Efficacy and safety of subcutaneous and sublingual immunotherapy in birch pollinosis

Abstract

Rationale To compare the efficacy and safety of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) we evaluated the two treatments in patients with rhinitis and asthma from birch pollen. Methods Forty-seven patients, 25 males and 22 females with a mean age of 39.8 yrs, range 18 to 60 yrs, were included in the study. Of them, 24 (11 males and 13 females) were treated with SCIT and 23 (14 males and 9 females) with SLIT. Allergen extracts from Stallergénes, namely Phostal™ for SCIT and Staloral™ for SLIT were used, with a build-up phase of respectively 13 weeks and 28 days and a maintenance dose of 8 IR for SCIT and 80 IR for SLIT. The treatment spanned from November 2001 to February 2002. Efficacy was assessed by symptom/medication scores during March 2002, period of birch pollination in northern Italy. Results The patients received a cumulative dose of 50.65 IR with SCIT and 4653.1 IR with SLIT, with a SLIT/SCIT ratio of 91.86 times. The mean symptom-medication score was 4.77 ± 1.41 for SCIT and 3.63 ± 1.08 for SLIT (p<0.001). In the build-up phase the rate of adverse reactions to SCIT was 12.5% for both local and systemic reactions; the reaction rate to SLIT was 13% for local reactions, 0% for systemic reaction. Conclusions In this study on patients with birch pollinosis SLIT with a cumulative dose about 100 times higher than that administered by subcutaneous route was more effective and more safe than SCIT.