Standardized Quantitative Evaluation of Clinical Effectiveness and Side Effect Profile of Subcutaneous and Sublingual Allergen-Specific Immunotherapy in Children: A 5-Year Single Center Experience

IF 0.3 Q4 ALLERGY

Astim Allerji Immunoloji Pub Date : 2021-12-22 DOI:10.21911/aai.652

Nazan Tökmeci, A. Demirhan, Merve TURKEGUN SENGUL, Burcu CAGLAR YUKSEK, Aylin KONT ÖZHAN, T. Arıkoğlu, S. Kuyucu

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Abstract

Objective: Allergen-specific immunotherapy (allergen-SIT) is a treatment method with variable efficacy in allergic diseases. This study aimed to investigate the effectiveness of allergen immunotherapy, frequency of LRs and SRs and variables affecting these parameters in patients who underwent allergen-SIT. Materials and Methods: In this study, the recorded data of 81 patients, who received subcutaneous (SCIT) or sublingual (SLIT) allergen immunotherapy for respiratory allergic diseases between 2014 and 2019, were analyzed. In asthma and/or allergic rhinoconjunctivitis (ARC) patients, the effectiveness of treatment was evaluated by analysing the change rates in disease symptom, medication and combined scores (symptom + medication) and visual analog score (VAS). Treatment success was defined by the degree of decrease in scores as; high response above 50%; low response between 20-50%; and failure <20%.Results: The mean age of allergen-SIT initiation was 11.4± 3.1 years. Diagnostic distributions of the patients were asthma (± ARC) in 64.2%, and ARC (without asthma) in 35.8%. The mode of allergen-SIT was SCIT in 77.8% (65% asthma and 35% ARC) and SLIT in 22.2% (61.1% asthma and 38.9% ARC). The main allergens used in allergen-SIT were mite (79%), grass-grain pollen (33.3%), alternaria (9.9%) and olea (8.6%). There was a significant decrease in symptoms, medication, combined and VAS scores in the asthma and ARC groups (p <0.0001), when end-SCIT values were compared to baseline. SLIT also resulted in significant decreases in these scores except asthma medication score. Among the asthma patients the rate of high-responders was 88.8% by SCIT and 50% by SLIT, according to combined asthma score. Among the ARC (without asthma) patients the rate of high-responders was 100% for both SCIT and SLIT. SCIT resulted in local (LR) and systemic side effects (SR) in 18% and 0.6% (all Grade I and Grade II) of the total injections performed. A high number of total injections was significantly associated with higher LR and SR rates. While LR was observed in 16.6% of the patients who underwent SLIT, no systemic reaction was found in any of the patients. Conclusion: SCIT was highly successful in the treatment of asthma and ARC in terms of the degree of therapeutic response. SLIT resulted in a high rate of good response in ARC patients, but a lower response degree in asthmatic patients. Systemic side effects were very low as a result of close risk monitoring and the dose adjustments performed. Keywords: Allergen-specific immunotherapy, SCIT, SLIT, efficacy, symptom score, medication score, visual analog score, side effects

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儿童皮下和舌下过敏原特异性免疫治疗的临床疗效和副作用的标准化定量评估:5年单中心经验

目的：过敏原特异性免疫疗法（变应原SIT）是一种治疗过敏性疾病的疗效不一的方法。本研究旨在调查过敏原免疫治疗的有效性、LRs和SRs的频率以及影响过敏原SIT患者这些参数的变量。材料和方法：在本研究中，分析了2014年至2019年间接受皮下（SCIT）或舌下（SLIT）过敏原免疫疗法治疗呼吸道过敏性疾病的81名患者的记录数据。在哮喘和/或过敏性鼻结膜炎（ARC）患者中，通过分析疾病症状、药物和综合评分（症状+药物）以及视觉模拟评分（VAS）的变化率来评估治疗的有效性。治疗成功的定义是得分下降的程度为；50%以上的高响应；20-50%之间的低响应；结果：过敏原SIT发生的平均年龄为11.4±3.1岁。诊断分布为哮喘（±ARC）64.2%，ARC（无哮喘）35.8%。过敏原SIT模式为SCIT 77.8%（65%哮喘和35%ARC）和SLIT 22.2%（61.1%哮喘和38.9%ARC）。过敏原SIT中使用的主要过敏原是螨（79%）、草花粉（33.3%）、交链孢菌（9.9%）和油酸（8.6%）。当SCIT终点值与基线值相比时，哮喘组和ARC组的症状、药物、综合评分和VAS评分显著降低（p＜0.0001）。除哮喘药物评分外，SLIT也导致这些评分显著下降。根据哮喘综合评分，在哮喘患者中，SCIT和SLIT的高应答率分别为88.8%和50%。在ARC（无哮喘）患者中，SCIT和SLIT的高应答率均为100%。SCIT导致18%和0.6%（均为I级和II级）的局部（LR）和全身副作用（SR）。大量的总注射与较高的LR和SR率显著相关。虽然在接受SLIT的16.6%患者中观察到LR，但在任何患者中都没有发现全身反应。结论：SCIT在哮喘和ARC的治疗反应程度上是非常成功的。SLIT导致ARC患者的良好反应率较高，但哮喘患者的反应程度较低。由于进行了密切的风险监测和剂量调整，系统副作用非常低。关键词：过敏原特异性免疫疗法，SCIT，SLIT，疗效，症状评分，药物评分，视觉模拟评分，副作用

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Astim Allerji Immunoloji ALLERGY-

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期刊介绍： Asthma Allergy Immunology has been published three times a year in April, August and December as the official and periodical journal of the Turkish National Society of Allergy and Clinical Immunology since 2003. All articles published in the journal have been available online since 2003. A peer reviewed system is used in evaluation of the manuscripts submitted to Asthma Allergy Immunology. The official language of the journal is English. The aim of the journal is to present advances in the field of allergic diseases and clinical immunology to the readers. In accordance with this goal, manuscripts in the format of original research, review, case report, articles about clinical and practical applications and editorials, short report and letters to the editor about allergic diseases and clinical immunology are published in the journal. The target reader population of the Asthma Allergy Immunology includes specialists and residents of allergy and clinical immunology, pulmonology, internal medicine, pediatrics, dermatology and otolaryngology as well as physicians working in other fields of medicine interested in allergy and immunological diseases.