What is immunotherapy treatment for allergies
Sublingual immunotherapy (SLIT) is placing the allergen under the tongue everyday in order to build immune tolerance. There are currently sublingual immunotherapy tablets approved by the FDA and available by prescription.
They are approved for use in patients with ragweed allergy and grass allergy.Allergy shots are probably more effective, but because of the time commitment involved with the injections some people prefer a sublingual alternative that can be done at home.
After informed consent, subjects will be randomly assigned to ILIT group or placebo group in double-blind manner.
In both group, causal allergen or placebo will be injected into inguinal lymph node through guidance by ultrasonography three times with 4-week interval. In ILIT group, initial dose of allergen will be 1,fold diluted solution from maximal concentration of allergen extract for subcutaneous immunotherapy (Tyrosine S, Allergy Therapeutic, West Sussex, UK) in volume of ml. If skin is highly reactive in skin prick test, the initial dose will be fold dilution from maximal concentration where diameter of wheal is less than that of histamine.
After the first dose, allergen concentration will be escalated 3-fold at second dose, and fold at third dose if there are no (or mild) local or systemic hypersensitivity reaction. The allergen concentration will not change at second or third dose if there is moderate local or systemic reaction. The allergen concentration will decrease by 10 or fold from previous concentration or further injection will be held if there is severe local or systemic reaction after sufficient explanation and discussion with subjects.
The investigators will assess allergic rhinitis symptom score before and 4, 12 months after the initial treatment.
Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and Sino-Nasal Outcome Test (SNOT) will be used. Visual analogue scale (VAS) of symptoms including rhinorrhea, sneezing, nasal obstruction, postnasal drip, eye/nose/ear/palate itching, dyspnea, wheezing, chest discomfort as well as urticaria, angioedema, and itching on exposed skin during exposure to causal allergen in daily life will be also evaluated. Skin prick test (SPT), intradermal test (IDT), blood sampling for serum entire immunoglobulin E (IgE), allergen-specific IgE, and allergen-specific immunoglobulin G4 (IgG4), nasal lavage for Th1, Th2, and Treg cytokines, and nasal provocation test (NPT) with Df and/or Dp allergen (in subjects whose AR symptoms are provoked by Df and/or Dp) will be also performed before and 4, 12 months after the initial treatment.
In addition, the investigators evaluated the change of subjects’ recognition of causal allergens, their avoidance, and AIT during this study. Using VAS, subjects were requested to score the rate of agreement with "Allergen provokes allergic symptoms in daily life", "Allergen avoidance can reduce allergic symptoms", "Allergen-specific Immunotherapy (AIT) can reduce allergic symptoms", "I can pay 50, Korean Won (KRW)/month for allergen avoidance", "I can pay , KRW/month for allergen avoidance", "I can pay , KRW/month for allergen avoidance", "I can pay , KRW for each injection of ILIT", "I can pay , KRW for each injection of ILIT", "I can pay , KRW for each injection of ILIT" before and after SPT/IDT, after NPT, 4 months and 1 year after ILIT.
Adverse events will be recorded and graded according to Muller classification and Ring and Meissner classification.
By performing rush immunotherapy, a patient can reach maintenance dosing much quicker.
The process is accomplished over one day. The patient takes medications to assist prevent allergic reactions for the three days prior to the procedure. At the finish of the day, the patient is where they would be if they had received 15 injections in the conventional build-up schedule (about halfway to maintenance). The patient will still need to finish the final half of the build-up conventionally. Allergic reactions are more common in rush patients, and it is not for everyone, but numerous patients appreciate the ability to reach maintenance more quickly because that is typically when allergic symptoms start to improve.