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International journal of Immunopathology, allergology, infectology.

Sublingual-oral low-dose allergy vaccination in allergic and mixed bronchial asthma

Sidorenko E.V., Vykhristsenko L.R.

Vitebsk state medical University, Vitebsk, Belarus

The aim was to evaluate the efficiency of sublingual-oral low-dose allergen immunotherapy (SLIT) in allergic and mixed asthma (BA) and the factors affecting it in the real clinical practice.

Materials and methods. The study involved 112 patients of the allergology department of the Vitebsk Regional Clinical Hospital with allergic and mixed bronchial asthma aged 18 to 60 years, who received sublingual- oral low-dose allergy vaccination with household allergens and standard pharmacotherapy (PT). The total monthly dose of allergic vaccine was 0.6 μg (115 PNU), course - 6.85 μg (685 PNU), the duration of a course of allergen-specific immunotherapy was 6 months. We observed 34 patients with allergic BA (18 women, 16 men) aged 36.1 (18-58) years (group 1, SLIT) and

18 patients with mixed (allergic and non-allergic) BA (14 women, 4 men) aged 42,2 (19-59) years (group 2, SLIT), 30 patients (19 women, 11 men) with allergic BA at the age of 39.1 (23-59) years (group 3, PT) and 30 patients (22 women,
8 men) with mixed (allergic and non-allergic) AD at the age of 45.1 (21-60) years (group 4, PT). During the year, a comprehensive monitoring of the patients condition was carried out with an assessment of the need for short-acting β2-agonists, inhaled glucocorticosteroids (IGCS), the frequency of BA exacerbations, the level of BA symptom control (AST-test), and quality of life (AQ-20). We took into account the presence of factors affecting the course of asthma and the effectiveness of ASIT, the duration of post-immunotherapy remission.

The results of the study. The efficiency of treatment with a sublingual-oral low-dose allergy vaccine was confirmed by a decrease in the number of doses of short-acting β2-agonists used after 6 months in the group of allergic BA, with their complete withdrawal in both groups by 12 months (p <0.001). The need in IGCS decreased by 50% in patients of groups 1 and 2 during the year (p <0.001). There were no exacerbations of the disease (p <0.001), the quality of life improved, the level of asthma symptom control increased to controlled in 1 group patients after 6 months, in 2 group patients - after 12 months (p <0.001). The duration of remission was 2 years in 17.6% (6/34) of patients of 1 group, in 11.1% (2/18) of 2 group patients. Patients of groups 3 and 4 did not show changes in the above indicators.
Conclusion. The data obtained confirm the effectiveness of the sublingual-oral low-dose allergy vaccine in both patients with allergic and mixed BA, a high level of adherence to therapy due to the convenient SLIT regimen and high safety. The maximum effect of low -dose SLIT is achieved with allergic BA, most pronounced at the early start of treatment, the absence of comorbid pathology (obesity, chronic obstructive pulmonary disease), and the patient's recommended lifestyle.

Keywords

Bronchial asthma, sublingual-oral low-dose allergy vaccine, asthma phenotypes, asthma control level, quality of life

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Reference

Sidorenko E.V., Vykhristsenko L.R. Immunopathology, allergology, infectology 2019; 3:25-35

DOI

10.14427/jipai.2019.3.25