Eiffcacy And Safety Of Specific Immunotherapy In Allergic Rhinitis

Objective：To observe the efficacy and safety of specific immunotherapy inallergic rhinitis (AR).Methods：120patients who were sensitized to house dust mites were studied. Astandardized extract of house dust mites was used for sublingual immunotherapy(SLIT)in69patients, anda standardized extract of dual house dust mites was usedfor SCIT in51patients. In the69patients who were treated by SLIT: themonoallergen sensitized group (sensitized to Dermatophagoides pteronyssinusand/or Dermatophagoides farina) included33patients, and the polyallergensensitized group (sensitized to house dust mites and other allergens) included36patients. The nasal symptom score, the medication scores, the life quality score,graded of eosinophil in nasal secretions, percentage ofeosinophil in vein blood,the eosinophil direct count in vein blood, the frictional exhaled nitricoxide(FENO), the nasal nitric oxide(NNO) and theadverse reaction wereevaluated before,6month and12month after SLIT in both group. In the51patients who were treated by SCIT: the monoallergen sensitized group included23patients, and the polyallergen sensitized group included28patients. The nasalsymptom score, the medication scores, the life quality score, and theadversereaction were evaluated before, the end of dose accumulation stage and12monthafter SLIT in both group. SPSS13.0was used for data analysis.Results：In the69patients who were treated by SLIT:43patients completedthe SLIT treatment for12months. In the monoallergen sensitized group21patients completed the SLIT treatment for12months，and the compliance rate was63.64%. And in the polyallergen sensitized group,22patients completed the SLITtreatment for12months and the compliance rate was61.11%.But thecompliance did not differ significantly between the groups（X2=0.047，p=0.829）. In the51patients who were treated by SLIT:43patients completed the SCIT treatment for12months. In the monoallergen sensitized group20patients completed the SCITtreatment for12months，and the compliance rate was86.96%. And in thepolyallergen sensitized guorp,22patients completed the SCIT treatment for12months and the compliance rate was was82.14%.But thecompliance did not differsignificantly between the groups（X2=0.007，p=0.934）.The compliance ofpatients who were treatedby SCIT was84.31%and by SLIT was62.32%. Theformer compliance rate was significantly higher than the latter (X2=6.987, p=0.008). In the patients who were treated by SCIT the main factors impacted thecompliance was skeptical about the efficacy and In the patients who were treatedby SLIT the main factors impacted the compliance was due to the work.Respectively, in patients treated by SLIT and SCLT, through the ANOVA forrepeated measures analysis in data of the nasal symptom score, the antiallergicmedication, the life quality score, graded of eosinophil in nasalsecretions,percentage ofeosinophil in vein blood, the eosinophil direct count inboth the monoallergen sensitized group and polyallergen sensitized guorp showedsimilar efficacy(p＜0.05).The results indicate the nasal symptom score, the antiallergic medication, thelife quality score, graded of eosinophil in nasal secretions,percentageofeosinophil in vein blood and the eosinophil direct count in vein blood decreasedSignificantly after receiving SLIT treatment for6months and12months（P＜0.05）. Compared with6months treatment the itching,congestion, the totalsymptom score, the life quality score, the medication scores were improvedsignificantly（P＜0.05）,but the discharge, sneezing, the eosinophil in nasalsecretions and the eosinophil in vein bloodhad no significant change inthe end of12months（P＞0.05）.11patients who were treated by SLIT were tested FENO and NNO. FENO and NNO significantly decreased after six months of SLIT treatment (P <0.01).The results indicate the nasal symptom score, the antiallergic medication, thelife quality score significantly after receiving SCIT treatment for the doseaccumulation stage and12months （P＜0.05）.Compared with the doseaccumulation stage treatment the itching, the total symptom score,activity,non–hay fever, nasalsymptom, eyesymptom, total life quality score, themedication scores were improved significantly（P＜0.05）,but the discharge,congestion, sneezing, Practical, Emotionshad no significant change inthe end of12months（P＞0.05）In patients who were treated by SLIT，3times adverse reactions occurred(14.29%) in the monoallergen sensitized group. And2times adverse reactionsoccurred (9.09%) in the polyallergen sensitized group. There was no statisticalsignificance(X2=0.003，p=0.956）.During12months of SCIT treatment，1489needle injection were performed and5times systemic adversereactionsOccurred.The incidences of systemic adverse reactions were0.43%and0.25%respectively of the monoallergen sensitized group and polyallergensensitized guorp. The difference was not statistically significant (X2=0.023, p=0.879).SLIT is safer than SCITConclusion：In polysensitized allergic rhinitis patients, SLIT and SCIT for Dpteronyssinus and/or D farinae produced improvements in symptoms comparableto those in monosensitized patients. SLIT and SCIT for D pteronyssinus and/or Dfarinae should be considered in polysensitized allergic rhinitis patients.Patientsreceiving SCIT compliance rate was significantly higher thanpatients undergoingSLIT. Security of SLIT was obviously higher than that of SCIT. NNO and FENOaretwo non-invasive methods to detect the airway inflammation. After6monthsSLIT treatment FENO and NNO values were significantly reduced.