Comparative evaluation of the efficacy, safety and economic costs high-dose and low-dose allergen specific immunotherapy with pharmacological therapy in patients with atopic bronchial asthma
Vitebsk State Medical University
The purpose of this research is to provide a comparative evaluation of the efficiency and safety of low-dose oral allergovaccines AV-1P and AV-2P with l high-dose oral and subcutaneous allergen specific immunotherapy (ASIT) in patients with atopic brochial asthma (ABA).
Methods. The study involved 213 patients with ABA. Treatment was carried out in groups: high-dose oral allergovaccine “Domal”, low-dose oral allergovacines AV-1P and AV-2P, subcutaneous ASIT, drugs according to protocol asthma, placebo. We studied the efficiency of the therapy on a 4-point rating scale, the dynamics of skin sensitization to the allergen, the level of IgE-antibodies in the serum of patients.
Results. Treatment of high-dose oral allergovaccine “Domal” and low-dose oral allergovaccines AV-1P and AV-2P was more effective as compared with subcutaneous ASIT (r = 0.04, p = 0.004 , p = 0.04) and pharmacotherapy (p = 0.04; p = 0.005; p = 0.01). In all groups, the efficiency of treatment was was higher than placebo. ASIT modulated serum level of specific IgE and reduction of allergen - induced early cutaneous responses (p <0,05). The frequency of adverse reactions, their severity and duration of an oral high-dose and low-dose ASIT were lower compared to subcutaneous ASIT (p <0,05). The cost of treatment with low-dose oral allergovaccines 10 times smaller than the oral high-dose allergovaccine “Domal” and 3 times less subcutaneous ASIT.
Conclusions. Oral administration of high and low doses of allergens induces imunological tolerance, is highly secure and easy to use. The additional benefit of low-dose oral allergovaccines is their low cost. The use of low-dose oral allergovaccines is an effective method of pathogenetic treatment of atopic brochial asthma.