Sublingual immunotherapy in polysensitized patients: effect on quality of life.

BACKGROUND: Quality of life (QOL) is an important issue in allergic rhinitis and has been evaluated in a number of studies that have shown how it is impaired in untreated patients and improved by effective treatment. However, there are no data concerning QOL after sublingual immunotherapy (SLIT) in polysensitized patients. OBJECTIVE: To evaluate the effect, in real-life clinical practice, of SLIT on QOL in a population of polysensitized patients with allergic rhinitis. METHODS: We prospectively evaluated 167 consecutively enrolled polysensitized patients with allergic rhinitis. QOL was measured in all cases with the Rhinoconjunctivitis Quality of Life Questionnaire at baseline and after 1 year of SLIT (performed in approximately 70% of cases using single allergen extracts provided by the same manufacturer). RESULTS: The most frequent causes of sensitization were grass pollen, Parietaria, and house dust mites. The mean number of sensitizations per patient was 3.65. SLIT was performed with 1 extract in 123 patients (73.6%), with 2 extracts in 31 patients (18.6%), and with more than 2 extracts in 13 patients (7.8%). The mean values of all the QOL items improved significantly (P < .01 in all cases), with the following reductions noted: activities, 3.96 to 2.89; sleep, 2.07 to 1.56; general problems, 2.16 to 1.5; practical problems, 3.69 to 2.58; nasal symptoms, 3.57 to 2.50; eye symptoms, 2.92 to 1.83; and emotional aspects, 2.2 to 1.44. CONCLUSIONS: This study provides evidence that QOL can be improved in polysensitized patients treated with SLIT, and that the use of just 1 or 2 allergen extracts seems to be sufficient and effective in terms of improving QOL.

Characteristics of patients with allergic polysensitization: the POLISMAIL study.

BACKGROUND: The natural history of respiratory allergy is commonly characterized by a worsening of symptom severity, frequent comorbidity of rhinitis and asthma, and polysensitization to aeroallergens. The polysensitization phenomenon starts since childhood and is rare to find monosensitized adult patients. However, there are few studies investigating the characteristics of polysensitized patients. METHODS: This study was performed on a large cohort of patients with allergic rhinitis (assessed by ARIA criteria) and/or mild to moderate asthma (assessed by GINA). The kind and the number of sensitizations, their patterns, and the relation with quality of life (QoL) measured by the Juniper's RQLQ guestionnaire, were evaluated. RESULTS: Globally 418 patients (50.2% males, 49.8% females, mean age 26.4 years, range 3.5-65 years, 64 smokers, 371 non-smokers) were enrolled: 220 had allergic rhinitis alone, and 198 allergic rhinitis and asthma. The mean number ofsensitizations was 2.6. Three hundred-five patients (73%) had persistent rhinitis (PER), 220 of them with moderate-severe form. There was no significant derence in rate of rhinitis and asthma in monosensitized or polysensitized patients. Most patients were sensitized to pollens, whereas only 24.2% of them were sensitized to perennial allergens. Polysensitization was significantly associated with some issues of QoL, confirming previous findings, but not with number ofsensitizations. CONCLUSIONS: This study provides data confirming for poly-sensitized patients the relevance of ARIA classification of AR. PER is the most common form of AR in this cohort, symptoms are frequently moderate-severe, and asthma is present in about the half of patients with AR.

Effects of sublingual immunotherapy in patients sensitised to Ambrosia. An open controlled study

Background: allergy to Ambrosia is a disease of growing importance in Europe. Injective and non injective immunotherapy have been recognised as safe and effective but no evidence is currently available for sublingual immunotherapy (SLIT) in patients sensitised to Ambrosia. This study was planned to assess the effects and the safety of SLIT in patients clinically sensitised to Ambrosia. Methods: 19 patients clinically sensitised to Ambrosia and treated with SLIT were compared to 14 patients treated only with drugs. Diary cards with symptoms and drug consumption were filled-in by patients during the pollen season whereas specific nasal challenge and skin prick test were run two months before and after the pollen season. Patients and doctors were also asked to express their subjective assessment about symptoms and drug consumption during the season. Results: SLIT-treated patients had less symptoms and a significantly minor drug intake (p = 0.04) as compared to untreated patients. Nasal challenge test improved significantly in the SLIT group (p = 0.0001) but not in the control group (p = 0.6875) with a significant difference between groups at the end (p = 0.0413) but not at the beginning of the trial (p = 0.213). The decrease in skin reactivity was significant in the control group (p = 0.0186) and highly significant in the SLIT group (p < 0.0001), with no difference between groups (p = 0.2987). Subjective assessment from both patients and doctors was favorable to SLIT (p = 0.0005 for symptoms; p = 0.0019 for drug consumption). Only one minor local side effect was registered during SLIT. Conclusions: according to our data, SLIT in patients allergic to Ambrosia is safe and able to improve both subjective and objective parameters (AU)

