Atopic diseases have significant morbidity (M S Gold and A S Kemp, Atopic disease in childhood, Med J Aust 2005; 182 (6): 298-304.); in some harmful immunological processes progress leading to obstructive airway diseases. The improved delivery of effective immunotherapy is an attempt to reduce the disease burden among sufferers of limited resources. The conventional SCIT delivery has long duration also significant necessary precautionary care. SLIT immunotherapy is well established, SCIT rush immunotherapy also established. The present observation - SLIT rush immunotherapy has been tried to assess efficacy and Safety.
Methods:
186 subjects age 18 to 50 yrs (41.1% male) were selected with allergic urticaria and or allergic rhinitis from single practice over 6 months, in 2010. Lone Rhinitis 90 (48.38%), lone Urticaria 48 (25.80%) and Rhinitis with Urticaria 48 (25.80%). The specific allergen selected following modified skin reactivity test. Bronchial asthma and COPD were excluded. Subjects consented following comprehensive information and placebo demonstration. Each individual received antihistamine, levocetirizine 5 mg daily 2 days prior and continued till the second vial finished. The therapy consists of topical sublingual allergen extracts, 4 vials of rising concentrations; 1st vial 1:2500, 2nd vial 1:250, 3rd vial 1:25, and 4th vial 1:10 dil.
The 1st concentration , daily 6 hourly schedules in increasing quantities (drops).
Then, 5 drops 6 hourly till contents of vial is finished; 2nd Vial 5 drops twice a day for two weeks; 3rd Vial 5 drops once a week, three months; 4th Vial 5 drops weekly 3 months; Thereafter same concentration 5 drops weekly for 5 yrs.
Follow-up initially, daily 5 days; then weekly 5 weeks; next monthly for 6 months; then yearly for 5 years.
Drop out 40% in September 2012 follow-up, compliance of remainder reasonable to good.
Results:
Significant (p<0.001) decrease in IgE & increase IgG reported, pre and post test Day 0 and 56 respectively. Similarly 18.8% high, 63.4% medium, 17.7% low- symptomatic improved responses according to GRC score. In first week two individuals reported mild stomatitis resolved spontaneously in 2-3 days; light headedness on the first day 6-8 hours after commencement - 8 individuals. No long term adverse effect reported.
Conclusions:
The observational evidence of positive efficacy and safety of RUSH SLIT immunotherapy merits further probing: a designed clinical trial.