Comparison between the effect of both subcutaneous and sublingual immunotherapy on cutaneous reactivity

Comparison between the effect of both Subcutaneous and Sublingual Immunotherapy on Cutaneous reactivity

Nasser Al-Ahmed, Nermina Arifhodzic, Mona Al-Ahmad, Ali Al-Enezi

Department of Allergy, Al-Rashed Allergy Centre, Ministry of Health,

State of Kuwait

Background: Allergen-specific immunotherapy (SIT) is associated with multiple clinical benefits including reduction of the rate of new sensitization, reduction in asthma development in certain population, and reduction in the severity of allergic airway disease and symptom-medication score. This is true for both routes though which such novel and highly selective treatment is mostly administered, namely sublingual and subcutaneous immunotherapy. In this study, we evaluated the effect of both forms of SIT on the wheal size for the most important outdoor allergens in our environment.

Methods: 59 children (mean age 14.2 years) with SAR due to sensitization to local pollen allergens (Bermuda grass and /or Salsola kali) finished a 3-year course of SIT after random allocation. 25 received SLIT and 34 received SCIT. Wheal size of allergens used in the SIT was compared before and after treatment course. Allergen extracts for both testing reagents and immunotherapy were prepared by Stallergenes, France.

Results: In the group received SCIT; there was a significant decrease in the mean wheal size for Salsola kali from 6.12 mm to 3.56 mm, and Bermuda grass from 4.65 mm to 2.82 mm (t test: p= 0.001 and p=0.004 respectively). Also, the group received SLIT had a significant reduction in mean wheal size for both Salsola kali and Bermuda grass, from 8.44 mm to 5.60 mm, and 5.08 mm to 3.04 mm, respectively (p= 0.004 and p=0.004, respectively).

Conclusion: Our study demonstrates that after a 3-year course of treatment; both modalities for administering immunnotherapy, i.e: SLIT and SCIT, result in a significant decrease in mean wheal size for pollen relevant to our desert country. This can be a confirmation for the role of both forms of SIT in modifying the nature of IgE-mediated diseases.

Key words:  SIT= Allergen-specific immunotherapy, SLIT = Sublingual immunotherapy, SCIT= Subcutaneous immunotherapy, SAR= Seasonal allergic rhinitis.