Efficacy of sublingual immunotherapy in children with asthma and rhinitis: A double‐blind, placebo‐controlled study

Abstract

To evaluate the efficacy of specific sublingual immunotherapy (SLIT), we enrolled 15 children with asthma and rhinitis (7 girls, 8 boys, mean +/- SD age of 11.7 +/- 3.3) allergic to house dust mite (HDM) into a double-blind, placebo-controlled study. After a run-in period, patients were randomized to receive either placebo (n = 7) or SLIT (n = 8) with a standardized Dermatophagoides pteronyssinus (D. pteronyssinus) + Dermatophagoides farinea (D. farinea) 50/50 extract. They received increasing doses up to 100 index units of reactivity (IR) every day for 4 weeks, then 100 IR/day for another 4 weeks, followed by maintenance therapy consisting of 20 drops 2 times a week for 4 months. Efficacy was assessed at the end of 6 months of therapy according to symptom and medication scores, serum total IgE levels, results of lung function tests, methacholine provocation tests, and skin prick tests. Daily means for the asthma score and use of inhaled beta-2-mimetics decreased significantly in the SLIT group (P = 0.05, P = 0.028, respectively), whereas no such difference was observed in the placebo group. At the end of follow-up, mean daily doses of intranasal steroids needed for control of rhinitis symptoms decreased significantly in the SLIT group (P = 0.04). Baseline skin sensitivity to D. pteronyssinus and D. farinea was not significantly different between in the two groups, whereas end-point wheal diameter obtained with D. pteronyssinus extract was significantly less in the SLIT vs. the placebo group (P = 0.026). At the end of 6 months, peak expiratory flow (PEF) values in the placebo group was significantly lower than in the SLIT group (P = 0.049). Throughout the treatment period, the SLIT group was found to have less asthma exacerbations than the placebo group (P = 0.007). The provocation concentration causing a 20% drop in forced expired volume in 1 sec did not change throughout the treatment period in either groups. None of the patients reported local or systemic side effects from SLIT. Results of this study suggests that SLIT may be a useful alternative or additional therapy in the treatment of children with asthma/rhinitis due to HDM.

Sublingual Immunotherapy in the Treatment of Allergic Asthma: A Systematic Review With Meta-Analysis

“…Bahçeciler et al 19 found similar results to those by Aydogan et al 18 with regard to sensitization to HMD. At the end of the study, there was a reduction in the use of nasal corticosteroids to control rhinitis symptoms in the SLIT group compared with the placebo group (p = 0.004).…”

Allergen-Specific Immunotherapy for Pediatric Asthma and Rhinoconjunctivitis: A Systematic Review

“…25,28 Five studies demonstrated significant improvement in rhinitis/ rhinoconjunctivitis scores with SLIT, compared with placebo, with moderate to strong magnitudes of effect. 33,34,[36][37][38] Four studies did not show significant improvement with SLIT, 25,26,29,32 and 1 of these favored placebo. 26 The strength of evidence is moderate that SLIT improves rhinitis symptoms.…”

“…[22][23][24][32][33][34][35]37,38 Seven studies evaluated dust mite allergen. [22][23][24][32][33][34]38 The SLIT-treated children in the placebo-controlled studies demonstrated moderate to strong improvement in asthma symptoms. The risk of bias was low in 3 studies.…”

“…[25][26][27][28][29][32][33][34][35][36][37][38] One-half of the studies evaluated dust mite allergens. 25,26,[32][33][34]38 Risk of bias was low in 4 studies, 27,29,32,34 medium in 6 studies, 26,33,[35][36][37][38] and high in 2 studies. 25,28 Five studies demonstrated significant improvement in rhinitis/ rhinoconjunctivitis scores with SLIT, compared with placebo, with moderate to strong magnitudes of effect.…”

“…[22][23][24][25][26][27][28][29]32,33,[35][36][37] Six studies evaluated dust mite allergen. [22][23][24][25][26]32 The placebo-controlled studies demonstrated significant reductions in medication use in the SLIT group relative to the placebo group, with moderate to strong magnitudes of effect in patients with asthma and/or rhinitis.…”