Analysis of adherence and determinants of sublingual immunotherapy in patients with Artemisia pollen-induced allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

Objective:To monitor adherence to specific sublingual immunotherapy （SLIT） in patients with seasonal allergic rhinitis（AR）, analyse factors influencing adherence, and provide research support to effectively improve adherence. Methods:Patients with AR who underwent Artemisia pollen SLIT at the Department of Otolaryngology-Head and Neck Surgery, First Hospital of Shanxi Medical University from May 2021 to April 2022 were retrospectively followed up by telephone to investigate the current status of treatment, count the causes of shedding, and extract relevant information from their medical record data for analysis. Results:Of the 112 patients surveyed, 34 discontinued treatment（30.3%）; patients who experienced adverse reactions and SLIT patients who had been on treatment for more than 6 months showed relatively good adherence（P<0.05）. The main reasons for discontinuation in patients who dropped out were: asymptomatic discomfort during the non-pollen phase and therefore discontinuation of treatment or feeling that treatment was ineffective 9 cases（26.5%）, forced discontinuation due to vaccination or pregnancy, or epidemics 6 cases（17.6%）. Conclusion:Long-term adherence of patients to Artemisia pollen SLIT still needs to be brought to the attention of healthcare professionals, especially in the early stages of treatment when good patient education and good channels of trust and communication between doctors and patients need to be established.

Compliance and withdraw reason of sublingual immunotherapy in 245 patients with allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the compliance of patients with allergic rhinitis（AR） receiving sublingual immunotherapy and its influencing factors. Methods:The clinical data of 291 AR patients who received sublingual immunotherapy for dust mites at the First Hospital of Peking University from January 2016 to January 2018 were retrospectively analyzed, and their outpatient or telephone follow-up was conducted. For patients whose treatment time was less than 2 years, the time and reason for the loss were recorded, and the factors affecting their compliance were discussed from the aspects of gender, age, and education. Results:Among the 291 patients, 245 cases（84.2%） were successfully followed up, and 193 cases（78.8%） fell off midway（treatment time<2 years）. The overall compliance rate was 21.22%（52/245）. The compliance rate of children is higher than that of adults（χ²=21.306, P<0.05）, and gender and education level have no significant effect on the compliance rate. The time period for the largest number of shedding was 6-<12 months after treatment（68 cases, 27.8%）. The main cause of shedding was symptom relief, which was considered cured（16.7%）. Secondly, within 3 months after treatment, a total of 61 patients（24.9%） fell off, of which 34 cases（13.9%） fell off because of troublesome medication, often missed medication, and simply stopped taking the drug. Statistics on the overall reasons for shedding in 193 patients, the top three shedding reasons were: cured after symptom relief（59 cases, 30.6%）, troublesome medication, discontinuation after missed dose（44 cases, 22.8%）, slow onset or ineffectiveness（26 cases, 13.5%）. Conclusion:The overall compliance of sublingual immunotherapy in patients with allergic rhinitis is poor, and the compliance of children is better than that of adults. Clinicians should focus on the reasons for patients to fall off at various times, strengthen patient education, enhance patient confidence in treatment, and improve the compliance of patients.

Allergic Rhinitis: A Critical Modern Review

Allergic rhinitis addresses a hyperactivity of the resistant framework in any case harmless particles making a fiery reaction where none is required. Allergic Rhinitis is clinically represented by a mixture of two or additional nasal symptoms: running, blocking, itching and sneezing. Allergic rhinitis is regularly partitioned by age, seriousness, and duration of symptoms. Investigation represents how epidemiologic evaluations on the commonness of hypersensitive or allergic rhinitis shift considerably with whether both clinical appraisal and testing were utilized to make the determination. The treatment of allergic rhinitis should combine allergen avoidance, pharmacotherapy and allergen immunotherapy. Treatments of allergic rhinitis include intranasal corticosteroids, oral and topical antihistamines, decongestants, intranasal cromolyn, intranasal anticholinergics. First-generation and Second-generation oral antihistamines and intranasal corticosteroids are the most effective modality for treating allergic rhinitis. Immunotherapy is an efficient immune-modulating treatment that ought to be counseled if pharmacologic medical care for allergic rhinitis isn't effective or not tolerated. This article provides an overview of the prevalence, pathophysiology, diagnosis, and appropriate management of the allergic rhinitis.

