Role of Sublingual Immunotherapy in Management of Patients with Moderate to Severe Allergic Rhinitis

Abstract Background Specific immunotherapy is the only effective etiological treatment for allergic rhinitis. Subcutaneous immunotherapy has several disadvantages like inconvenience, invasiveness, potentially severe systemic reaction and poor compliance. SLIT as an alternative route has been demonstrated. The safety and efficacy of sublingual immunotherapy (SLIT) have been confirmed by many studies. However, in Egypt, the research on efficacy and safety in patients with allergic rhinitis (AR) is still has to be elucidated. Objective The aim of this prospective study is to evaluate the efficacy and safety of SLIT in moderately to severe monosensitized and polysensitized allergic rhinitis patients. Methods In this study, 75 patients with moderate to severe allergic rhinitis were randomized to receive SLIT (n = 50) or placebo (n = 25) for one year duration. Evaluation of the patients regarding TNSS, RQLQ scores, TMS and VAS score were performed at baseline, and then at 6 and 12 months of therapy. Allergen specific IgG, nasal smear for eosinophilic count were studied at baseline and 12 months. Results A total of 40 of 50 SLIT and 20 of 25 placebo patients completed the study. SLIT demonstrated a significant reduction of miniRQLQ score (p<.001), (TNS) (p<.001), (TMS) (p<.001) and VAS (p<.001) when compared with placebo. In objective parameters, Serum sIgG levels increased significantly in the SLIT group at 12 months (13.36 to 35.19) compared with placebo group (7.72 to 9.82) (p<.001). Nasal smear for eosinophilic count significantly decreased in SLIT group at 12 months (from 1.477 to 0.542) compared to placebo (1.547 to 1.409) (p =.012). No relevant systemic symptoms were registered, the only advere events occurred in SLIT group was oral itching and tingling with no effects on patient contiuity of the study Conclusion SLIT is effective, safe and well tolerated treatment for allergic rhinitis and the clinical efficacy on rhinitis symptoms was more evident when compared with the placebo.