Evaluation of local nasal immunotherapy to Dermatophagoides sp. in patients with allergic rhinitis

Abstract

Introduction: The aim of this study was to evaluate the clinical efficacy of allergen-specific nasal immunotherapy (LNIT) by observing the improvement in the patient’s quality of life, and the side effects of this route of immunotherapy. Methods: From a cohort of 2687 patients with perennial rhinitis treated at the Clinical and Experimental Immunology Service-Hospital Geral-Santa Casa da Misericórdia do Rio de Janeiro for 5 years, a total of one hundred thirty six patients positive in the prick test for Dermatophagoides pteronyssinus (Dp) and Dermatophagoides farinae (Df), were divided into two groups of cases (n=108) and controls (n=28) undergoing or not LNIT, both submitted to the same type of control treatment for the same amount of time. Both groups were classified into mild, moderate and severe rhinitis. Quality of life was assessed based on a questionnaire for Rhinoconjunctivitis, carried out at each visit, with a rating from 0 to 6 according to the increasing degree of difficulty in performing common tasks or nasal, ocular or other symptoms. Results: No systemic side effects or bronchospasms were observed in the cases. Both patients and controls with moderate and severe rhinitis had quality of life grades 3 and 4; 5 and 6 respectively, before immunotherapy. Comparison of cases with controls during the controller medication phase associated with nasal immunotherapy (cases) showed an improvement in quality of life for both (Grades: 0-2, after 5 weeks). Full use of the controller medication was 15 weeks followed by more eighteen weeks with half doses. Patients under LNIT, when the control medication was withdrawn after the sixth series of nasal immunotherapy, maintained the improvement in quality of life with grades of 0-1, not requiring regular and frequent use of symptomatic therapy. Until the final evaluation time, three years and two months, the patients who remained until the end of the immunotherapy regimen (n=89) did not present or significantly reduced the need for control medication, remaining with a degree of quality of life: Degree: 0 and 1.The controls, in the period of 33 weeks of return for consultations, with the withdrawal of the controller medication, reported that they needed the frequent use of controller medicines due to the recurrence of symptoms. The quality of life questionnaire showed a worsening, with grades ranging from 3 to 5, when evaluated in this phase without regular symptomatic medication. Conclusions: The of LNIT performed with full concentrations, did not show secondary reactions with risks to patients and that the effect of inducing tolerance to the antigens of Dermatophagoides sp. was achieved, based on the observation of the decrease in the use of control medications for signs and symptoms and mainly by the improvement in the patients’ quality of life.