Journal List > Allergy Asthma Respir Dis > v.3(3) > 1059095

Lee, Kim, Yang, Yu, and Hong: Comparison of short-term effects between subcutaneous and sublingual immunotherapies in children with house dust mite-sensitized allergic rhinitis and asthma

Abstract

Purpose

There have been several studies on comparisons of efficacy between subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) in children with house dust mite (HDM)-sensitized allergic rhinitis (AR), without consistent results. This study was conducted to compare short-term effects between SCIT and SLIT in Korean children with HDM-sensitized AR.

Methods

Fifty-three children (mean age, 11.15±2.82 years) with HDM-sensitized AR and with/without asthma (SCIT group, n=33; SLIT group, n=20) were enrolled. Clinical symptom scores and skin prick test results were assessed before, and after 3, 6, and 12 months of immunotherapy. Blood tests, including eosinophils, total serum IgE, and HDM-specific IgE, and adenosine 5'-monophosphate, and methacholine bronchial challenge tests were performed before and after 12 months of immunotherapy.

Results

In the SCIT group, the symptom scores improved after 3 months compared to those before immunotherapy, whereas they improved after 6 months in the SLIT group. Significant decreases in skin reactivity to HDM were observed after 3 months only in the SCIT group. Decreases in total eosinophil counts and improvements in methacholine bronchial provocation tests were observed after 12 months of immunotherapy only in the SCIT group. No difference in severe adverse reactions was noted in either group.

Conclusion

The results of this study suggest that SCIT may have more rapid effects on clinical symptoms and skin reactivity in children with AR, compared to SLIT.

Figures and Tables

Table 1

General characteristics of study population

aard-3-180-i001
Characteristic SLIT SCIT P-value
No. of subjects 20 33
Sex 1.000
 Male/female 16/4 26/7
Age (yr) 10.20 ± 3.25 11.73 ± 2.39 0.055
Skin prick test
Der f mean wheal 6.96 ± 2.87 7.89±4.64 0.420
Der p mean wheal 8.41 ±3.16 7.74±2.87 0.429
Asthma 13 24 0.553
Symptom scores, initial
 AR 17.27 ± 2.69 15.85±4.56 0.243
 Asthma 17.80 ± 4.60 18.85±6.00 0.720
IMT compliance (%) 82.00 ± 12.64 100.00±0 < 0.001
Adverse effects
 Local reaction 1 (oral itching sensation) 23 (injection site swelling, itching) < 0.001
 Systemic reaction 1 (systemic urticaria) 6 (dyspnea, systemic urticaria) 0.233
New sensitization 0.217
 No/yes 16/4 30/3

Values are presented as number or mean± standard deviation. Categorical variables were analyzed using chi-square test or Fisher exact test, as appropriate.

SLIT, sublingual immunotherapy; SCIT, subcutaneous immunotherapy; Der f, Dermatophagoides farinae; Der p, Dermatophagoides pteronyssinus; AR, allergic rhinitis;IMT, immunotherapy.

Table 2

Comparison of changes in symptom scores of allergic rhinitis between subcutaneous immunotherapy group and sublingual immunotherapy group

aard-3-180-i002
Treatment duration (mo) Symptom scores (point) P-value
SLIT (n=20) P-value* SCIT (n=33) P-value*
0 17.27±1.22 15.85±0.78 0.327
3 17.03±1.43 0.868 13.33±0.78 0.002 0.025
6 13.74±1.31 0.009 13.41±0.78 0.002 0.829
12 11.81±1.30 < 0.001 11.80±0.80 < 0.001 0.996

Values are presented as mean± standard error.

SLIT, sublingual immunotherapy; SCIT, subcutaneous immunotherapy.

*Comparisons between baseline and time point in both immunotherapy groups were analyzed using paired t-test or Wilcoxon signed rank test. Comparisons of symptom scores in allergic rhinitis between SLIT and SCIT groups at each time point were analyzed using Mann-Whitney U-tests.

Table 3

Comparison of changes in skin reactivity within and between subcutaneous immunotherapy group and sublingual immunotherapy group

aard-3-180-i003
Treatment duration (mo) Skin prick test, Der p (A/H ratio) P-value Skin prick test, Der f (A/H ratio) P-value
SLIT (n=20) P-value* SCIT (n=33) P-value* SLIT (n=20) P-value* SCIT (n=33) P-value*
0 2.02±0.10 1.99±0.08 0.769 1.80±0.11 1.93±0.08 0.328
3 1.68±0.13 0.014 1.78±0.08 0.015 0.533 1.61±0.12 0.164 1.60±0.07 < 0.001 0.985
6 1.82±0.10 0.077 1.60±0.06 < 0.001 0.057 1.69±0.08 0.385 1.44±0.05 < 0.001 0.014
12 1.75±0.09 0.009 1.45±0.06 < 0.001 0.008 1.64±0.08 0.201 1.46±0.06 < 0.001 0.070

Values are presented as mean± standard error.

Der f, Dermatophagoides farinae; Der p, Dermatophagoides pteronyssinus; A/H ratio, allergen (mm)/histamine (mm) ratio in skin prick test; SLIT, sublingual immunotherapy; SCIT, subcutaneous immunotherapy.

*Comparisons of values between 0 month and time point were calculated using paired t-test or Wilcoxon signed rank test. Comparisons of differences between 0 months and 12 months in both SLIT and SCIT groups were calculated using t-test or Mann-Whitney test.

Table 4

Comparisons of clinical and laboratory parameters within and between subcutaneous immunotherapy and sublingual immunotherapy groups

aard-3-180-i004
Parameter SLIT (n=20) SCIT (n=33) P-value
0 Month 12 Months P-value* 0 Month 12 Months P-value*
Serum eosinophils (µL) (n=53) 683.33±412.69 439.17±209.35 0.076 582.31±357.04 392.31±288.96 0.010 0.682
Specific IgE (kUA/L) (n=53)
Der p 36.40±35.39 44.32±35.45 0.249 41.33±30.78 40.09±28.32 0.814 0.310
Der f 60.40±40.72 58.67±36.17 0.773 70.91±32.77 62.41±26.68 0.080 0.399
Total serum IgE (kU/L) (n = 53) 634.28±656.03 593.66±329.35 0.859 517.60±566.90 709.26±815.63 0.050 0.382
Provocation test
 AMP PC20 (mg/mL) 36.80±21.72 (n=5) 114.61±167.37 (n=5) 0.686 120.06±117.16 (n=16) 158.88±145.83 (n=16) 0.125 0.869
 MCH PC20 (mg/mL) 4.24±2.06 (n=7) 14.22±11.31 (n=7) 0.063 5.93±6.84 (n=26) 11.80±10.01 (n=26) < 0.001 0.322

Values are presented as mean± standard deviation.

SLIT, sublingual immunotherapy; SCIT, subcutaneous immunotherapy; Der p, Dermatophagoides pteronyssinus; Der f, Dermatophagoides farinae; AMP, adenosine 5'-monophosphate; MCH, methacholine; PC20, provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second.

*Comparisons of values between 0 month and at 12 months were calculated using paired t-test or Wilcoxon signed rank test. Comparisons of differences in each value between 0 months and 12 months in both SLIT and SCIT groups were calculated using t-test or Mann-Whitney test

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