Sublingual Immunotherapy Plus Pharmacotherapy Improves Asthma, Pulmonary Symptoms

By Jeff Craven /alert Contributor
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The addition of standardized quality (SQ) house dust mite (HDM) sublingual immunotherapy (SLIT) to pharmacotherapy appears to be more effective than pharmacotherapy alone in treating patients with allergic asthma, recent research published in The Journal of Allergy and Clinical Immunology: In Practice has shown.

“[A]dding SLIT to standard asthma therapy provides a significant improvement in symptoms and pulmonary function compared with pharmacotherapy in patients with asthma and rhinitis sensitized to HDM,” Makoto Hoshino, MD, PhD, from the Division of Clinical Allergy and Department of Internal Medicine at Atami Hospital, International University of Health and Welfare in Atami, Shizuoka, Japan, and colleagues wrote in their study. “Improvement of airflow limitation with SLIT was associated with the decrease in eosinophilic airway inflammation independently.”

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Hoshino and colleagues evaluated the inflammation and airway structural changes in 102 patients with allergic asthma patients and rhinitis who were sensitized to HDM after receiving pharmacotherapy with or without SLIT for 48 weeks. The researchers assessed fractional exhaled nitric oxide (FeNO), pulmonary function and clinical symptoms in patients at baseline and follow up. 

There was a significant reduction in FeNO (P < .01) in the SLIT plus pharmacotherapy group, with no change in the pharmacotherapy only group. While there were no significant differences in airway dimension in the control group, the SLIT plus pharmacotherapy group had a significant reduction in airway wall area/body surface area (P < .001), wall area percentage (P < .01), wall thickness (P  < .001), luminal area increase (P  < .05), airflow limitation improvement (P  < .001) as well as improvement in clinical scores (P  < .05). SLIT treatment improving airflow limitation was also inversely associated with the reduction in FeNO and changes in CT parameters, researchers said. With regard to pulmonary function, the SLIT plus pharmacotherapy group had significantly increased forced expiratory volume in 1 second (P  < .01) and forced vital capacity (P  < .01) scores.

While the study was limited due to the lack of a placebo arm, a low number of patients evaluated in each group, and had shorter duration than standard immunotherapy, the results still showed a benefit of SLIT with pharmacotherapy compared with pharmacotherapy alone, the researchers noted.

“The comparison between immunotherapy and pharmacotherapy is still a matter of debate. The main problem in comparison agents is that the clinical benefits of SLIT can be appreciated only in the long term, whereas pharmacotherapy can act immediately,” Hoshino and colleagues said. “On the other hand, the small number of patients lost to follow-up after 1 year indirectly testifies for the persistence of subjects with the prescribed care.”


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