Efficacy of sublingual immunotherapy in adult allergic asthma from Minia University hospitals

Background: specific immunotherapy is the sole treatment for changing the natural course of allergic diseases and minimizing the risk of an exacerbation. Sublingual immunotherapy is may be preferred worldwide considering the favorable safety profile and absence of anxiety provoking injections. Many updated recommendations of its use with reports emphasize the need for a methodological control of research projects in order to increase their objectivity. Patients and methods: this study is designed to be open labeled, randomized and double armed parallel groups; 80 adult asthmatic patients were screened for mild to moderate persistent asthma by history, clinical examination ,chest X ray ,FEV1 , then screened for atopic sensitized patients with total IgE and skin prick test . Then patients were randomized into 2 equal groups, group 1 received ICS plus SLIT for 9 months and group 2 received ICS for the same period. Serum total IgE was evaluated before and after treatment, every 3 months FEV1 was evaluated and monthly clinical evaluation by Asthma symptom control sheet, medication score were done throughout the entire period. Results: 80 patients were randomized into 2 equal groups, group 1 received ICS plus SLIT for 9 months and group 2 received ICS for the same period. In group 1 serum level of total IgE after treatment show a significant decrease while FEV1 after treatment show significant increase. In group 2 serum level of total IgE after treatment show no significant difference while FEV1 show no significant difference. Conclusion: Serum level total IgE is a good biomarker significantly decreased with SLIT therapy. Keyword: SLIT, allergen immunotherapy, allergic diseases, atopic, asthma, asthma control, asthma exacerbations, lung function. Introduction Allergic diseases result from an unbalanced response of the specific immune system generating allergen-specific immunoglobulin E antibodies, which mediate various clinical symptoms, such as asthma and allergic rhinitis, upon re-exposure to allergen Aim of work (1) , The most prevalent form of asthma is allergic asthma where individuals have a genetic predisposition for the development of an antigen specific IgE mediated response to common aeroallergens (2) . Dendritic cells in the airway epithelium and sub mucosa detect inhaled allergens, including house dust mite (HDM), pollen, fungal spores and cockroach antigen. The IgE antibody bound to high affinity receptors on dendritic cells facilitates the uptake and internalization of these allergens (3) , specific immunotherapy (SIT) by the sublingual route (sublingual immunetherapy, SLIT) has been increasing in acceptance in clinical practice, mainly in Central Europe, it is currently the most used form of specific immunotherapy in children. This is due to its ease of administration and documented safety. (4) , currently numerous treatments aimed at managing the symptoms associated with asthma exist. Although these treatments may offer symptom relief, they have potential side effects that may be experienced by the patient. Furthermore, the majority of current treatments do not resolve the underlying immunological mechanism causing asthma. This has led to researchers shifting their attention to the possible use of immunotherapy; Allergen immunetherapy rehabilitates the immune system. This involves administering increasing doses of allergens to accustom the body to substances that are generally harmless (pollen, house dust mites) and thereby induce specific long-term tolerance. (5) . Patients and methods This study will be conducted on 80 adult patients with mild to moderate bronchial asthma disease, screened for mild to moderate MJMR, Vol. 30, No. 3, 2019, pages (146-149). Mohammed et al., 147 Efficacy of sublingual immunotherapy in adult allergic asthma persistent asthma by history, clinical examination, chest X ray, FEV1, then screened for atopic sensitized patients with total IgE and skin prick test. This will divide into two groups: Group one: 40 adult asthmatic patients on sublingual immunotherapy in addition to pharmacotherapy Group two: 40 adult asthmatic patients on pharmacotherapy alone. Inclusion criteria: adult patients with clinical and functional diagnosis of Asthma (stable disease) Exclusion criteria: Patients on specific allergen immunotherapy, Pregnant females, Patients currently on oral antihistamines, or any other drugs that inhibit the SPT reaction, Patients with positive dermographism, Asthmatic patient presented by pneumonia, Asthma with other systemic disease. (6)