Short-term efficacy of sublingual immunotherapy in patients with allergic rhinitis of all ages / 中国基层医药

Objective:To investigate the short-term efficacy of sublingual immunotherapy in patients with allergic rhinitis of all ages.Methods:The data of 230 patients with allergic rhinitis of all ages who received sublingual immunotherapy in The Third People's Hospital of Bengbu from November 2020 to September 2021 were included in this study. Patient distribution characteristics were analyzed. Ninety-three patients were randomly selected and divided into child, adolescent, and adult groups according to different ages. Total nasal symptom scores measured before and 4 months after sublingual immunotherapy were compared among patients of different ages to evaluate the short-term efficacy of sublingual immunotherapy. The skin prick test was used to determine the allergic state of patients. Change in total nasal symptom score after treatment relative to that before treatment was used to evaluate the efficacy of sublingual immunotherapy.Results:The age range of patients receiving sublingual immunotherapy was large (3-71 years), but the average age was only 17.70 years. Ninety-three patients were followed up, including 50 children and 43 adolescents or adults. After 4 months of sublingual immunotherapy, total nasal symptom score in children and adolescents or adults were significantly decreased compared with those before treatment [(3.66 ± 1.69) points vs. (6.60 ± 1.96) points, (3.49 ± 1.72) points vs. (6.28 ± 2.28) points, both P < 0.001]. Before and after treatment, there was no significant difference in total nasal symptom score between children and adolescents or adults (both P > 0.05). Conclusion:Patients with allergic rhinitis who receive sublingual immunotherapy tend to be young. Short-term sublingual immunotherapy is effective for allergic rhinitis. There is no remarkable difference in the efficacy of sublingual immunotherapy between patients with allergic rhinitis of all ages.

Inmunoterapia con ácaros Valergen por vía sublingual y subcutánea en pacientes alérgicos. Cabaiguán 2010-2019 / Sublingual and subcutaneous Valergen mite immunotherapy in allergic patients in Cabaiguán 2010-2019

RESUMEN Fundamento: La inmunoterapia consiste en la administración de dosis crecientes del alérgeno para controlar la sensibilidad hacia este. Objetivo: Describir el comportamiento de la inmunoterapia por vía subcutánea o sublingual a ácaros. Metodología: Estudio retrospectivo realizado en Cabaiguán, periodo de 2010 a 2019, el universo de 267 pacientes con pruebas positivas a ácaros y la muestra de 53 pacientes. Los datos se obtuvieron del registro de datos. Resultados: Usó la vía sublingual el 60.4 %, predominó el grupo de edad entre 5-18 años (41.5 %), la vía subcutánea se utilizó en un 39.6 %, fue más frecuente en el sexo masculino (58.5 %). La vía subcutánea se indicó mayoritariamente en la rinitis alérgica (20.7 %) y la sublingual en el asma (32.1 %); para ambas, fue el Dermatofagoide pteronyssinus el ácaro de mayor sensibilidad y utilización (43.4 %), el tiempo de administración dominante fue de 3 años (67.9 %). El control de los síntomas se alcanzó con la vía sublingual (37.7 %). En la vía sublingual no se presentaron eventos adversos en el 43.3 %, con la vía subcutánea 11.3 % de los eventos adversos fueron locales y 7.6 % sistémicos leves. Conclusiones: La vía sublingual fue la más utilizada, la de mayor control de los síntomas y menos eventos adversos en el estudio.

ABSTRACT Background: Immunotherapy consists of the administration of the allergen increasing doses to control sensitivity towards it. Objective: To describe the behavior of subcutaneous or sublingual immunotherapy to mites. Methodology: Retrospective study carried out in Cabaiguán, from 2010 to 2019, the universe of 267 patients with positive tests to mites and the sample 53 patients. Data were obtained from the data record. Results: 60.4 % used sublingual, the age group between 5-18 years prevailed (41.5 %), the subcutaneous was used in 39.6 %, and it was more frequent in males (58.5 %). The subcutaneous was indicated mainly in allergic rhinitis (20.7 %) and sublingual in asthma (32.1 %); for both, Dermatofagoide pteronyssinus was the highest sensitivity and use mite (43.4 %) the dominant administration time was 3 years (67.9 %). Symptom control was achieved by sublingual (37.7 %). In sublingual, there were no adverse events in 43.3 %, with the subcutaneous, 11.3 % of the adverse events were local and 7.6 % were mild systemic. Conclusions: Sublingual was the most used, the one with the highest control of symptoms and the fewest adverse events in the study.

