Sublingual Immunotherapy Effective and Long-Lasting in Children

Emma Hitt, PhD

March 10, 2003

March 10, 2003 (Denver) — Efficacy of sublingual immunotherapy appears to be maintained for four to five years after therapy is discontinued, researchers reported here at the 60th meeting of the American Academy of Allergy, Asthma, and Immunology on Saturday.

Studies have suggested that sublingual immunotherapy is safe and effective, but perhaps less effective than injection immunotherapy, and its long-term efficacy is unclear.

Giovanni Passalacqua, MD, from the Department of Internal Medicine, Genoa University, Italy, and colleagues evaluated whether sublingual immunotherapy provides long-lasting efficacy in a prospective study of 60 children (mean age, 8.5 years) with allergic asthma or rhinitis due to mites.

Subjects were subdivided into two groups. One group underwent a four- to five-year course of immunotherapy with a standardized extract of drops placed sublingually and drug therapy; the other group received only drug therapy.

At baseline, the end of treatment, and four to five years after treatment discontinuation, researchers determined the presence of asthma, use of anti-asthma drugs, and specific IgE levels.

In the sublingual immunotherapy group, the presence of asthma was significantly reduced compared with the control group ( P < .001), as was the use of asthma medications ( P < .01), Dr. Passalacqua and colleagues reported.

The peak expiratory flow rate increased over time in the immunotherapy group but not in the drug therapy only group. No changes were seen in new sensitizations in either group. In the drug therapy group, but not the sublingual immunotherapy group, specific IgE increased marginally over the course of the 10-year study ( P = .06).

The researchers conclude that "sublingual immunotherapy is effective in children and that it maintains the clinical efficacy for 4 to 5 years after discontinuation."

"One of the concerns about sublingual immunotherapy is that the long-term effects have not been demonstrated, but now we have done this," Dr. Passalacqua told Medscape. "These findings suggest that sublingual immunotherapy should become more accepted in clinical practice," he added.

Dr. Passalacqua noted that he and his colleagues have been using sublingual immunotherapy in their clinic for the past 10 years. "The effect is likely to last longer than four to five years, although we do not have data to support this."

Ronina Covar, MD, an allergy/immunology specialist at the National Jewish Medical and Research Center in Denver, Colorado, told Medscape that the study was interesting but that an important issue is how asthma symptoms were determined, and this is not clear.

"From this study, it looks as though they have cured asthma with sublingual immunotherapy, which is an important finding, but it will all depend on how they evaluated asthma," Dr. Covar said.

She also pointed out that the study did not appear to be randomized.

AAAAI 60th Annual Meeting: Abstract 7. Presented March 8, 2003.

Reviewed by Gary D. Vogin, MD

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