Long-Term Efficacy of Sublingual Immunotherapy in Patients With Perennial Rhinitis

ArticleinThe Laryngoscope 117(6):965-9 · July 2007with13 Reads
DOI: 10.1097/MLG.0b013e31804f8141 · Source: PubMed
Sublingual immunotherapy has a documented clinical efficacy, but only a few long-term studies have been performed in people with perennial rhinitis. The purpose of this study was to evaluate the long-term efficacy of sublingual immunotherapy. One hundred thirty-seven patients with allergies to house dust mites were treated with sublingual house dust-mite-specific immunotherapy for 2 or 3 years and were also observed for 3 years after discontinuation of the treatment. The patients were divided into 2 groups: group A (67 patients) received active treatment for 2 years and then 1 year for placebo, and group B (70 patients) received active treatment for 3 years. The success of the treatment was evaluated with the symptom score, skin prick test results, and the nasal allergen challenge score. According to our study results, we found a greater improvement in the 3 years of sublingual immunotherapy compared with the 2 years of sublingual immunotherapy when we looked at the comparative results of the total 6 years. We suggest 3 years of sublingual immunotherapy for patients with perennial allergic rhinitis who require immunotherapy and do not accept the subcutaneous route of allergen administration.
    • "Furthermore, after the relapse of allergic symptoms, an additional 1 year of SLIT had an effect on relieving symptoms (Level III) [28]. The effect of 2 years or 3 years of SLIT for HDM persisted for 3 years after the discontinuation of this therapy, and a stronger effect was noted after 3 years of therapy (Level III) [16]. A meta-analysis of 22 reports revealed that the efficacy of SLIT was maintained for 5 years after the completion of treatment (Level Ia) [33]. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: Sublingual immunotherapy (SLIT) appears to offer practical advantages for the treatment of allergic rhinitis (AR). Based on a review of the scientific literature, we present recommendations as guiding principles to administer SLIT safely. Methods: Clinical questions concerning SLIT were prepared. Literature published between January 2003 and December 2012 was searched from PubMed, the Cochrane Library, and Japana Centra Revuo Medicina. Qualified studies were analyzed and the results were evaluated, consolidated, and codified. We answered 17 clinical questions and, based on this, presented evidence-based recommendations. Results: Sublingual immunotherapy improved symptoms (e.g., quality of life [QOL]) and reduced medication scores in seasonal AR and perennial AR. Most SLIT-induced adverse effects were local oral reactions, although systemic adverse effects such as gastrointestinal symptoms, urticaria, and asthma are occasionally reported. There have been no reports of lethal anaphylactic reactions by SLIT. When SLIT is continued for 3-4 years, its effect persists long after discontinuation. Conclusion: A correct diagnosis of AR and sufficient informed consent from patients are required before initiating SLIT. Sublingual immunotherapy should be continued for 3 years or longer. The initial administration of SLIT during the uptitration of an allergen vaccine and the general condition of patients are critical for the safe performance of SLIT.
    Full-text · Article · Nov 2015
    • "The duration of treatment varies considerably from one study to another, from 3 months of treatment to 3, 4, or even 5 years109110111112113. It seems that the duration of the effect depends in part on the duration of SLIT itself [233, 234]. Nevertheless, virtually no studies evaluate efficacy in terms of optimal duration. "
    [Show abstract] [Hide abstract] ABSTRACT: Specific sublingual immunotherapy (SLIT) has been proved to be a safe and effective approach in respiratory allergy. However, further research is required on aspects such as patient selection, use of optimal dosing, effects on asthma, long-term effects, and management of adverse reactions. In addition, the widely heterogeneous nature of studies on SLIT performed to date and the application of the criteria for subcutaneous immunotherapy make it difficult for the prescribing clinician to draw accurate and useful conclusions. Therefore, the QUASAR Group (QUality in the Administration of SLIT in Allergic Rhinitis), which comprises allergologists with broad clinical experience in SLIT, investigated the latest research findings and available data on this approach. Working parties were formed in 3 different categories: selection of candidates for SLIT, treatment efficacy, and adverse reactions. We performed a PubMed search for articles that were representative of each category and found 850. From these, we finally selected 266 articles, which were reviewed to retrieve data on SLIT. Evidence for each clinical question was graded according to the Oxford classification. The resulting text was evaluated on 3 occasions by all the members of the group until the final version was agreed upon. In this version, we review available evidence on SLIT, particularly with pollens, which is the subject of most articles. In areas where evidence is insufficient, an alternative agreed upon by the members of the QUASAR group is presented. Finally, we propose algorithms for selecting candidates for SLIT and for management of adverse events.
    Full-text · Article · Jul 2014
    • "These effects are due to complex, profound and persistent modifications in the immune response to allergens [27]. There is a study showed greater improvement in 70 patients with dust mites AR treated with SLIT in 3 years compared with 67 patients treated for 2 years [28] . In another prospective open controlled study, 4 groups of mono-sensitized patients to mites received drug treatment only and another 3 groups received SLIT for 3, 4, or 5 years and all groups were observed for 15 years. "
    [Show abstract] [Hide abstract] ABSTRACT: Allergic rhinitis (AR) is a globally increasing health problem affecting the quality of life. Specific immunotherapy is an available causal treatment changing the basic allergic mechanisms of the disease. Over one hundred years, subcutaneous immunotherapy (SCIT) was developed and proved its efficacy but many adverse effects were recorded including anaphylaxis. In 1986, sublingual immunotherapy (SLIT) was introduced as an alternative solution to solve this problem. Our study aims to discuss SLIT from the points of efficacy, safety, adherence and guidelines developed. A literature search was conducted in Medline/PubMed and the Cochrane Library in January 2013 using the keywords "allergic rhinitis, sublingual immunotherapy, efficacy, safety, compliance, adherence, guidelines." All types of publications were included. We augmented our study by searching the reference lists of identified reviews. SLIT has been established in many guidelines as an evidence-based effective treatment in AR with safer profile than SCIT. The meta-analyses confirmed its efficacy and showed a significant reduction in both symptoms and medication scores. The most common recorded adverse effects were minor local effects in the mouth, gastrointestinal reactions with few cases of anaphylaxis and no fatality. Adherence is more favorable for SLIT mainly because it is safe, noninvasive and easily taken at home. We support the call to conduct large multi-centric studies to gain more statistical power and overcome the problem of heterogeneity observed in the meta-analyses.
    Full-text · Article · Apr 2013
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