Effectiveness of Sublingual Immunotherapy in the Treatment of HDM-Induced Nasobronchial Allergies: A 3-Year Randomized Case-Control Study From Kashmir.

Shahid M Baba,Ayaz Gull,Afaq H Beigh,Qurteeba Qadri,Taha A Qureshi,Zafar A Shah,Roohi Rasool

doi:10.3389/fimmu.2021.723814

Shahid M Baba, Ayaz Gull + Show 5 more

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https://doi.org/10.3389/fimmu.2021.723814

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Abstract

Allergen immunotherapy (AIT) is the only disease-modifying treatment for allergic disorders that induces immunological tolerance through administration of specific allergens. Studies on AIT for subcutaneous route are in abundance; however, the efficacy of AIT in tablet form through sublingual route has not been well elucidated. The present prospective, parallel-group, controlled study sought to compare the efficacy of sublingual immunotherapy (SLIT) tablets with pharmacotherapy (PT) in 332 house dust mite (HDM)-specific allergic asthma and/or rhinitis patients over a period of 3 years. Patients were followed up for a 6-month run-in period and then randomly stratified as those who would receive SLIT, SLIT in addition to PT (SLIT+PT), and PT alone. AIT was administered in the form of sublingual tablets. Symptom and medication scores were measured every 3 months. In vitro evaluation of serum total and HDM specific immunoglobulin E (HDM sIgE) levels was carried out every 3 months, whereas in vivo skin prick test was performed annually for 3 years. Our study demonstrated sustained clinical improvement, reduction in inhaled corticosteroid (ICS) dose and duration as well as prevention from development of neosensitization to other aero allergens in HDM-allergic asthmatics and/or rhinitis patients treated with 3 years SLIT. Despite a remarkable clinical improvement with AIT, we observed that SLIT did not significantly change the skin reactivity to HDM at 3 years and there was no significant change in the ratio of serum total and HDM sIgE. Given the immune and disease modifying effects of AIT in allergic diseases, the present study supports the notion of its sublingual mode being an effective long-term immunomodulator in HDM-sensitized nasobronchial allergies.

Highlights

Respiratory allergies, the prevalence of which has increased over the past 3 decades, affect a large part of the general population and have emerged as a global health problem [1, 2]
Previous studies have shown that house dust mites (HDMs) Dermatophagoides pteronyssinus (Dp) and Dermatophagoides farinae (Df) are the most common inhalant allergens worldwide that coexist in most geographical regions [3, 4]
The present study enrolled 332 cases comprised of 168 allergic rhinitis and 164 allergic asthma patients who were stratified into three treatment groups

Summary

Introduction

Respiratory allergies, the prevalence of which has increased over the past 3 decades, affect a large part of the general population and have emerged as a global health problem [1, 2]. 85% of patients with respiratory allergies are typically HDM-allergic and if left untreated, can lead to an increased risk of asthma [3, 4]. While rescue treatment with antihistamines, nasal/inhaled corticosteroids (ICSs) and b2-agonists can control symptoms in majority of the patients, it does not modify the natural course of the disease and the underlying dysregulated immune response continues to be at work. Allergen-specific immunotherapy (AIT) is the only etiologybased treatment modality capable of modifying disease manifestations due to its immunomodulatory effects and forms the cornerstone in the management of respiratory allergies [7,8,9]. AIT reduces the risk of new allergic sensitization and early treatment with specific immunotherapy can even prevent it from evolving into asthma [10, 11]. In the initial period of treatment, PT does assume its importance and needs to be given in unison with AIT, albeit to be subsequently replaced by AIT alone in a vast majority of the patients

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