Antecedentes: la alergia a Ambrosia, es una enfermedad de importancia creciente en Europa. Tanto la inmunoterapia subcutánea como la no inyectada, han demostrado ser seguras y eficaces, pero actualmente no se dispone de evidencia sobre la inmunoterapia sublingual (ITSL) en pacientes sensibles a Ambrosia. Este estudio se desarrolló para valorar los efectos y la seguridad del ITSL en pacientes clínicamente sensibles a Ambrosia.Métodos: 19 pacientes sensibles a Ambrosia y tratados con ITSL, se compararon con 14 pacientes tratados solamente con medicación antialérgica. Durante la época de polinización los pacientes rellenaron diariamente cartillas indicando los síntomas y la medicación consumida. Se realizaron pruebas del pinchazo cutáneo y pruebas de provocación nasal específica dos meses antes y después de la polinización. Tanto los pacientes como los médicos evaluaron subjetivamente los síntomas y medicación durante este período.Resultados: los pacientes tratados con ITSL mostraron menor sintomatología y una reducción significativa del consumo de medicamentos (p = 0,04) comparado con los pacientes no tratados. La provocación nasal mejoró significativamente en el grupo tratado con ITSL (p = 0,0001) pero no en el grupo control (p = 0,6875) con una diferencia significativa al final (p = 0,0413) pero no al principio del ensayo (p = 0,213). La disminución de la reactividad de la piel fue significativa en el grupo control (p = 0,0186) y altamente significativa para el grupo ITSL (p < 0,0001), con poca diferencia entre ambos grupos (p = 0,2987). La valoración subjetiva tanto de médicos como de pacientes fue favorable para la ITSL (p = 0,0005 en los síntomas, y p = 0,0019 en el consumo de medicamentos). Solo se registró un caso de reacción local leve con la ITSL.Conclusiones: según nuestros datos, la ITSL en pacientes alérgicos a Ambrosia es seguro, y capaz de mejorar tanto los parámetros subjetivos como los objetivos. (AU)

Effects of sublingual immunotherapy in patients sensitised to Ambrosia. An open controlled study.

BACKGROUND: Allergy to Ambrosia is a disease of growing importance in Europe. Injective and non-injective immunotherapy have been recognised as safe and effective but no evidence is currently available for sublingual immunotherapy (SLIT) in patients sensitised to Ambrosia. This study was planned to assess the effects and the safety of SLIT in patients clinically sensitised to Ambrosia. METHODS: 19 patients clinically sensitised to Ambrosia and treated with SLIT were compared to 14 patients treated only with drugs. Diary cards with symptoms and drug consumption were filled-in by patients during the pollen season whereas specific nasal challenge and skin prick test were run two months before and after the pollen season. Patients and doctors were also asked to express their subjective assessment about symptoms and drug consumption during the season. RESULTS: SLIT-treated patients had less symptoms and a significantly minor drug intake (p = 0.04) as compared to untreated patients. Nasal challenge test improved significantly in the SLIT group (p = 0.0001) but not in the control group (p = 0.6875) with a significant difference between groups at the end (p = 0.0413) but not at the beginning of the trial (p = 0.213). The decrease in skin reactivity was significant in the control group (p = 0.0186) and highly significant in the SLIT group (p < 0.0001), with no difference between groups (p = 0.2987). Subjective assessment from both patients and doctors was favorable to SLIT (p = 0.0005 for symptoms; p = 0.0019 for drug consumption). Only one minor local side effect was registered during SLIT. CONCLUSIONS: According to our data, SLIT in patients allergic to Ambrosia is safe and able to improve both subjective and objective parameters.

The role of suggestion in asthma. II. Effects of a bronchoconstrictor drug on bronchial reactivity under bronchoconstrictor or bronchodilator suggestion.

Previous studies have shown that suggestion may modify bronchial reactivity to both inactive diluents and pharmacologically bronchoconstrictor or dilator substances. In our study, 14 patients were subjected to two methacholine challenge tests presented, respectively, as a bronchoconstrictor or as a bronchodilator drug. Forced expiratory volumes in one second were recorded and a PD20 was determined. No significant differences were reported in PD20 values of each patient after the two kinds of suggestion.

Evaluation of allergic etiology in perennial rhinitis.

In 197 patients with perennial rhinitis, 49 patients (24.9%) were found to be allergic to perennial inhalant allergens, 37 patients (18.8%) allergic to seasonal allergens, 52 patients (26.4%) had food intolerance, 12 patients (6.6%) showed evidence of nasal infection, and in 46 patients (23.3%) etiology was undetermined.