Long Term Prevention of Asthma and Rhinitis in Children with Atopic Dermatitis Four-Year After Discontinuation of Sublingual Immunotherapy

Background: Atopic Dermatitis is a disease with high prevalence in Italy (about 15% of the population). As known, Atopic Dermatitis is often associated with respiratory allergy to mite.We previously showed that sublingual immunotherapy (SLIT) to mite has a beneficial clinical effect in  patients with allergic extrinsic Atopic Dermatititis (AD). To investigate the long term  effects, we performed a 4-year follow up after the termination of SLIT.

Methods: 46 children with AD, aged 5-16 years and allergic to mite were re-assessed 4 years after discontinuation of a 2-year course of SLIT (or placebo). Methacholine provocation tests were carried out at baseline, after 2 years (when SLIT was stopped) and after 4 years. The development of asthma and rhinitis was assessed by clinical evaluations.

Results: The children who previously had received SLIT had significantly less asthma after 6 years as evaluated by clinical symptoms: odd ratio 3.73 (0.130 vs 0.511; P=0.02) as compared to the former placebo group. In addition, significantly less patients reported an increase in asthma scores  P= 0.003. A significant difference in bronchial methacholine responsiveness was found between the two groups (P=0.03), with an overall lower bronchial hyperreactivity in children  who previously received active SLIT.

Conclusions: A 2-year course of SLIT to mite provided a long term clinical effect and prevented the development of  asthma in children with allergic extrinsic form of Atopic Dermatitis.