Sublingual allergen immunotherapy: Safety, adherence, efficacy in adolescents during COVID-19 pandemic

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.