KHOA DICH VU HO HAP

Sublingual immunotherapy for allergic rhinitis (Review)

Radulovic S, Calderon MA, Wilson D, Durham S

(The Cochrane Collaboration and published in The Cochrane Library 2011, Issue 2)

INTRODUCTION Allergic rhinitis (AR): impair quality of life. affecting 10-40% of people worldwide The ARIA guidelines:

allergen avoidance: first-line treatment antihistamines, topical nasal corticosteroids: control symptom specific immunotherapy: severe disease (not respond to usual therapy)

curbing allergic disease: prevent increasing allergies, eczema, sinus infections, and even asthma

O B J E C T I V E S

To evaluate the efficacy and safety of sublingual immunotherapy for allergic rhinitis in adults and children.

M E T H O D S Types of studies: Randomised, double-blind, placebo-

controlled clinical trials. Types of participants: any age (children and adults). history of allergic rhinitis, with/without allergic conjunctivitis with/without allergic asthma. the allergen: identified. positive skin prick tests and/or high specific IgE

M E T H O D S Allergen: aero-allergens into seasonal, perennial: grass

pollen (23 studies), parietaria (5 ), ragweed (2), trees ( 9), house dust mite (8), cat (1 ).

Types of interventions: investigating the efficacy and safety of sublingual

immunotherapy. regardless of treatment dose, duration

M E T H O D STypes of primary outcome measures

Symptom scores rhinorrhea, nasal itching, nasal obstruction, and sneezing four-point scale: 0: no symptom; 1: mild; 2: moderate; up

to 3: severe.Medication scores: O point : local antiallergic medication 2 points: each tablet of antihistamine3 points: each dose of oral prednisolone, 0.50 mg

betamethasone.

M E T H O D STypes of Secondary outcome measuresMeasurement of serum IgE and IgGAllergen sensitivity (eye, nose or skin). Quality of life. Adverse event reports.

R E S U L T SDescription of studies

September 2002- August 2009 : 60 randomised controlled trials 49 studies (meta-analyses ): 2333 SLIT vs 2256 placebo 11 studies: adverse event data

15 studies in children reported: 702 SLIT vs 690 placebo 17 studies ( treated < 6 months): 890 SLIT vs 882 placebo 16 studies ( treated 6-12 months): 867 SLIT vs 869 placebo 16 studies ( treated >12 months): 580 SLIT vs 509 placebo

DISCUSSION (1) The treatment effect: children = adults, especially

symptom scores - 15 studies at children (Bufe 2009; Wahn2009)

The effect: perennial allergens (house dust mite) > seasonal – few studies => need more studies of perennial rhinitis.

Symptom score reduction: treatment for longer than 12 months are the best treatment (Dahl 2008; Durham 2010)=> recommendations or guidelines for the use of SLIT in allergic rhinitis.

Side effects: little distress, no lasting effect, rarely adverseto warrant withdrawal of treatment.

DISCUSSION (2)

Asthma or wheeze: no more likely in SLIT than in placebo.

Gastrointestinal effects: rare, more apparent in SLIT in paediatric trials.

No severe systemic reactions/anaphylaxis, none of using adrenaline.

=> SLIT safe treatment with low incidence of side effects.

C O N C L U S I O N

A reduction in SLIT: symptoms (SMD -0.49; 95% (CI) -0.64 to -0.34, P < 0.00001) medication requirements (SMD -0.32; 95% CI -0.43 to -0.21,

P < 0.00001) None severe systemic reactions/ anaphylaxis, none of

using adrenaline Further research : concentrate on optimising allergen

dosage and duration

Thanks for your attention!

OTHER Meta-analysis of the Efficacy of Sublingual

Immunotherapy in the Treatment of Allergic Asthma in Pediatric Patients, 3 to 18 Years of Age

Results:73 articles, 9 studies 441 patients: 232 SLIT vs 209 placebo Heterogeneity due to widely differing scoring systems A significant reduction: symptoms (SMD 1.14; 95% CI, 2.10 -0.18; p 0.02) medication use (SMD 1.63; 95% CI, 2.83 -0.44; p 0.007)