ABSTRACT
Background: Allergic rhinitis, one of the most common chronic allergic diseases, commonly associated with asthma, has a disease modifying therapy, allergen-specific immunotherapy (AIT). AIT can play a significant role in the reduction of clinical and immunological reaction to the culprit allergen, decreasing the onset of new sensitizations, preventing the onset of asthma, and reducing use of pharmacological treatments. This latter aspect is highly relevant for adolescents, a category of patients that frequently prefer to use "as few drugs as possible". AIT continuation may be difficult in some situations, such as the COVID-19 pandemic. Difficulty in accessing hospitals was experienced by many leading to a discontinuation of therapies for chronic conditions, such as allergic rhinitis. Method(s): We report our experience on the management, safety and adherence to sublingual immunotherapy (SLIT) prescribed to 25 adolescents affected by allergic rhinitis (house dust mite (HDM) -8 patients, SLIT grass pollen -12 patients, SLIT parietaria -5 patients), during the COVID-19 pandemic, following EAACI recommendations. The first administration of SLIT was carried out under medical supervision. We used a personalized monitoring approach according to the type of SLIT prescribed and according to the needs presented by each patient, advising them how to recognize and manage a possible reaction. Result(s): No immediate severe adverse reactions were reported by patients. Between the 2nd and 5th day of SLIT, 4 patients in therapy with HDM SLIT, experienced an exacerbation of rhinitis symptoms, with resolution after the use of oral antihistamine and topical cortisone+antihistamine before taking the daily dose of SLIT (for 30 days). Two patients on grass pollen SLIT and 2 patients on HDM SLIT, with gastric upset after taking SLIT daily while fasting, presented a resolution of the symptom after we advised them to take the daily dose in the morning after breakfast. Five patients interrupted SLIT for COVID-19 infection, until complete resolution. To date, all 25 patients are continuing SLIT, with good tolerability, with an improvement of rhinitis symptoms. Conclusion(s): We have reported real-life SLIT adherence and safety in adolescents that started SLIT during the COVID-19 pandemic to confirm how SLIT is a winning strategy and the only modifying treatment for allergic conditions.
ABSTRACT
Allergen immunotherapy (AIT) is a common treatment for patients with allergic asthma and allergic rhinoconjunctivitis. There is evidence that the COVID-19 pandemic could have altered the administration of AIT in patients in some countries, as the pandemic caused major limitations to healthcare access and delivery. The objective of this study was to evaluate the impact of the disruption imposed by the pandemic on the perceptions and administration of AIT therapies in Italy. An online survey was carried out among Italian allergists between 22 February 2021 and 12 April 2021. The results show that Italian physicians (N=66) did not consider that the COVID-19 pandemic presented an added risk to patients with allergic asthma or rhinitis receiving AIT. Although most treatments continued, there were reduced rates of AIT therapy initiations and sublingual AIT was favored over subcutaneous AIT.
Subject(s)
Asthma , COVID-19 , Sublingual Immunotherapy , Asthma/therapy , COVID-19/epidemiology , COVID-19/therapy , Desensitization, Immunologic/methods , Humans , PandemicsABSTRACT
Background: The COVID-19 pandemic represents a challenging global crisis. Guidelines have provided recommendations on allergen immunotherapy (AIT) practice, but very few real-life data have been reported on how AIT has been managed. In the framework of an ongoing project on AIT (The CHOICE project) in France and Spain, we developed a sub-study to evaluate the impact of COVID-19 in AIT clinical practice. The objective was to assess how the pandemic crisis affected aeroallergen AIT prescription patterns during the first hard lockdown and the following period. The survey was open for 30 days and was closed on November 4th, 2020. Method: An online questionnaire gathering information on physicians' profile and a questionnaire on possible issues concerning AIT, related to COVID-19, were developed and run among participants Results: 95 doctors participated to the survey: 62.1% were Spanish and 37.9% French, 72.7% females, with a mean age 48.2 years (±SD10.2). During the lockdown phase, 70.9% of participants received significantly less respiratory patients, than in 2019. Besides, 90.7% of physicians acknowledged a reduction in AIT prescriptions, with a median reduction of 75% [0-100], which was significantly beyond the decrease in examined patients (median 50% [0-100], p < 0.001). For new prescriptions, 57.6% of participants reported qualitative changes, with more sublingual immunotherapy (SLIT) than usual, especially in Spain (26.9% vs. 5.9% in France, p = 0.021). For SCIT on maintenance, 54.5% of doctors applied modifications, mainly temporarily pausing the treatment. After the lockdown, clinic normalization was only partially achieved, and still 32.6% of physicians (p = 0.001) reported a maintained decrease in the number of patients. The reduction in new AIT prescriptions was still very marked (52.6%). Also, qualitative changes were less frequent (23.5%), but prescribing more SLIT remained the most common modification (18.9%). Conclusion: Our novel real-life data show that the COVID-19 pandemic correlates to a reduction in respiratory patients consulting allergy specialists, and in new AIT prescription, with changes in qualitative prescription patterns. Our results are highly relevant to understand how AIT has been handled in real life, have insights on the amplitude of the impact of the crisis, and implement new strategies to ensure a quality and timely healthcare not only for those who missed their consultations, but also for future patients.
