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Injective versus sublingual immunotherapy in Alternaria tenuis allergic patients
P Bernardis1, M Agnoletto, P Puccinelli
1Institute of Immunology, Universidad Austral de Chile, Valdivia, Chile.
Abstract:
Little knowledge is available on molds either from the environmental or clinical points of view. The latter is mainly due to the lack, until recent times, of purified and standardized extracts. Injective immunotherapy, largely used for patients allergic to mites and pollens, is regarded with some concern for molds. On the other hand, mold-related allergic symptoms (i.e.,from Alternaria tenuis) have in Italy an incidence of about 5 percent, mainly in young patients. We have therefore run a pilot study comparing the efficacy and safety of injective (SIT) and sublingual (SLIT) immunotherapy by administering the same purified and standardized extract of Alternaria tenuis to a total of 23 patients for two years, according to an open experimental plan. Excellent tolerance was shown to SLIT while four (two medium-grade) side effects appeared with SIT. Clinical improvement, subjectively stated comparing symptoms (mainly rhinitis) and drug consumption before and after the therapy, confirmed by an increase in the Specific Nasal Provocation threshold, was obtained with both therapies, but with a statistically significant difference in favour of SLIT. Skin reactivity and blood Alternaria tenuis specific IgE, total IgG and IgG changed in the SIT-treated group, while no statistically significant change was shown in the SLIT-treated group. These results are in good agreement with previous reports on SIT and SLIT with other inhalant allergens (mites, grasses), and suggest the potential use of SLIT for Alternaria allergy, mainly in young patients, when there are concerns about the safety of and compliance with the traditional injective therapy.
Insights
Sublingual immunotherapy (SLIT) shows excellent tolerance and clinical improvement for Alternaria allergy, making it a promising alternative to traditional injective immunotherapy (SIT), especially for young patients.
Area of Science:
- Allergology
- Immunology
- Environmental Health
Background:
- Limited knowledge exists regarding clinical aspects of mold allergies.
- Standardized mold extracts for immunotherapy have only recently become available.
- In contrast to mite and pollen allergies, mold immunotherapy faces safety concerns.
Purpose of the Study:
- To compare the efficacy and safety of sublingual immunotherapy (SLIT) versus traditional injective immunotherapy (SIT) for Alternaria tenuis allergy.
- To evaluate clinical outcomes and immunological changes in patients receiving either SLIT or SIT.
Main Methods:
- A pilot study was conducted over two years with 23 patients.
- Patients received a purified and standardized Alternaria tenuis extract via either open-label SLIT or SIT.
- Clinical symptoms, drug consumption, and immunological markers were assessed.
Main Results:
- SLIT demonstrated excellent tolerance with no significant side effects.
- SIT resulted in four side effects, two of medium grade.
- Both SLIT and SIT improved clinical symptoms and nasal provocation thresholds, with SLIT showing a statistically significant advantage.
- SLIT did not induce significant changes in skin reactivity or specific IgE/IgG levels, unlike SIT.
Conclusions:
- SLIT is a safe and effective treatment for Alternaria allergy, particularly in young patients.
- SLIT offers a viable alternative to SIT, addressing safety and compliance concerns associated with traditional injective methods.
- The findings support the broader application of SLIT for inhalant allergen immunotherapy.