Subcutaneous Versus Sublingual Immunotherapy for Allergic Rhinitis and/or Asthma

Nerin Nadir Bahceciler; Nazan Cobanoglu

Disclosures

Immunotherapy. 2011;3(6):747-756. 

In This Article

Subcutaneous Immunotherapy Compared With Sublingual Immunotherapy

There are a few number of studies including comparison of SCIT versus SLIT to date.[105–108] In a study including asthmatic adults sensitized to HDM, patients were randomized to receive either SCIT, SLIT or placebo. SCIT for 1 year significantly improved asthma and rhinitis symptom scores, whereas only rhinitis symptom scores improved in the SLIT group.[107] Meanwhile, both groups demonstrated significant decrease in medication scores in comparison with baseline values. The placebo group demonstrated no significant changes in any of the evaluated parameters. In another double-blind, controlled study in which SLIT was compared with SCIT, both symptom and medication scores improved in the treatment groups compared with placebo as well as baseline.[105] The rhinitis score decreased by 0.75 in the SCIT group and 0.36 in the SLIT group. In another study conducted in an open fashion in which patients receiving alternaria SLIT for 2 years were compared with those receiving SCIT, rhinitis scores improved more than that in the SCIT group.[106] A double-blind, double-dummy study compared SCIT with SLIT in patients sensitized to grass pollen. Significant improvements were detected in symptom and medication scores in both groups. Immunological parameters including IgG, specific IgG4 and skin reactivity improved only in the SCIT group.[108]

In a very recently published study, clinical efficacy and immunological mechanisms of SCIT and SLIT were compared in children with asthma/rhinitis sensitized to HDM. This was a prospective, open-labeled and randomized study, comparing children in this respect for the first time. A total of 48 children were randomized to receive either SCIT, SLIT or pharmacotherapy alone. SLIT and SCIT demonstrated a significant reduction of total rhinitis, asthma, medication and visual analog scale scores, skin reactivity to HDM when compared with pharmacotherapy. Moreover, titrated nasal provocative dose significantly increased in both immunotherapy groups when compared with pharmacotherapy. No adverse events were reported in SLIT, while two patients in the SCIT group developed serious adverse events following injection. Der p 1-driven IL-10 significantly increased in the SCIT group at the end of 1 year. Interestingly, although Bet v 1 was used as a negative control for PBMC cultures, Bet v 1-driven TGF-β increased significantly in the SLIT group at the end of 1 year. This result led to the speculation that increases of Bet v 1-driven TGF-β (an allergen that the patients were not sensitized to) could possibly point to the mechanism of action in the prevention of new sensitizations following SIT.[109] In a more recent open-labeled, prospective study of the same group conducted on asthmatic children sensitized to HDM, patients were randomized to receive either SCIT, SCIT plus SLIT, SLIT or pharmacotherapy. Children were followed for a duration of 12 months and were evaluated for symptom/medication scores, allergen-specific nasal reactivity and Der p 1-driven cytokine responses at baseline, 1, 4 and 12 months. An earlier improvement in symptom and medication scores was detected in the SCIT group, whereas later in the SLIT group (4 vs 12 months). Positivity of allergen-specific nasal provocation test significantly decreased at 4 and 12 months of both SCIT and SLIT groups when compared with pharmacotherapy group. There was no significant difference in cytokine levels at baseline and 1 month. At the fourth month, the SCIT group demonstrated higher levels of Der p 1-driven IL-10 and IFN-γ while the SLIT group demonstrated higher IL-10 and TGF-β. Both immunotherapy groups demonstrated significantly higher allergen-driven IL-10 and TGF-β at 12 months when compared with pharmacotherapy group. This is the first study comparing the kinetics of allergen-driven cytokine secretion of SLIT and SCIT throughout 12 months of treatment.[110]

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