Keywords
Allergic rhinitis
Asthma
Treatment effectiveness
Abstract
Background: Allergen-specific immunotherapy is an important therapeutic modality for the management of allergic rhinitis and allergic asthma.
Objective: To assess the effectiveness and safety of allergen-specific subcutaneous immunotherapy in patients with respiratory allergies at the University Hospital of Puebla after twelve months of treatment.
Methods: A longitudinal, sequential, analytic, quasi-experimental, prolective study. The study was carried out for twelve months with patients of both sexes, aged four to sixty-five years, diagnosed with asthma and/or rhinitis, and with sensitization to aeroallergens. The CARAT and Portnoy questionnaires were collected every two months in order to assess the effectiveness and safety respectively.
Results: 47 patients were included: 37 (78.7 %) of them were female. The average age was 29.8 years. 76.6 % of them were diagnosed with allergic rhinitis, and 23.4 % of them were diagnosed with both asthma and allergic rhinitis. The comparison of averages of the initial CARAT questionnaire against the final average by means of a student’s t-test showed a t-value of -8.86 and a p-value of < 0.05. A total frequency of local adverse reactions of 19 % and systemic adverse reactions of 2.1 % was reported after 6 and 12 months of treatment.
Conclusions: The assessed scheme of immunotherapy, derived from the Mexican clinical practice guidelines of immunotherapy 2011, is effective with a desirable safety profile.
References
Eifan AO, Calderón M, Durham S. Allergen immunotherapy for house dust mite: clinical efficacy and immunological mechanisms in allergic rhinitis and asthma. Expert Opin Biol Ther. 2016;13(11):1543-1556. DOI 10.1517/14712598.2013.844226
Roche A, Wise S. Subcutaneous immunotherapy. Int Forum Allergy Rhinol. 2014;4(Suppl 2):51-54. DOI: 10.1002/alr.21382
Moral AJ, Carretero P, Mateo MB, et al. Principales alérgenos de interior. En: Dávila IJ, Jáuregui I, Olaguibel JM, Zubeldía J, editores. Tratado de alergología. España: Ergon; 2016.
Larenas-Linnemann D, Salas-Hernández J, Vázquez-García JC, Ortiz-Aldana I, Fernández-Vega M, Del Río-Navarro BE, et al. Guía Mexicana del Asma 2017. Rev Alerg Mex. 2017;64(Supl 1):s11-s128. DOI: 10.29262/ram.v64i0.272
Global Initiative for Asthma [internet]. Wisconsin: Global Strategy for Asthma Management and Prevention; 2020. Disponible en: https://ginasthma.org/wp-content/uploads/2020/04/GINA-2020-full-report_-final-_wms.pdf
Larenas-Linnemann D, Mayorga-Butrón JL, Sánchez-González A, Ramírez-García A, Medina-Ávalos M, Figueroa-Morales MA, et al. ARIA México 2014. Adaptación de la guía de práctica clínica ARIA 2010 para México. Metodología ADAPTE. Rev Alerg Mex. 2014;61(Supl 1):S3-S116. Disponible en: http://revistaalergia.mx/ojs/index.php/ram/article/download/52/69
Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63(Suppl 86):8-160. DOI: 10.1111/j.1398-9995.2007.01620.x
Brozek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017;140(4):950-958. DOI: 10.1016/j.jaci.2017.03.050
Nelson HS. Injection immunotherapy for inhalant allergens. En: Adkinson NF, Bochner BS, Busse WW, Holgate ST, editores. Middleton’s allergy principles and practice. EE. UU.: Elsevier; 2014.
Cardona R, Rojas W. Mecanismos básicos de las alergias. En: Rojas W, Anaya JM, Gómez LM, Aristizábal BH, Cano LE, Lopera D , editores. Inmunología de Rojas. Colombia: Corporación para Investigaciones Biológicas Fondo Editorial; 2015.
