Long-term effects of sublingual immunotherapy (SLIT) in preventing the development of asthma in allergic rhinitis: Revision of 15-year follow-up
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
Background Sublingual immunotherapy (SLIT) has been shown to be effective in controlling the symptoms of allergic rhinitis and asthma, but few studies have assessed its long-term preventive effects on lower-airway inflammation and asthma onset. Objective We sought to evaluate prospectively the long-term effects of SLIT on lower-airway function in patients with allergic rhinitis caused by house dust mites (HDM). Methods We performed a post hoc analysis of a previously published prospective, open-label study involving patients with allergic rhinitis who were monosensitized to mites and followed for 15 years. All participants had bronchial hyperreactivity and were originally assigned to 4 groups receiving either pharmacological therapy alone or SLIT for 3, 4, or 5 years (SLIT 3, SLIT 4, and SLIT 5). Skin sensitization, methacholine reactivity, and respiratory function were evaluated annually during the winter months. Results Seventy-eight patients were enrolled, and 59 completed the study. Over 15 years of observation, new sensitizations occurred in all participants in the control group but in fewer than one-quarter of patients who received SLIT for 3, 4, or 5 years (21%, 12%, and 11%, respectively). Among patients with rhinitis treated only with intranasal corticosteroids and systemic antihistamines, the development of asthma, defined as a decline in FEV to below 80% of the predicted value, was observed in 58% (7 of 12). In contrast, progression to asthma was significantly less
Abstract
Background Sublingual immunotherapy (SLIT) has been shown to be effective in controlling the symptoms of allergic rhinitis and asthma, but few studies have assessed its long-term preventive effects on lower-airway inflammation and asthma onset. Objective We sought to evaluate prospectively the long-term effects of SLIT on lower-airway function in patients with allergic rhinitis caused by house dust mites (HDM). Methods We performed a post hoc analysis of a previously published prospective, open-label study involving patients with allergic rhinitis who were monosensitized to mites and followed for 15 years. All participants had bronchial hyperreactivity and were originally assigned to 4 groups receiving either pharmacological therapy alone or SLIT for 3, 4, or 5 years (SLIT 3, SLIT 4, and SLIT 5). Skin sensitization, methacholine reactivity, and respiratory function were evaluated annually during the winter months. Results Seventy-eight patients were enrolled, and 59 completed the study. Over 15 years of observation, new sensitizations occurred in all participants in the control group but in fewer than one-quarter of patients who received SLIT for 3, 4, or 5 years (21%, 12%, and 11%, respectively). Among patients with rhinitis treated only with intranasal corticosteroids and systemic antihistamines, the development of asthma, defined as a decline in FEV to below 80% of the predicted value, was observed in 58% (7 of 12). In contrast, progression to asthma was significantly less frequent among patients with rhinitis treated with SLIT, regardless of treatment duration: 1 of 14 patients in the SLIT 3 group (7%), 1 of 16 in the SLIT 4 group (6%), and 1 of 17 in the SLIT 5 group (6%). Conclusion In the long term, SLIT provided a significant clinical benefit in HDM-induced allergic rhinitis by reducing both the allergic march and asthma onset and by limiting the decline in lung function, as measured by FEV1. abs0010