ABSTRACT
Background: COVID-19 may present with many different clinical manifestations and a wide severity range. Common signs are respiratory disorders, that could be similar in some cases to those observed in allergic rhinitis or asthma. Respiratory allergies may be treated with allergen immunotherapy (AIT). It is assumed that AIT reduces the tendency to produce IgE, modulates the Th2-polarized immune system, increases IFN-γ production and reduces allergic inflammation. On the other hand, it is described that severe forms of COVID-19 are related to the secretion of type-I cytokines. The main purpose of the following survey was to evaluate, from the physician's perspective, if COVID-19 could have an impact in allergic diseases, and specially in patients treated with AIT. Method: A web-based survey (SurveyMonkey®) of 18 questions was defined to evaluate, from the clinician's perspective, the impact of COVID-19 in allergic diseases and patients under AIT based in their clinical practice. It was shared with a pool of 855 Italian physicians. Results: A total of 62 respondents answered the survey. 93% asked to their patients regularly about COVID-19. They estimated that 1/100 have had COVID-19, being mild in the 88% of cases, with no severe or fatal cases to their knowledge. 16% observed higher incidence of COVID-19 in patients with rhinitis, but most of them considered that disease was equal to other patients (71%) or less severe (24%). Similar was observed for asthma. None of the responders considered that COVID-19 was more severe in patients with AIT, however, 48% prescribed AIT less frequently. Most doctors (75%) maintained their prescription habits, while 22% increased SLIT vs SCIT. Conclusion: Among the 62 Italian doctors answering the survey, doctors reduced AIT prescription during COVID-19 pandemic, switching to SLIT in some cases. They did not consider that AIT could affect COVID-19 severity. In addition, some doctors believed that COVID-19 is less severe in allergic rhinitis or asthma patients.
ABSTRACT
Background: Allergen-specific immunotherapy (AIT) is the only treatment that cures allergic diseases. Subcutaneous immunotherapy (SCIT) is a conventional treatment which introduced more than 100 years ago. Novel oral formulation sublingual immunotherapy (SLIT) has shown equal efficacy to SCIT, while it is safe without life-threatening allergic reaction. Amid a pandemic of COVID-19, patients are advised to avoid hospital visits. SLIT might be the right choice because patients can take the tablets at home and no need to go to the hospital for weekly injections like SCIT. However, no recent report on the efficacy of changing the route of immunotherapy from SCIT to SLIT. The study aims to assess the efficacy of switching SCIT to SLIT in patients with house dust mite (HDM) allergy. Method: A randomized controlled study was undertaken in 40 patients with allergic rhinitis with/without asthma and receiving maintenance phase of HDM SCIT (TCTR20200606002). HDM SLIT tablet was given daily for 12 weeks and compared to patients with continue SCIT. The principle outcome measure was symptom-medication score (SMS) and asthma control test (ACT) score. immunologic changes in fresh whole blood to monitor T cell subsets, including regulatory T cells (tregs), dysfunctional tregs, and T helper 2 cells were investigated by the flow cytometry method and Der p2-specific IgE, Der p2-specific IgG4 and Der p2-specific IgE/IgG4 were investigated by ELISA method at baseline and 12 weeks after switching treatment. Results: Of 40 patients, 19 patients in the SLIT group and 20 patients in the control group achieved the study. There were no significant differences in SMS and ACT scores between the SLIT group and SCIT group during 12 weeks of treatment. Significantly reduced SMS after 8 weeks compared to baseline (17.6 ± 2.9 to 14 ± 2.4, p = 0.028) was demonstrated in the patients with SLIT. T cell subsets' frequency, specific IgE, IgG4 and IgE/IgG4 ratio did not change significantly in both groups at the end of the study. No severe adverse drug reactions were reported.
ABSTRACT
The demand for allergen specific immunotherapy (AIT), especially sublingual immunotherapy (SLIT), is increasing because of its efficacy in inducing clinical remission of allergic diseases and its low risk of side effects. Since not all patients that undergo SLIT demonstrate an improvement in allergic symptoms, the development of biomarkers to predict the outcome and adjuvants for SLIT is desired. Saliva is the first target with which tablets used in SLIT come into contact, and salivary pH, chemical properties or microbiome composition are reported to possibly be associated with the outcome of SLIT. Antibodies such as IgG4 and IgA not only in the serum but also in the saliva are increased after SLIT and may also be associated with the efficacy of SLIT. The development of the metagenomic sequencing technique makes it possible to determine the microbiome composition and ratio of each bacterium, and researchers can investigate the relationships between specific bacteria and the immune response. Some bacteria are reported to improve the SLIT outcome and have the potential to be used as biomarkers for the selection of patients and as adjuvants in SLIT. Here, we introduce biomarkers for SLIT and present recent findings regarding the relationship between saliva and SLIT.
ABSTRACT
BACKGROUND: Sublingual immunotherapy (SLIT) had good effectiveness for children with allergic rhinitis (AR). However, no studies explored the effect of persistent allergen exposure on SLIT treatment. Coronavirus disease 2019 (COVID-19) restricts outdoor activities of children significantly. We aimed to evaluate the effectiveness of SLIT during this special period. METHODS: A total of 335 AR children who sensitize to house dust mite (HDM) undergoing SLIT were recruited in this study. The clinical effectiveness and safety were evaluated at different time points using symptom and medication scores. The serum total IgE and specific IgE (sIgE) at different time points were detected by using the Unicap system. RESULTS: The total nasal symptoms score (TNSS) and total medication score (TMS) during the epidemic of COVID-19 increased significantly compared with the same period last year (p < 0.05), despite that they were still significantly lower than baseline levels (p < 0.05). The occurrence of adverse reactions at different time points had no significant differences. We also found that the family of the good response group had more frequent bedding cleaning. Both the tIgE and sIgE levels had no significant changes during SLIT treatment. CONCLUSION: Our results suggest that continuous HDM exposure reduced the effectiveness of SLIT, whereas effective reduction of HDM levels by frequent bed cleaning will be helpful during the SLIT treatment.