Efficacy of Sublingual Immunotherapy versus Subcutaneous Immunotherapy in Treatment of Children with Grass Pollen Induced Vernal Keratoconjunctivitis by Eosinophilic Cationic Protien

Abstract

Objective: The aim of this study was to compare efficacy of sublingual allergen immunotherapy versus subcutaneous allergen immunotherapy for treatment of children with grass pollen induced VKC. Methodology: This study involved 46 cases with grass pollen induced vernal keratoconjunctivitis as proved by specific IgE test. According to the route of administration of immunotherapy, the cases were randomly distributed into 2 groups; group (A) included cases received sublingual immunotherapy (23 cases) and group (B) included cases received subcutaneous immunotherapy (23 cases). The response to the treatment was evaluated in the two groups using a clinical scoring system which comprises the total subjective symptom scores (TSSS) and the total ocular sign score (TOSS) every 3 months and also by measurement of the level of specific IgE and ECP every 6 month for one year. Results: There was statistically significant improvement in VKC cases treated with either sublingual immunotherapy (group A) or subcutaneous immunotherapy (group B) (p<0.001) as proved by specific IgE test, ECP test, total subjective symptom scores (TSSS) and total ocular signs score (TOSS). Our data indicate that there was no statistically significant difference between a long-term treatment with grass pollen SLIT and SCIT in children with VKC as regard specific IgE neither at 6 months nor 12 months of treatment (P1= 0.315 and P1=1.01 ). There was also no statistically significant difference between both methods as regard ECP (P1= 0.61 and P1=0.61). Our study indicates also that there was no statistically significant difference between SLIT and SCIT as regard TSSS score at 3 month (p=0.187), at 6 month (p=0.88), at 9 month (p=0.47), and at 12 month (p=0.43) of treatment. Our study shows also that there was no statistically significant difference between SLIT and SCIT as regard TOSS score at 3 month (p=0.34), at 6 month (p=0.38), at 9 month (p=0.79), and at 12 month (p=0.83 ) of treatment. Conclusions: Sublingual immunotherapy is considered a viable alternative to subcutaneous Immunotherapy as there is better adherence to sublingual Immunotherapy. Protocols of SLIT have a more convenient and shorter schedules compared with that of SCIT, they have less anaphylactic reactions and preferred to children. Moreover SLIT is preferred in children. In addition, SCIT has more anaphylactic reaction.