Immunothérapie allergénique sublinguale en Tunisie : profil de tolérance et d’efficacité

Abstract

BackgroundAllergen immunotherapy is currently the only treatment likely to impact the natural history of allergic disease. The sublingual route appears to exhibit better safety and has confirmed clinical efficacy. However, further research is required on aspects such as patient selection, use of optimal dosing, long-term effects, and management of adverse reactions. In addition, the widely heterogeneous nature of studies on sublingual allergen immunotherapy (SLIT) performed to date and variations in the application of the subcutaneous immunotherapy make it difficult for the prescribing clinician to draw accurate and useful conclusions. Study objectivesIn this study, we aim to describe the treatment regimens for sublingual allergen immunotherapy practiced routinely in Tunisia. The secondary objectives include description of the respiratory allergies leading to treatment and evaluation of the efficacy and safety of treatment, patient satisfaction and compliance, and patient management practices. MethodsThis was a longitudinal prospective study in 200 patients presenting allergic disease in whom sublingual immunotherapy was initiated in accordance with the ultra rush protocol. ResultsThe average patient age was 18 years (range: 3 to 44 years). Specific immunotherapy was selected for severe persistent allergic rhinitis, either alone (25%) or associated with mild-to-moderate persistent asthma (75%). Sensitivity to dust mites was established in all our patients and confirmed by ACT (100%). The local adverse effects noted consisted of oral pruritus (12% of cases). No serious systemic effects such as anaphylactic shock, angioedema, or moderate or severe asthma attack, were observed in our study. Assessment of symptom intensity during SLIT showed a 77% decrease in symptoms score and a 55% decrease in medication score. No transition from rhinitis to asthma occurred and no new allergies emerged. ConclusionOur study demonstrated that SLIT is effective and tolerable in Tunisian patients presenting allergic rhino-conjunctivitis and/or asthma. Further long-term controlled trials are required to reinforce the present results.