Impact on quality of life and safety of sublingual and subcutaneous immunotherapy in children with severe house dust mite and pollen-associated allergic rhinoconjunctivitis

Abstract

Background: Pollen and house dust mite (HDM) subcutaneous immunotherapy (SLIT) and pollen subcutaneous immunotherapy (SCIT) are effective therapies for children with allergic rhinoconjunctivitis (AR). There are no previous direct comparative studies investigating quality of life (QoL) of all three immunotherapy regimes. The aim of this study was to compare QoL and safety in children receiving these immunotherapies for AR. Methods: Demographic characteristics, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and Visual Analogue (VAS) scores were assessed in 249 children undergoing HDM and pollen immunotherapy at a UK specialist paediatric centre between 2007 and 2019. Results: All three immunotherapy regimes led to a > 50% improvement in QoL and VAS after 3 years of therapy, with significant improvements by the end of the first year (p < 0.05) and further improvements between 1 and 3 years (p < 0.05). Age, gender, ethnicity and route of administration had no significant bearing on efficacy. Older, polysensitised children and those receiving HDM SLIT were all more likely to discontinue their treatment (all with p < 0.05). The only patient to suffer from anaphylaxis requiring intramuscular adrenaline, and 80% experiencing exacerbations of their asthma had received pollen SCIT. Conclusions: Pollen SCIT and pollen and HDM SLIT all lead to significant improvements in QoL. The risk of anaphylaxis is low, but SCIT is associates with a 1 in 5 chance of asthma flares in the days after its administration. Discontinuation of therapy is more frequent in older, polysensitised children, and those undergoing HDM immunotherapy.

Sublingual immunotherapy for pediatric patients with mite allergies

“…[ 25 ] A randomized, placebo-controlled trial conducted among Japanese children aged 5 to 17 years found that daily administration of house dust mite tablets was associated with a reduced total combined rhinitis score (symptoms and medications) and was effective in both children and adolescents. [ 26 ] A randomized, placebo-controlled trial of 15 Turkish children found that SLIT improved the symptoms of rhinitis and asthma. [ 27 ] A trial comparing SLIT to SCIT and pharmacotherapy found that both SLIT and SCIT were associated with clinical improvement in rhinitis and asthma; however, severe adverse events were more common with SCIT.…”

Assessment of Coronavirus disease, the nose pollution filter, fermented spicy Kimchee, and peppery hot soup consumed in Korea

“…Bousquet et al ( 2020 ) have found that reported Covid-19 deaths in Germany are relatively low as compared to many European countries, and among other factors that may be significant are the dietary habits. Germans and Ukrainians consume pickled sauerkraut from time to time, along with regular consumption of alcoholic beer.…”

Update on pathomechanisms and treatments in allergic rhinitis

“…A real‐world allergy immunotherapy (REACT) retrospective cohort study assessed the long‐term and sustained effectiveness of AIT in AR using data collected between 2007 and 2017 and suggested that patients receiving AIT had a reduced likelihood of asthma exacerbation and pneumonia 69 . Notably, both HDM‐SCIT and HDM‐SLIT have proven to be safe and efficient in reducing nasal symptoms and corticosteroid use in preschool AR patients; however, multivariate logistic regression analysis has indicated that BMI and high serum HDM‐specific IgE represent some of the main risk factors associated with therapy‐related side effects 17,70–73 . Although most patients with HDM sensitivity are co‐sensitized with Der p and Dermatophagoides farinae (Der f), the consensus regarding the AIT protocol for polysensitized patients varies among different continents 74,75 .…”