A model for management of sublingual immunotherapy.
High dose sublingual immunotherapy (SLIT) is generally well tolerated, since most side effects are local reactions involving the oral or gastrointestinal mucosa. However, such reactions, if not adequately managed, may lead the patient to stop SLIT.


OBJECTIVE
We introduce a method to manage side effects of SLIT, which was successfully applied on a group of children undergoing SLIT.


METHODS
SLIT was performed with Staloral 300 (Stallergénes, Antony, France) by the schedule in 11 days indicated by the manufacturer with a tap dose of 8 pressures of the 300 IR concentration. The treatment was managed by flow charts suggesting adjustment of dose, regimen, or kind of assumption depending on the kind of reactions (oral, gastrointestinal, respiratory).


RESULTS
An overall number of 200 children (120 males, 80 females, mean age 9 yrs, range 3-14 yrs) were treated. Of them, 155 (77.5%) had no reaction, while 45 (22.5%) had side effects, consisting of 20 oral itching or burning, 15 gastrointestinal symptoms and 10 rhinitis. No systemic reaction was observed. All side effects were successfully managed by the proposed method, thus reaching the maintenance dose in all patients but one, reporting repeated intense oral itching, who stopped SLIT.


CONCLUSIONS
High dose SLIT is well tolerated in treated patients. In most patients with side effects, which are mainly oral itching or gastrointestinal disturbances due to contact with the allergen extract, a proper management allows to reach the maintenance dose with no further reactions.
Frati
F
F
University of Perugia, Department of Obstetric, Gynaecologic and Paediatric Sciences, Perugia, Italy.
Sensi
L
L
Di Rienzo
V
V
Senna
G E
GE
Incorvaia
C
C
Marcucci
F
F
D000286:Administration, Sublingual; D000293:Adolescent; D000485:Allergens / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D019090:Case Management; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology; D006801:Humans; D008297:Male; D011537:Pruritus / Q000209:etiology
D000485:Allergens