Efficacy, safety and compliance of immunotherapy in the treatment of allergic rhinitis: a Meta-analysis / 中华耳鼻咽喉头颈外科杂志

Objective@#By use of Meta analysis to compare efficacy, safety and compliance of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) on allergic rhinitis (AR).@*Methods@#Cochrane Library, Pubmed, Embase, CNKI Database, Wan Fang and Chinese Sci-tech Journal Database (from established time to May of 2018) were searched for trials about the AR treated by SCIT and SLIT. The relevant literatures were screened, and the randomized controlled studies were chosen. Nasal symptom scores, visual analogue scale (VAS) scores, adverse reactions and compliance were used as the outcome indicators, and the methodological quality of the literatures was evaluated strictly. The extracted data were analyzed by RevMan 5.3 and Stata 14 software.@*Results@#A total of 20 randomized controlled studies were included, the overall quality of which was relatively high. No publication bias was found. There was no significant difference in nasal symptom scores, VAS scores and compliance between SCIT and SLIT (SMD value was 0.03, 0.14, respectively, RR=1.12; 95%CI value was -0.17-0.23, -0.03-0.31, 0.92-1.35, respectively, all P>0.05); SLIT group resulted in lower overall incidence of adverse reactions than that of SCIT group (RR=1.79, 95%CI: 1.42-2.26, P<0.05).@*Conclusion@#Both SCIT and SLIT have similar eppecacy and compliance for treatment of AR, while adverse reactions are more frequently observed in SCIT.

Progress in sensitized protein components and subcutaneous specific immunotherapy for dust mites / 国际儿科学杂志

Dust mites are one of the most common inhalant allergens in the world.The prevalence of dust mite allergy is on the rise in the worldwide,it is a chronic worldwide health problem that seriously affects the work,study and daily life of patients.This review demonstrates the allergic diseases caused by dust mite,the sensitized protein components of the dust mite and the research progress of allergen-specific immunotherapy,and the application of anti-IgE monoclonal antibodies to IgE-mediated allergic reactions is also briefly described.

Consenso Brasileiro sobre Alergia Alimentar: 2018 - Parte 2 - Diagnóstico, tratamento e prevenção. Documento conjunto elaborado pela Sociedade Brasileira de Pediatria e Associação Brasileira de Alergia e Imunologia / Brazilian Consensus on Food Allergy: 2018 - Part 2 - Diagnosis, treatment and prevention. Joint position paper of the Brazilian Society of Pediatrics and the Brazilian Association of Allergy and Immunology

Na última década o conhecimento sobre a etiopatogenia da alergia alimentar (AA) avançou muito. A identificação de novas formas clínicas de apresentação, aliada à aquisição de novos métodos laboratoriais, possibilitaram a realização do diagnóstico etiológico de modo mais preciso, sobretudo quanto à reatividade cruzada entre alimentos e mesmo na identificação de marcadores indicativos de formas clínicas transitórias, persistentes e quadros mais graves. A padronização dos testes de provocação oral permitiu a sua realização de forma mais segura e possibilitou a sua inclusão entre as ferramentas disponíveis para uso na confirmação etiológica da AA. Apesar disso, a exclusão do alimento responsável pelas manifestações clínicas continua sendo a principal conduta terapêutica a ser empregada. Entre os pacientes alérgicos às proteínas do leite de vaca, a disponibilidade de fórmulas especiais, por exemplo parcialmente hidrolisadas, extensamente hidrolisadas à base da proteína do leite de vaca e fórmulas de aminoácidos, tem facilitado o tratamento substitutivo do leite de vaca para esses pacientes. A abordagem atual da anafilaxia é revisada, uma vez que os alimentos são os principais agentes etiológicos em crianças. Avanços na conduta de algumas manifestações gastrintestinais também são abordados. Na atualidade, a imunoterapia oral tem sido cada vez mais utilizada. A aquisição de novos agentes, os imunobiológicos, também são apresentados à luz das evidências científicas e clínicas atuais. Considerações sobre história natural da AA, assim como sobre formas de prevenção da AA também são abordadas. Em conclusão, o Consenso Brasileiro sobre Alergia Alimentar de 2018 objetivou rever os métodos diagnósticos e esquemas de tratamento disponíveis e empregados no acompanhamento de pacientes com AA, visando a melhor abordagem terapêutica desses pacientes.

