Sublingual immunotherpay as a relevant alternative in the treatment of allergic rhinitis: an intervention study

ABSTRACT

It is well known that, specific immunotherapy, together with avoidance of the allergen and symptomatic treatment forms part of the treatment of allergy. The best known and most studied form is subcutaneous immunotherapy [SCIT], whose efficacy was demonstrated in numerous studies. However, in spite of having been shown to be safe, it is not free of adverse effects and must be administered under the supervision of medical personnel. Sublingual immunotherapy [SLIT] may be used as an alternative treatment in allergy. This study was conducted to assessthe efficiency of sublingual immunotherapy as a relevant alternative for treatment of allergic rhinitis. The study included 50 patients with allergic rhinitis; diagnosis was based on clinical manifestations and confirmed by presence of eosinophilia in nasal smear. Their mean age was 22 years ranging from 16 to 60 years, 22 of them were males and 28 were females. All patients were subjected to clinical examination, nasal smear examination for eosinophile count, skin prick test, initial assessment for total IgE and IgE specific allergens [RAST], after receiving sublingual immunotherapy patients were followed up by total IgE and RAST after 24 months, staloral 10ml of a 10,100 iu/ml solution of an allergen extract was used as sublingual solution for desensitization, which specially prepared for each individual,doses are adminisrereted daily at increasing doses until the maintenance dose is reached.Doses of extract were delivered by puffs directly under tongue and kept under tongue for 2 minutes before being swallowed. Results showed that the cause of allergic rhinitis in this study was found to be dust mites in 44% of cases and fungus allergens in 12% of them while it was mixed in 44% of the studied cases. There was a statistically significant improvement in the mean total IgE from 789.24 IU/ML before treatment to 341.24 IU/ML after treatment [P<0.001], according to RAST it revealed changes from a mean of 2.95 IU/ML to 1.09 IU/ML after treatment in fungus and from a mean of 3.1 to 1.21 IU/ML after treatment in mites as well as from a mean of 5.6 to 2.6 IU/ML after treatment in the mixed group, in addition to a significant decrease in the mean diameter of skin prick test reactions after immunotherapy in all types of allergens and amelioration of symptoms in all cases. The follow up of these patients by total IgE and [RAST] revealed much improvement. It is concluded that sublingual immunotherapy [SLIT] is safe and may be considered as a relevant alternative to subcutaneous immunotherapy [SCIT], for the treatment of allergic rhinitis.