Clinical Data and Inflammation Parameters in Patients with Cypress Allergy Treated with Sublingual Swallow Therapy and Subcutaneous Immunotherapy

Abstract

The clinical efficacy of immunotherapy, either by high dose sublingual-swallow therapy (SLIT) or subcutaneous immunotherapy (SCIT), has been demonstrated in patients with pollinosis but few studies have been carried out analysing differences in these treatments in terms of an improvement of clinical and allergic phlogosis parameters. The aim of this double-blind placebo-controlled study is to investigate the efficacy of high dose SLIT and SCIT using a purified standardized Juniperus ashe; extract in a population of allergic patients monosensitized to cypress. Forty patients with cypress-allergic rhino conjunctivitis were administered therapeutic or placebo SLIT or SCIT for 12 months. Laboratory parameters were studied, namely the eosinophil cationic protein (ECP) level in nasal lavage and in serum, as well as the number of eosinophils (EOS) in peripheral blood and in nasal lavage and the level of eosinophil chemotactic activity (ECA). These parameters were correlated with clinical symptoms, evaluated by means of the clinical symptoms score (CSS). After SCIT and SLIT the levels of ECP and ECA were reduced in nasal lavage. We also observed a significant reduction in the values of ECP in serum in the patients treated with SLIT. EOS were unchanged in peripheral blood, but significantly reduced in nasal lavage. These data were in accordance with the improvement of clinical symptoms, supported by the close correlation between CSS and laboratory parameters. Our data confirm a clinical improvement correlated with a decline in inflammation parameters after one year of immunotherapy, supporting the hypothesis that treatment with a major allergen of cypress is able to change the course of allergic rhinitis.Epidemiological data have demonstrated an increased prevalence of cypress allergy among patients in recent years in Italy (1-2) and in other European countries (3-5). The clinical features are characterized by a higher prevalence ofconjunctivitis and rhinitis during the pollen season, with a lower percentage of asthma (2, 6), thus resembling the symptoms of"recurrent" viral infections and causing undervaluation of this pollinosis (7).Following reports of the clinical efficacy of immunotherapy, we conducted a double-blind placebo-controlled study, treating allergic patients

Sublingual grass and ragweed immunotherapy: Clinical considerations—a PRACTALL consensus report

“…Studies directly comparing the 2 treatment modalities are limited by study size and power (Table III). [14][15][16][17][18][19][20][21][22][23][24][25] In one study directly comparing the efficacy of SLITand SCIT by using timothy extract produced by the same company (SCIT: Alutard SQ and SLIT: Grazax; ALK-Abell o, Hørsholm, Denmark), there was a significant chance in in nasal challenge threshold only in the SCITtreated subjects. 26…”

Therapeutic Effects and Biomarkers in Sublingual Immunotherapy: A Review

“…A meta-analysis of SLIT for grass pollinosis gave SMDs for the symptom (active; N = 1, 518, placebo; N = 1, 453) and medication (active; N = 1, 428, placebo; N = 1, 358) scores of −0.32 ( P < 0.0001) and −0.33 ( P < 0.0002), respectively, in favor of active treatment compared with placebo [26]. Both meta-analyses showed positive therapeutic effects of SLIT, especially for seasonal rhinitis, and these effects are comparable with those of SCIT [18, 27–29]. It has also been suggested that immunotherapy with SLIT and SCIT in combination may be beneficial [30].…”

Dosing of sublingual immunotherapy for allergic rhinitis: evidence‐based review with recommendations

“…A PubMed search revealed 4 studies that met inclusion criteria . Two papers examined treatment with Japanese cedar ( Cry j1 ), whereas the others examined mountain cedar/Ashe juniper. In each of the 4 papers, improvement was seen in symptom scores, quality‐of‐life measures, or allergy medication use.…”