Over the last decade, knowledge about the etiopathogenesis of food allergy (FA) has advanced a great deal. The identification of new clinical presentations, associated with the acquisition of new laboratory methods, have made the diagnostic process more accurate, especially with regard to cross-reactivity between foods and the identification of biomarkers suggestive of transitory, persistent clinical forms and/or more severe manifestations. The standardization of oral provocation tests has made their performance safer and has allowed their inclusion among the tools available for use in the etiological confirmation of FA. Despite this, exclusion of the food involved in the clinical manifestations remains as the main therapeutic strategy. Among patients allergic to cow's milk proteins, the availability of special formulas, e.g., partially hydrolyzed and extensively hydrolyzed cow's milk protein-based formulas, in addition to amino acid formulas, has facilitated the introduction of substitute formulas for these patients. The current approach to anaphylaxis is reviewed, since food is the major etiological agent in children. Advances in the management of some gastrointestinal manifestations are also addressed. Currently, oral immunotherapy has been increasingly used. The acquisition of new agents, namely, immunobiological agents, is also described in light of current scientific and clinical evidence. Considerations on the natural history of FA, as well as on ways how to prevent FA, are addressed. In conclusion, the 2018 Brazilian Consensus on Food Allergy aimed to review the diagnostic methods and treatment schemes available and used in the follow-up of patients with FA, with a view to adopting the best possible therapeutic approach to these patients.

Efficacy and Safety of Sublingual Immunotherapy in Elderly Rhinitis Patients Sensitized to House Dust Mites

PURPOSE: This study aims to determine the efficacy and safety of house dust mite (HDM)-sublingual immunotherapy (SLIT) in elderly patients with AR. METHODS: A total of 45 patients aged ≥ 60 years with HDM-induced AR who had ≥ 3 A/H ratio on skin prick test and/or ≥ 0.35 IU/L to both Dermatophagoides farinae and Dermatophagoides pteronyssinus by ImmunoCAP were enrolled in 4 university hospitals. To evaluate additional effects of HDM-SLIT, they were randomized to the SLIT-treated group (n = 30) or control group (n = 15). Rhinoconjunctivitis total symptom score (RTSS), rhinoscopy score, Korean rhinoconjunctivitis quality of life questionnaire, rhinitis control assessment test, asthma control test scores, and adverse reactions, were assessed at the first visit (V1) and after 1 year of treatment (V5); for immunological evaluation, serum levels of HDM-specific immunoglobulin A/IgE/IgG1/IgG4 antibodies and basophil response to HDMs were compared between V1 and V5 in both groups. RESULTS: There were no significant differences in demographics, RTSS, skin reactivity to HDMs, or serum total/specific IgE levels to HDMs (P < 0.05, respectively) between the 2 groups. Nasal symptom score and RTSS decreased significantly at year 1 in the 2 groups (P < 0.05). There were no significant differences in percent decrease in nasal symptom score and RTSS at year 1 between the 2 groups (P < 0.05); however, rhinoscopic nasal symptom score decreased significantly in the SLIT-treated group (P < 0.05). Immunological studies showed that serum specific IgA levels (not specific IgE/IgG) and CD203c expression on basophils decreased significantly at V5 in the SLIT-treated group (P = 0.011 and P = 0.001, respectively), not in the control group. The control group required more medications compared to the treatment group, but there were no differences in adverse reactions. CONCLUSIONS: It is suggested that HDM-SLIT for 1 year could induce symptom improvement and may induce immunomodulation in elderly rhinitis patients.

