Different Development Forms of Local Allergic Rhinitis towards Birch

Abstract

Background. Efficacy of allergen immunotherapy (AIT) in local allergic rhinitis (LAR) is a new subject of research. The presence of asthmatic symptoms in patients with LAR in the context of AIT is unexplored. Objective. The efficacy and safety of AIT in patients with LAR towards birch pollen were investigated. The possibility of concomitant local allergic asthma in studied patients and the impact of AIT on it were examined. Methods. 36 patients with LAR towards birch were included in three years of AIT in a double-blind, placebo-control study. Primary outcome measurement was the mean changes in the combined symptom and medication scores (CSMSs) after AIT, and the second is the changes in the quality of life (QoL). Skin prick tests, serum, nasal allergen-specific IgE to birch, nasal and bronchial provocation challenge tests with birch allergen, methacholine tests, and spirometry were carried out at baseline and after AIT. Results. Mean CSMSs of three years of AIT were significantly decreased in the active group from 5.88 (range: 4.11-9.01) to 1.98 (range: 1.22-4.51; p<0.05). After three years of AIT, there was a significant increase of toleration for birch allergen from the mean concentration of 6250±1200 SQ-U/ml up to 45000±2500 SQ-U/ml (p=0.02) during repeated nasal challenges. 16 patients with LAR had the positive results of methacholine tests, and 11 of them had a positive bronchial challenge to birch allergen. After AIT, the significant decrease of bronchial responsiveness to birch allergen in 5 from 7 patients was confirmed (p=0.03). QoL assessed by the use of the RQLQ score was improved after AIT from 1.84 (95% CI: 1.53-1.97) to 1.45 (95% CI: 1.32-1.62) score in the active group after three years of AIT therapy (p=0.03). Conclusion. AIT to birch can be useful and safe in a patient with local allergic rhinitis and also with concomitant asthmatic symptoms. Further studies are needed.

Local Respiratory Allergy: From Rhinitis Phenotype to Disease Spectrum

“…Importantly, the BAC induced a sustained increase of airway hyper-responsiveness in LAA patients ( 10 ). Of note, a recent study conducted in Poland, confirmed the presence of asthma and LAA in 76% and 58% of LAR patients reporting asthmatic symptoms, respectively ( 15 ). Both pollens (e.g.…”

“…Regarding the immunological mechanisms driving the clinical effect, the four RDBPCCT showed that SCIT-treated LAR patients experience a significant increase of serum sIgG 4 from the 6 th month of therapy (15,(74)(75)(76). Moreover, one of the Polish trials also demonstrates that birch-SCIT blunts the seasonal peak of nasal sIgE from the first year of treatment (76).…”

Precision Medicine in House Dust Mite-Driven Allergic Asthma

“…Of note, specific reactivity to HDM is associated with eosinophilic airway inflammation in both LAR and LAA patients. On the other hand, in a recent Polish study conducted in 36 individuals with birch pollen-driven LAR, the presence of asthma and LAA was specifically investigated [21]. Of note, asthma diagnosis was confirmed in 76% of LAR patients reporting suggestive bronchial symptoms, whereas 58% of them tested positive in the bronchial challenge with birch pollen.…”

“…As in LAR, a BAC is required to diagnose LAA ( Figure 2). The patients included in the two studies defining the LAA phenotype suffered from persistent mild-to-moderate asthma, which remained controlled through the study period [8,21]. Therefore, all individuals could be subjected to a BAC.…”

“…Nevertheless, SCIT had only been administered for six months at the moment of evaluation, and this study did not confirm either the diagnosis of asthma or of LAA. On the other hand, in a recent Polish clinical trial conducted in 36 LAR patients, the presence of LAA due to the birch pollen and the effect of a three-year cycle of SCIT (Alutard© Betula verrucosa 100,000 SQ-U/mL, ALK-Abello, Hørsholm, Denmark) on the disease were specifically analyzed [21]. BACs were performed before and after the administration period, and the bronchial tolerance to the allergen increased significantly in LAA patients treated with SCIT but not in those who received placebo.…”