normal and not significantly changed at 0, 6 and 12 months of IT. His symptoms completely resolved with IT alone after 2 months. The patient suffered one sinus infection during the first year of IT and no other infections.

Discussion: Allergen immunotherapy in the setting of prolonged HIV infection treated with HAART has not been well studied. Due the T cell modification that occurs during IT, the effects on viral load and subsequent CD4+  T cell count is not known. In a previous case report, HIV viral load initially increased but then normalized after the initiation of IT. Our case illustrates no change in HIV status and excellent clinical results using allergen immunotherapy on one patient with prolonged HIV infection.