The International Study of the Allergic Rhinitis Survey: outcomes from 4 geographical regions

BACKGROUND: Allergic rhinitis (AR) is a global health problem and is characterised by one or more symptoms, including sneezing, itching, nasal congestion and rhinorrhea. OBJECTIVE: We investigated the features of AR and the physician's approach to the management of AR patients in four geographical regions. METHODS: In this cross-sectional study, a questionnaire survey concerning AR was completed by Honorary and Corresponding Members of the Italian Society of Rhinology from different countries among 4 world geographical regions—Asia, Europe, the Americas, and Africa. RESULTS: The prevalence of AR was reported to be 15%–25%. Children and adolescents, as well as young adults, were the age groups more affected by AR with comorbidities of asthma, sinusitis, conjunctivitis, and nasal polyposis. Nasal symptoms of AR were more intense in the spring (51.92%) and autumn (28.85%). The most common aero-allergens were pollen and mites (67.31%), animal dander and pollutants (23.08%), and fungal allergens (21.15%). Allergen-specific immunotherapy was prescribed for both perennial and seasonal allergens (32.69%) via sublingual swallow (46.15%) and subcutaneous (32.69%) routes. For the AR patients, the most prescribed drugs were intranasal corticosteroids (86.54%) and oral H₁-antihistamines (82.69%). CONCLUSION: A network of experts can improve our knowledge concerning AR epidemiology, and together with guidelines, could assist practitioners and otolaryngologists in standardising the diagnosis and treatment of AR.

Allergen-Specific Immunotherapies for Food Allergy

With rising prevalence of food allergy (FA), allergen-specific immunotherapy (AIT) for FA has become an active area of research in recent years. In AIT, incrementally increasing doses of inciting allergen are given with the goal to increase tolerance, initially through desensitization, which relies on regular exposure to allergen. With prolonged therapy in some subjects, AIT may induce sustained unresponsiveness, in which tolerance is retained after a period of allergen avoidance. Methods of AIT currently under study in humans include oral, sublingual, epicutaneous, and subcutaneous delivery of modified allergenic protein, as well as via DNA-based vaccines encoding allergen with lysosomal-associated membrane protein I. The balance of safety and efficacy varies by type of AIT, as well as by targeted allergen. Age, degree of sensitization, and other comorbidities may affect this balance within an individual patient. More recently, AIT with modified proteins or combined with immunomodulatory therapies has shown promise in making AIT safer and/or more effective. Though methods of AIT are neither currently advised by experts (oral immunotherapy [OIT]) nor widely available, AIT is likely to become a part of recommended management of FA in the coming years. Here, we review and compare methods of AIT currently under study in humans to prepare the practitioner for an exciting new phase in the care of food allergic patients in which improved tolerance to inciting foods will be a real possibility.

Sublingual Immunotherapy Tablets Relieve Symptoms in Adults with Allergic Rhinitis: A Meta-analysis of Randomized Clinical Trials / 中华医学杂志(英文版)

<p><b>Background</b>Sublingual immunotherapy (SLIT) has been proven to be effective against house dust mite-induced allergic rhinitis. However, the efficacy in adults with allergic rhinitis has never been reported on SLIT tablets. The current meta-analysis aimed to illustrate the differentiated efficacy of SLIT tablets on allergic rhinitis.</p><p><b>Methods</b>Our systematic review and meta-analysis were performed on allergic rhinitis patients and aimed to summarize those randomized controlled studies (RCTs). PubMed, EMBASE, Cochrane library, and MEDLINE were screened for associated articles. We included RCTs on allergic rhinitis patients undergoing SLIT therapy and reporting outcomes on symptom relief and serum-specific IgE levels. The effect of SLIT tablets on the Rhinitis Quality Life Questionnaire Score (RQLQ), Rhinitis Total Symptom Score (RTSS), and serum-specific IgE levels was evaluated using RevMan 5.3.</p><p><b>Results</b>Seven studies were included, with 2723 patients identified. All of the studies were RCT. The included seven studies were all conducted on adults. Among the included seven articles, five researches administered patients with SLIT tablets and were eligible for meta-analysis of RTSS, consisting of 1490 patients. Overall, RTSS was significantly reduced in the SLIT tablet group compared with that in the placebo group (standard mean difference = -0.33, 95% confidence interval [-0.54, -0.13], P < 0.01). There was no significant difference in specific IgE levels between SLIT and placebo patients.</p><p><b>Conclusions</b>SLIT tablets effectively relieve rhinitis symptoms in adults with allergic rhinitis. Nevertheless, the current evidence may be limited due to sample size and the heterogeneity between studies. Large sample size and multiple center RCTs on the efficacy of different formulations of SLIT drugs are still needed to provide further evidence and a more precise recommendation.</p>

