Olea sublingual allergoid immunotherapy administered with two different treatment regimens

Abstract

Sublingual immunotherapy (SLIT) with monomeric carbamylated allergoid administered in accordance with the standard regimen has proven to be effective and safe. Achieving clinical benefit, however, requires a lengthy period of time so it is not very suitable for short-lasting allergies. We thus performed this study to compare an administration protocol starting in the coseasonal period (with a 4-day build-up phase) with a precoseasonal scheme to verify if the former regimen provides the same benefit in a shorter period of time. The prospective, randomized, drug therapy-controlled study was conducted in 33 rhinitic patients monosensitized to Olea with or without asthma. Ten patients were assigned to the coseasonal therapy with 5000 allergic units (AU)/week for 6 weeks, 11 to the precoseasonal therapy with 3000 AU/week for 10 weeks, and 12 to drug therapy. They were treated from April or May to June 2008. A visual analog scale (VAS) was performed at baseline and after treatment to assess the well being of the patients. Drug consumption was evaluated by means of a monthly diary. There was greater VAS improvement in both the SLIT groups versus the controls, but it was statistically significant only in the coseasonal group (p < 0.01). Furthermore, there was a reduction in the rescue medication only in the coseasonal SLIT (p < 0.05 versus drug therapy). One mild adverse event was observed. The allergoid SLIT was shown to be effective and safe in Olea allergy in particular when a coseasonal regimen was used.

Coseasonal Initiation of Allergen Immunotherapy: A Systematic Review

“…The frequency of discontinuation with coseasonal initiation was 7% or less in the remaining SLIT studies (see Table E4 in this article's Online Repository at www.jaci-inpractice.org). [17][18][19][20][26][27][28][29][30][31] This discontinuation rate is similar (ranges from 1% to 6%) to published data for treatment initiation outside of the season. 32,33 Systemic allergic reactions in SLIT coseasonal initiation studies…”

“…In the prospective, observational studies reported by Sieber et al, 16 the severe AEs were not specifically described, but 89% of all AEs (coseasonal and outof-season initiation combined) during titration were assessed as mild to moderate. In the prospective, open-label RCT reported by Leonardi et al,18 no severe AEs were reported with coseasonal initiation or preseasonal initiation. In the SLIT DBPC-RCT published by Reich et al, 30 the rate of severe AEs was 4% in subjects receiving coseasonal initiation versus 0% in subjects receiving placebo (Table E4).…”

“…Although the rate of systemic allergic reactions was not specifically reported in the prospective, observational study reported by Ariano et al, 17 it was noted that regardless of the timing of SLIT initiation (preseasonal, peak season, or after peak season), the systemic AEs were "mild and self-resolving." No systemic allergic reactions were reported in the prospective, observational study of coseasonal and postseasonal initiation by Schwab et al,20 or in the prospective, open-label RCT of coseasonal initiation, preseasonal initiation, and pharmacotherapy controls reported by Leonardi et al 18 In the 3 SLIT DBPC-RCTs, the rate of systemic allergic reactions ranged from 0.3% to 2% in subjects receiving coseasonal initiation and 0% to 1% in subjects receiving placebo (Table E4). [29][30][31] In a prospective, open-label RCT of coseasonal initiation versus pharmacotherapy, systemic allergic reactions occurred in 4% (n ¼ 2) of coseasonally initiated patients and 2% (n ¼ 1) of pharmacotherapy treated patients (Table E4).…”

“…Five SLIT studies directly compared coseasonal AIT initiation with out-of-season initiation (3 prospective, observational studies and 2 prospective, open-label, RCTs). [16][17][18][19][20] Study bias and quality are described in this article's Online Repository at www.jaciinpractice.org.…”

Evaluation of a sublingual immunotherapy solution in olive-induced respiratory allergy in Jordan: a retrospective observational study

“…They found that SLIT reduced dyspnea and conjunctivitis scores and cutaneous allergen reactivity compared with placebo 15. However, few subsequent studies have evaluated SLIT in olive-associated AR, and when so, such studies have been small, and/or of short duration 16. Patients with olive sensitivity usually form a minority of a larger study cohort 5,17…”