Allergic Rhinitis and its Impact on Asthma scores in asthmatic patients with and without allergic rhinitis

Abstract Background: Allergic rhinitis and allergic asthma are chronic inflammatory conditions that frequently coexist, both with hallmark eosinophilia. Immunotherapy is an established treatment for allergic diseases. Noninjective routes for immunotherapy, such as the sublingual route, are thought to be valuable therapeutic options for respiratory allergy. Aim of the study: In the present study, sublingual immunotherapy (SLIT) using multiple allergens was administered to allergic asthmatic patients with and without allergic rhinitis aiming to evaluate the clinical efficacy of and changes in allergen-specific antibodies during SLIT and its effect on control of asthma severity and nasal allergy scores. Patients and methods: The study included 40 patients in two groups: group I included 20 asthmatic patients and group II included 20 patients with both proven bronchial asthma and allergic rhinitis. All patients were subjected to assessment of the status of asthma and hence its degree of control using the Global Initiative for Asthma (GINA) guidelines; patients received SLIT according to the results over a period of 1 year and were clinically reassessed monthly. In addition, for the recruited candidates, the initial total immunoglobulin E (IgE) levels were measured and pulmonary function tests were performed at the time of recruitment and repeated after 6 months and 1 year of the initiation of the course of SLIT. SLIT was stopped for asthmatic patients during acute exacerbation and resumed after complete asthma control. Results: There was a statistically significant decrease in blood eosinophils but a statistically insignificant decrease in total IgE 1 year after SLIT in both groups. Results of specific IgE to food and inhalants revealed that there was statistically significant reduction in the number of allergens in both groups 1 year after SLIT. Results of the skin prick test revealed similar results. Our results revealed that the scores of, both Allergic Rhinitis and its Impact on Asthma and GINA had improved in all patients after 1 year of continuous therapy. Conclusion: SLIT is a safe treatment strategy that significantly reduces symptoms and medication requirements and improves asthma control in both asthmatic patients with and without allergic rhinitis. SLIT using multiple allergens lowered the allergen burden in both asthmatic patients with and those without allergic rhinitis. Level of evidence: 1b (Clinical Decision Rule tested within one clinical center).