Effect of sublingual immunotherapy on platelet activity in children with allergic rhinitis / Efeito da imunoterapia sublingual sobre a atividade plaquetária em crianças com rinite alérgica

Abstract Introduction: The role of platelet activation in allergic inflammation is receiving increasing attention. Sublingual immunotherapy for allergic rhinitis can modify the immunological process to an allergen, rather than simply treating symptoms. Objective: The aim of this study was to explore the role of platelet activation during sublingual immunotherapy in children with allergic rhinitis. Methods: Forty-two House Dust Mite - sensitized children with allergic rhinitis were enrolled and received House Dust Mite allergen extract for sublingual immunotherapy or placebo. Serum of different time points during treatment was collected and used for detection of Platelet Factor-4 and Beta-Thromboglobulin concentration by Enzyme-Linked Immuno Sorbent Assay. Results: Our data showed decreased expression of Platelet Factor-4 and Beta-Thromboglobulin protein after one year's sublingual immunotherapy. In addition, the decrease of symptom scores and serum Platelet Factor-4 and Beta-Thromboglobulin protein concentrations was positively related. Conclusion: During sublingual immunotherapy, platelet activation was inhibited significantly. Our results might indicate that inhibition of platelet activation within the systemic circulation is an important mechanism during sublingual immunotherapy.

Resumo Introdução: O papel da ativação de plaquetas na inflamação alérgica recebeu atenção crescente. A imunoterapia sublingual para rinite alérgica pode modificar o processo imunológico a um alérgeno, em vez de tratar os sintomas simplesmente. Objetivo: Explorar o papel da ativação plaquetária durante a imunoterapia sublingual em crianças com rinite alérgica. Método: Quarenta e duas crianças com rinite alérgica sensibilizadas por ácaros de poeira domiciliar (APD) foram inscritas e receberam extrato de alérgeno de APD para imunoterapia sublingual ou placebo. O soro de diferentes pontos no tempo durante o tratamento foi recolhido e usado para a detecção de fator 4 plaquetário e concentração de beta-tromboglobulina por ensaio imunoenzimático. Resultados: Nossos dados mostraram diminuição da expressão de fator 4 plaquetário e proteína beta-tromboglobulina após imunoterapia sublingual de um ano. Além disso, a diminuição dos escores de sintomas e o fator 4 plaquetário sérico e concentrações de proteína beta-tromboglobulina foram relacionados de maneira positiva. Conclusão: Durante imunoterapia sublingual, a ativação plaquetária foi inibida significativamente. Os nossos resultados podem indicar que a inibição da ativação de plaquetas dentro da circulação sistêmica é um mecanismo importante durante imunoterapia sublingual.

Comparison of efficacy of subcutaneous immunotherapy and sublingual immunotherapy for treating allergic rhinitis / 重庆医学

Objective To compare the curative efficacy and safety of subcutaneous immunotherapy (SCIT) versus sublingual immunotherapy (SLIT) for allergic rhinitis.Methods A total of 127 cases of patients with allergic rhinitis in the outpatient department of our hospital from June 2009 to March 2016 were retrospectively analyzed,including 79 cases treated with SCIT and 48 cases treated with SLIT.The curative effects and adverse reactions were compared between the two groups.Results After 3-year treatment,the total effective rate in the SCIT group was 75.9%,which was higher than 72.9% in the SLIT group,but the difference was not statistically significant (χ2=0.15,P>0.05).The incidence rate of adverse reactions in the SCIT group was 26.6%,which was higher than 10.4% in the SLIT group,the difference between the two groups was statistically significant (χ2=4.79,P<0.05).Conclusion The two desensitization treatment methods all gain better effect,but SLIT has lower occurrence rate of adverse reactions.

