Clinical experience of sublingual allergen-specific immunotherapy of allergic rhinitis in a coronavirus pandemic

Background. In recent years, there has been a significant increase in the incidence of allergic rhinitis (AR). According to official statistics, every third adult Russian suffers from AR, and official statistics do not reflect the real situation. The article presents the experience of using sublingual allergen-specific immunotherapy (SLIT) in patients with perennial and seasonal AR (PAR and SAR) caused by sensitization to pollen allergens and house dust mites in a coronavirus infection (CVI) pandemic. Objective.Evaluation of the efficacy, safety and tolerability of SLIT in AR patients in the COVID-19 pandemic. Methods. 53 patients with AR were examined, including 21 - with PAR and 32 - with SAR. From 2017 to 2020 patients received SLIT with etiotropic allergens. The control of the course of AR in patients was assessed in dynamics according to the frequency and severity of nasal symptoms, taking into account the need for medicines, the visual analogue scale (VAS) score, the need for basic therapy, allergic-immunological parameters (total IgE, asIgE to household and pollen allergens, eosinophilic cationic protein (ECP), diameter of scarification tests with allergens). Results. At the end of the full course of treatment, the clinical efficacy of SLIT with Staloral “Birch pollen allergen”, taking into account excellent and good results, was 95.5%, with Oralair - 100.0%, with Staloral “Mite allergen” - 95.3% . The frequency of exacerbations in patients with PAR decreased by 7 times, in patients with SAR - by 6.2 times. Patients have increased control over the course of AR: the total score of the AR control questionnaire decreased against the background of SLIT by the Staloral «Birch pollen allergen» from 11.0 to 3.3 points, by the drug Oralair - from 10.2 to 4.2 points, by the drug Staloral «Tick allergen» - from 9.1 to 4.0 points; the MS score decreased from 52.1 to 18.1, from 52.0 to 22.2 and from 46.2 to 15.1 points, respectively (p<0.05). Against the background of SLIT in patients with PAR, the total IgE level decreased by 1.9 times, asIgE to household allergens - by 3.4 times (from 4.88 to 1.44 kU/L), the diameter of skin tests - by 1.4 times, ECP - by 2 times (from 32.65 to 16.01 ng/ml; p<0.05). In patients with SAR, the total IgE level decreased by 2.0 times, asIgE to tree allergens - by 3.2 times (from 5.23 to 1.65 kU/L), to cereal grasses - 2.8 times (from 4.64 up to 1.66 kU/L), the diameter of skin tests - by 2.6 times, ECP - by 2.8 times (from 33.98 to 12.11 ng/ml; p<0.05)., Mild adverse events in the form of local reactions were observed in 39.6% of cases. During the CVI pandemic, follow-up of patients was carried out using telemedicine technologies. In only one patient, SLIT was temporarily suspended due to mild COVID-19. Conclusion. SLIT is a safe and high effective method of AR immunotherapy, which can be carried out despite the patient’s self-isolation regimen due to COVID-19 infection.

sublingual allergen-specific immunotherapy, allergic rhinitis, pandemic, coronavirus infection