Sublingual Immunotherapy for Allergic Rhinitis: A Prospective Study Based on AAOA Consensus Dosing Protocol

Abstract

Objectives: Study the efficacy and safety of sublingual immunotherapy (SLIT) based on the original American Academy of Otolaryngologic Allergy (AAOA) Consensus dosing protocol for treatment of allergic rhinitis (AR). Methods: Patients undergoing SLIT for more than 12 months between 2007-2010 were prescribed escalation (over 3 months) and maintenance doses as recommended by AAOA. Sinonasal-Outcome-Test-20 (SNOT-20) questionnaire scores were used for calculations of repeated measures analysis of variance (ANOVA) with contrast testing to define trends. Results: Data from fifteen males and six females with a mean follow-up duration of 17.57 months were analyzed. Fourteen patients had minor side effects, including AR exacerbation (5 cases), itching (8), rash (2), diarrhea (1), and palatal ulcer (1). None required admission or treatment discontinuation. ANOVA testing revealed a significant linear decreasing trend in rhinological (F1,13 = 11.2), ear/facial (F1,13 = 5.4), sleep (F1,13 = 6.9), psychological (F1,13 = 13.1), and overall SNOT-20 (F1,13 = 14.5) scores. Our results show overall SNOT-20 scores improving by 31% from baseline within 3 months initiation of therapy, and continued to improve progressively during the maintenance phase up to 69%. Domain scores analyzed showed greatest improvements in ear/facial symptoms (up to 86%) and psychological function (up to 77%). Rhinologic and sleep function scores also showed impactful improvements of up to 56% and 61% respectively. Conclusions: This is the first published paper to study and demonstrate the safety and efficacy of SLIT based on AAOA consensus dosing protocol. A standardized regime will allow more meaningful comparison between studies.