Single-allergen Sublingual Immunotherapy versus Multi-allergen Subcutaneous Immunotherapy for Children with Allergic Rhinitis / 华中科技大学学报（医学）（英德文版）

It has always been controversial whether a single allergen performs better than multiple allergens in polysensitized patients during the allergen-specific immunotherapy.This study aimed to examine the clinical efficacy of single-allergen sublingual immunotherapy (SLIT) versus multi-allergen subcutaneous immunotherapy (SCIT) and to discover the change of the biomarker IL-4 after 1-year immunotherapy in polysensitized children aged 6-13 years with allergic rhinitis (AR) induced by house dust mites (HDMs).The AR polysensitized children (n=78) were randomly divided into two groups:SLIT group and SCIT group.Patients in the SLIT group sublingually received a single HDM extract and those in the SCIT group were subcutaneously given multiple-allergen extracts (HDM in combination with other clinically relevant allergen extracts).Before and 1 year after the allergen-specific immunotherapy (ASIT),the total nasal symptom scores (TNSS),total medication scores (TMS) and IL-4 levels in peripheral blood mononuclear cells (PBMCs) were compared respectively between the two groups.The results showed that the TNSS were greatly improved,and the TMS and IL-4 levels were significantly decreased after 1-year ASIT in both groups (SLIT group:P＜0.001;SCIT group:P＜0.001).There were no significant differences in any outcome measures between the two groups (for TNSS:P＞0.05;for TMS:P＞0.05;for IL-4 levels:P＞0.05).It was concluded that the clinical efficacy of single-allergen SLIT is comparable with that of multi-allergen SCIT in 6-13-year-old children with HDM-induced AR.

Effectiveness of Specific Sublingual Immunotherapy in Korean Patients with Atopic Dermatitis

BACKGROUND: Sublingual immunotherapy (SLIT) with house dust mites (HDM) preparation has recently been proven to be beneficial for treating allergic rhinitis and asthma. However, there has been no report regarding the efficacy and safety of SLIT in Korean patients with atopic dermatitis (AD). OBJECTIVE: We intended to investigate the efficacy and safety of SLIT in Korean patients with AD. METHODS: A total of 34 patients with AD and immunoglobulin E (IgE)-proven HDM sensitization (Class ≥3) were recruited. Eczema area and severity index (EASI) score, total serum IgE level, specific IgE assays to Dermatophagoides pteronyssinus, D. farinae, and adverse effects were recorded during follow-up. "Responder" was defined as a patient with ≥30% improvement in EASI score after SLIT. RESULTS: Twenty-three patients continued SLIT for 12 months or more, whereas 3 patients (8.8%) dropped out because of exacerbation of dermatitis, and 8 patients (23.5%) were lost to follow-up. The average duration of SLIT treatment was 22.4 months (range, 12~32 months). EASI scores reduced significantly after 6 months of treatment (p<0.05) compared with those at baseline. A total of 18 patients were determined to be responders to SLIT after 6 months. Total and specific IgE serum levels did not significantly reduce after SLIT. No patients experienced serious adverse events, with the exception of two patients who developed transient lip and tongue swelling. CONCLUSION: Our study demonstrated that SLIT with HDM extracts is effective and tolerable in Korean patients with AD. Further controlled long-term trials are required to reinforce the current results.

Therapeutic efficacy and safety of sublingual immunotherapy in treatment of adults with seasonal allergic rhini-tis:a meta-analysis / 局解手术学杂志

Objective To systematically investigate the efficacy and safety of sublingual immunotherapy( SLIT) in the treatment of a-dults with seasonal allergic rhinitis( SAR) .Methods Literature was retrieved online in CNKI,CBM,VIP,Wanfang data,PubMed,EMBase, Medline,Cochrane Library,et al.After screening literature,data collection and assessment quality,randomized controlled trials relevant to our study were selected independently based on inclusion and exclusion criteria by two researchers.Statistical analyses were conducted by RevMan 5.2 software.Results A total of 13 RCTs were enrolled.The meta-analysis revealed that SLIT provided a significant improvement in aspect of reducing Symptom Scores(SS) and Medication Scores (MS)of adults with SAR,the difference had statistical significance(P<0.000 01). Compared to placebo,SLIT could increase the rate of adverse events( AEs) in the treatment of adults with SAR compared to placebo.The fre-quently reported AEs during clinical trials were oral pruritus,tongue edema,ear pruritus,throat irritation,et al.Conclusion Sublingual im-munotherapy could improve the symptoms significantly and reduce the SS and MS in the treatment of adults with SAR.And its safety could be well tolerated.