Martín-Muñoz M, Pineda F, Muiños T, Fontan M, Nevot S, Bosque M, et al. Changes in IL-10 and specific antibodies associated to successful Dermatophagoides pteronyssinus immunotherapy in children during the first year of treatment. Allergol Immunopathol (Madr). 2013;41(1):4-10. DOI: 10.1016/j.aller.2011.12.005
Akdis CA, Akdis M. Mechanisms of allergen-specific immunotherapy and immune tolerance to allergens. World Allergy Organ J. 2015;8(1):1-12. DOI: 10.1186/s40413-015-0063-2
Shamji MH, Durham SR. Mechanisms of allergen immunotherapy for inhaled allergens and predictive biomarkers. J Allergy Clin Immunol. 2017;140(6):1485-1498. DOI: 10.1016/j.jaci.2017.10.010
Azevedo P, Correia de Sousa J, Bousquet J, Bugalho.Almeida A, Del Giacco SR, Demoly P, et al. Control of Allergic Rhinitis and Asthma Test (CARAT): dissemination and applications in primary care. Prim Care Respir J. 2013;22(1):112-126. DOI: 10.4104/pcrj.2013.00012
Fonseca JA, Nogueira-Silva L, Morais-Almeida M, Azevedo L, As-Sousa A, Branco-Ferreira M, et al. Validation of a questionnaire (CARAT10) to assess rhinitis and asthma in patients with asthma. Allergy. 2010;65(8):1042-1048. DOI: 10.1111/j.1398-9995.2009.02310.x
Cox L, Larenas-Linnemann D, Lockey RF, Passalacqua G. Speaking the same language: the World Allergy Organization subcutaneous immunotherapy systemic reaction grading system. J Allergy Clin Immunol. 2010;125(3):569-574. DOI: 10.1016/j.jaci.2009.10.060
Álvarez-Cuesta E, Bousquet J, Canonica GW, Durham SR, Malling HJ, Valovirta E, et al. Standards for practical allergen-specific immunotherapy. Allergy. 2006;61(Suppl 82):1-20. DOI: 10.1111/j.1398-9995.2006.01219_1.x
Larenas-Linnemann D, Ortega-Martell JA, D el Río-Navarro B, Rodríguez-Pérez N, Cruz A, Estrada A, et al. Guía Mexicana de Práctica Clínica de Inmunoterapia 2011. Rev Alerg Mex. 2011;58(1):16-21. Disponible en: https://www.elsevier.es/es-revista-revista-alergia-mexico-336-articulo-guia-mexicanapractica-clinica-inmunoterapia-X0002515111209882
Valle-Rodríguez F, López-García AI, Rivero-Yeverino D, Caballero-López CG, Papaqui-Tapia JS, Ruíz-Márquez IP, et al. Eficacia y seguridad de la inmunoterapia subcutánea para alérgenos inhalables en pacientes con alergia respiratoria. Rev Alerg Mex. 2019;66(3):301-307. DOI: 10.29262/ram.v66i3.617
Larenas-Linnemann D, Luna-Pech JA, Rodríguez-Pérez N, Rodríguez-González M, Arias-Cruz A, Blandón-Vijil V, et al. GUIMIT 2019, Guía Mexicana de Inmunoterapia. Guía de diagnóstico de alergia mediada por IgE e inmunoterapia aplicando el método ADAPTE. Rev Alerg Mex. 2019;66(Supl 1):1-105. DOI: 10.29262/ram.v66i5.631
Erekosima N, Suárez-Cuervo C, Ramanathan M, Kim JM, Segal JB, Lin SY, et al. Effectiveness of subcutaneous immunotherapy for allergic rhinoconjunctivitis and asthma: a systematic review. Laryngoscope. 2014;124(3):616-627. DOI: 10.1002/lary.24295
Abramson MJ, Puy RM, Weiner JM. Injection allergen immunotherapy for asthma. Cochrane Database Syst Rev. 2010(8):CD001186. DOI: 10.1002/14651858.CD001186.pub2
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