Effectiveness and safety of allergen immunotherapy in patients with allergic rhinitis complicated by rheumatic autoimmune diseases: a case series study

Abstract

Background Allergen immunotherapy (AIT) is the only treatment that has modified the natural history of allergic diseases. However, since its overall effect on the immune system has not been elucidated, AIT is either absolutely or relatively contraindicated in patients with rheumatic autoimmune diseases (RADs). Therefore, there have been no long-term observations of patients with RADs receiving AIT; thus, the effectiveness and safety of AIT in these patients remain unclear. Methods This was a single-center retrospective observational study. RAD patients receiving AIT for allergic rhinitis at our institution were selected. Changes in the activity of RAD patients were investigated for 2 years from baseline, including those who discontinued AIT. The effectiveness of AIT was also investigated using the Japan Allergic Rhinitis Standard Quality of Life Questionnaire. Results Thirteen patients with RADs were enrolled in the study. All patients received sublingual immunotherapy, of which four discontinued AIT owing to adverse events. Among all patients, the symptoms of RADs in three patients worsened during the observation period; however, none of them were causally related to AIT. Most of the adverse events associated with AIT were mild, in which only one patient required drug intervention due to worsening rhinitis symptoms. In the nine patients who were able to continue AIT, their eye and nasal symptom scores showed a significant improvement from 1.67 (1.5–2.0) at baseline to 0.67 (0–1.17) in the 2nd year of treatment (p = 0.0141). Conclusions AIT is a safe and effective treatment modality for patients with allergic rhinitis complicated by RADs.

Ulcerative colitis developed after remission of eosinophilic pneumonia

“…In fact, SLIT was safely conducted for rheumatic patients without exacerbation. 5 There are anecdotal reports of eosinophilic esophagitis that developed after SLIT, whereas the colon histology of the patient did not reveal eosinophilic inflammation, suggesting pathophysiology of UC might be independent from SLIT. The patient might originally have had a predisposition for UC.…”

“…According to the European Academy of Allergy and Clinical Immunology's guidelines, although an active autoimmune disease is a contraindication for initiation of SLIT, there is no evidence that SLIT induces an autoimmune disease. In fact, SLIT was safely conducted for rheumatic patients without exacerbation 5 . There are anecdotal reports of eosinophilic esophagitis that developed after SLIT, whereas the colon histology of the patient did not reveal eosinophilic inflammation, suggesting pathophysiology of UC might be independent from SLIT.…”