Assessment of sublingual immunotherapy efficacy in children with house dust mite-induced allergic asthma optimally controlled by pharmacologic treatment and mite-avoidance measures

Although several studies have demonstrated the efficacy of subcutaneous immunotherapy in allergic asthma, few have shown the same benefit using sublingual immunotherapy (SLIT) in asthmatic patients. This study was conducted to assess the efficacy of house dust mite (HDM) SLIT in addition to allergen...

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Bibliographic Details
Published in:	Pediatric allergy and immunology Vol. 18; no. 1; pp. 47 - 57
Main Authors:	Pham-Thi, Nhân, Scheinmann, Pierre, Fadel, Riad, Combebias, Anne, Andre, Claude
Format:	Journal Article
Language:	English
Published:	Oxford, UK Blackwell Publishing Ltd 01-02-2007 Blackwell
Subjects:	Administration, Sublingual Adolescent Adrenal Cortex Hormones - therapeutic use Allergens - administration & dosage Allergens - immunology allergy Animals Antigens, Dermatophagoides - administration & dosage Antigens, Dermatophagoides - immunology asthma Asthma - drug therapy Asthma - immunology Asthma - therapy Biological and medical sciences Child Child, Preschool Chronic obstructive pulmonary disease, asthma corticosteroids Dermatophagoides pteronyssinus Desensitization, Immunologic - methods Double-Blind Method Female house dust mite Humans Immunopathology Male Medical sciences Pneumology Pyroglyphidae - immunology Quality of Life sublingual immunotherapy Human Immunopathology Lung disease Allergy Corticosteroid Desensitization house dust mite Respiratory disease Treatment efficiency House dust Sublingual administration Mite Asthma Immunology Treatment corticosteroids Bronchus disease Obstructive pulmonary disease sublingual immunotherapy Child
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Summary:	Although several studies have demonstrated the efficacy of subcutaneous immunotherapy in allergic asthma, few have shown the same benefit using sublingual immunotherapy (SLIT) in asthmatic patients. This study was conducted to assess the efficacy of house dust mite (HDM) SLIT in addition to allergen avoidance and standard pharmacologic treatment. A double‐blind, placebo‐controlled trial was performed in 111 children (aged 5–15 yr) with HDM‐induced mild‐to‐moderate asthma. After a 4‐week baseline phase, patients were randomly assigned to receive SLIT with tablets of HDM extract (n = 55) or placebo (n = 56) for 18 months. Pharmacologic treatment was adjusted every 3 months following a step‐down approach. Asthma symptom scores, reduction in use of inhaled corticosteroids and inhaled β2‐agonists, rhinitis symptoms, lung function tests, skin sensitivity to HDM, dust mite‐specific immunoglobulin (Ig) E and IgG4, and quality of life (QoL) were assessed during the study. After 18 months of treatment, diurnal and nocturnal asthma symptoms scores did not show significant differences between SLIT and placebo groups. Inhaled corticosteroids and inhaled β2‐agonists use was reduced in both groups without significant differences between groups. There were no significant differences in lung function (forced expiratory volume in 1 s and peak flow rate variations) between groups. Rhinitis symptom score decreased in both groups, with no difference between the two groups. The severity dimension of QoL was significantly improved in the SLIT group (age 6–12 yr). SLIT induced a significant reduction of skin sensitivity to HDM (p < 0.01) and a significant increase in HDM‐specific IgE and IgG4 antibodies (p < 0.001) in the SLIT group compared with the placebo group. SLIT was well tolerated with mild/moderate local adverse events. No severe systemic reactions were reported. This study indicates that, when mild–moderate asthmatic children are optimally controlled by pharmacologic treatment and HDM avoidance, SLIT does not provide additional benefit, despite a significant reduction in allergic response to HDM. Under such conditions, only a complete, but ethically unfeasible, discontinuation of inhaled corticosteroid would have demonstrated a possible benefit of SLIT.
Bibliography:	ArticleID:PAI475 istex:4694B6B9B2D83E0074B6857D1BE3FEF6D5712DA6 ark:/67375/WNG-FDPRVSBD-6 Acknowledgments . The members of the study group are listed in the ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-News-1 ObjectType-Feature-3
ISSN:	0905-6157 1399-3038
DOI:	10.1111/j.1399-3038.2006.00475.x