Sublingual Allergoid Immunotherapy: A New 4-Day Induction Phase in Patients Allergic to House Dust Mites

Abstract

Sublingual immunotherapy with monomeric allergoid (allergoid SLIT), given according to the standard scheme, has proved effective and safe in many clinical trials. However, its build-up phase requires a long time ranging from 16 days to 14 weeks. This study therefore investigated whether, with a four-day up-dosing, the same benefit could be achieved in a shorter time. Thirty rhinitic and/or asthmatic patients (16 M and 14 F, mean age 36±8.2 years) allergic to house dust mites (HDM) with or without other sensitizations were randomized to allergoid SLIT or standard drug therapy. The build-up phase lasted four days. The first day the patients took a 300 AU tablet, the second day two 300 AU tablets, the third day three 300 AU tablets and the fourth day four 300 AU tablets. The total amount taken during the up-dosing was 3000 AU. Patients were then treated for 12 months at the dosage of 2000 AU/week (total amount of allergen: 104,000 AU/year). The symptom score and drug consumption were recorded from November to February on monthly diary cards. At baseline and after 12 months a Visual Analogue Scale (VAS) was used to rate the patients' well-being. Skin prick test reactivity was evaluated before and after the 12-month treatment in both groups using 10 mg/mL histamine as reference. VAS scores rose significantly (about 45%) in both groups in comparison to baseline (p=0.001). In addition, there was a significantly greater reduction of the global symptoms score (about 52%) - but not in drug consumption - in the SLIT group in comparison to controls (p=0.0004). The SLIT group showed a highly significant reduction (about 39%) in skin prick test reactivity (p=0.000003) while the control group remained unchanged (p=0.5226). No severe adverse events were observed. Even with this short four-day up-dosing, the allergoid SLIT proves to be safe. In addition, it is already effective in patients allergic to HDM after 12 months, and significantly reduces allergen-specific skin reactivity.

Asthma in Children and Adolescents: A Comprehensive Approach to Diagnosis and Management

“…While the (42) of these children was treated with a single allergen, seven were treated with two or more extracts and experienced benefit as well [156]. Studies on the efficacy of SLIT have been done for dust mite [157,158], Olea [159], grass pollen [160], and others. Other novel forms of immunotherapy include the development of allergen vaccines based on allergenderived T cell peptides, recombinant allergens, and hypoallergenic allergen derivatives [161].…”

A Review of Allergoid Immunotherapy: Is Cat Allergy a Suitable Target?

“…Not only could the general decrease in the symptom or medication score be validated in several allergoid studies, but also skin test reactivity and nasal reactivity decreased during active testing [28,76]. Significantly, greater reduction of global symptom scores and skin test reactivity in the active treatment group (compared with pharmacotherapy) could also be demonstrated: compared with the pharmacotherapy group, there was only a nearly significant decrease in drug consumption in the allergoid group, but overall, the allergoid group showed better results in general and an excellent safety outcome [77].…”

“…It would also be interesting to analyze clinical end points of allergoid SLIT and compare them to conventional SLIT or SCIT in terms of efficacy. The superiority of monomeric allergoids to pharmacotherapy or placebo has already been highlighted in many studies [46][47][48][49][50][51]53,55,[57][58][66][67]69,75,[77][78][79][80]. What is needed is proof that allergoids are able to scientifically and medically replace conventional SLIT or SCIT in order to enable a safer, and hence, improved method for the patient's state of health and quality of life.…”