Clinical efficacy of subcutaneous immunotherapy given as a single and mixture of two non-cross reactive allergens in patient with seasonal allergic rhinitis

Clinical efficacy of subcutaneous immunotherapy given as a single and mixture of two non-cross reactive allergens in patient with seasonal Allergic rhinitis

Nermina Arifhodzic, Mona Al-Ahmad, Nasser Al-Ahmed, Ali Al-Anezi, Radakrishna Paniker, Nasser Fakim, Nasser Behbehani

Allergy Centre, Kuwait

 

Background: Subcutaneous specific immunotherapy (SCIT) has a proven efficacy in treatment of patients with severe form of seasonal allergic rhinitis.

Aim of the study: To assess therapeuticall effect of SCIT in seasonal allergic rhinitis patients treated with single or mixture of two non - cross reactive allergens extract.

Patients and Methods: In cohort of 187, one hundred and six patients (mean age 30.4±13.1, 69 male) completed 3- years SCIT course. Patients received either single allergen vaccine in 100% concentration (Stellergenes, Alustal), accordingly to their clinical symptoms (related to the pollination of particular plants) and results of skin prick test. Bermuda grass SCIT given in 14% of patients, Salsola kali in 35% of patients, while 51% of patients received mixture of both Salsola and Bermuda (50% + 50%). After up-dosing phase, the treatment continued with monthly injection of maintenance dose (0.8 ml/IR300). Reduction in total clinical symptom score (TCSS) was  calculated from dairy card records done in the peak of pollen season before beginning of SIT and 3 years later: reduction less than half considered as  a poor response; more than half considered good/ very good improvement.

Results:  There was no statistically significant difference in clinical efficacy between 2 groups of patient. Very good clinical response was seen in 71.4 %, patients treated  with grass allergen vaccine, 64.3 % weeds and 84.6% patients treated  with mix of both (p= 0.4). Very small number of patients (8.8%) did not find significant benefit of SIT if they compare it with previous drug therapy only, especially in patients treated with weed allergen extract. (14.3%)

Conclusion: SCIT with single or mixture of 2 allergens vaccine has similar clinical effect in majority of our patients.  Treatment with high dose of well standardized allergen, through long enough period of time is successful even if combination of 2 non-cross reactive allergens..

Key words: subcutaneous immunotherapy, single allergen vaccine, combined allergen vaccine