A practical view of immunotherapy for food allergy / 소아과

Food allergy is common and sometimes life threatening for Korean children. The current standard treatment of allergen avoidance and self-injectable epinephrine does not change the natural course of food allergy. Recently, oral, sublingual, and epicutaneous immunotherapies have been studied for their effectiveness against food allergy. While various rates of desensitization (36% to 100%) and tolerance (28% to 75%) have been induced by immunotherapies for food allergy, no single established protocol has been shown to be both effective and safe. In some studies, immunologic changes after immunotherapy for food allergy have been revealed. Adverse reactions to these immunotherapies have usually been localized, but severe systemic reactions have been observed in some cases. Although immunotherapy cannot be recommended for routine practice yet, results from recent studies demonstrate that immunotherapies are promising for the treatment of food allergy.

Der p 1, Der p 2 and Der p 10 IgE Reactivities in Allergic Rhinitis Patients in Korea

BACKGROUND AND OBJECTIVES: To evaluate IgE reactivity profiles to Der p 1, Der p 2, and Der p 10 in house dust mite (HDM) allergic rhinitis (AR) patients in Korea. Symptomatic and serologic changes after sublingual immunotherapy (SLIT) were analyzed according to IgE profiles. MATERIALS AND METHODS: Sixty AR patients diagnosed with an HDM allergy were tested for the presence of IgE antibodies against purified HDM allergen molecules (i.e., nDer p 1, rDer p 2, and rDer p 10) and native Dermatophagoides pteronyssinus (Dp) using ImmunoCAP 250®. Symptom scores and laboratory findings were analyzed after SLIT. RESULTS: Prevalence rates of IgE for Dp, Der p 1, Der p 2, and Der p 10 were 100%, 98.3%, 93.3%, and 8.3%, respectively. After one year of immunotherapy with SLITone○R (standardized to major allergens, but not Der p 10), symptom scores and laboratory findings improved in patients with and without Der p 10 IgE antibodies. CONCLUSION: In Korean AR patients, specific IgE antibodies to Der p 1 or Der p 2 are present in most Dp-allergic patients, while reactivity to Der p 10 is very low. Allergic symptoms improved in patients with Der p 10 IgE antibodies after SLIT.

Effect of high-dose sublingual immunotherapy on respiratory infections in children allergic to house dust mite

BACKGROUND: Allergic rhinitis is characterized by eosinophil inflammation. Allergic inflammation may induce susceptibility to respiratory infections (RI). House dust mite (HDM) sensitization is very frequent in childhood. Allergen immunotherapy may cure allergy as it restores a physiologic immune and clinical tolerance to allergen and exerts anti-inflammatory activity. OBJECTIVE: This study investigated whether six-month high-dose, such as 300 IR (index of reactivity), HDM-sublingual immunotherapy (SLIT) could affect RI in allergic children. METHODS: Globally, 40 HDM allergic children (18 males; mean age, 9.3 years) were subdivided in 2 groups: 20 treated by symptomatic drugs (group 1) and 20 by high-dose HDM-SLIT (group 2), since September 2012 to April 2013. The daily maintenance dose of HDM-SLIT was 4 pressures corresponding to 24, 4.8, and 60 µg, respectively of the major allergens Dermatophagoides pteronyssinus (Der p) 1, Der p 2, and Dermatophagoides farinae (Der f) 1. RI was diagnosed when at least 2 symptoms or signs, and fever were present for at least 48 hours. A family pediatrician provided diagnosis on a clinical ground. RESULTS: SLIT-treated children had significantly (p = 0.01) less RI episodes (3.5) than control group (5.45). About secondary outcomes, SLIT-treated children had less episodes of pharyngo-tonsillitis (p < 0.05) and bronchitis (p < 0.005), and snoring (p < 0.05) than control group. In addition, SLIT-treated children had less fever (p < 0.01) and took fewer medications, such as antibiotics (p < 0.05) and fever-reducers (p < 0.01), than control group. CONCLUSION: This preliminary study might suggest that also a short course (6 months) of high-dose SLIT, titrated in µg of major allergens, could reduce RI in allergic children.