title: Long-term comparison of sublingual immunotherapy vs inhaled budesonide in patients with mild persistent asthma due to grass pollen.
abstract: BACKGROUND
  Few studies have compared the effects of immunotherapy and inhaled steroids. The main limitation of such studies is the long duration required to fully appreciate the effects of immunotherapy.
  
  
  OBJECTIVE
  To compare the effects of inhaled budesonide and sublingual immunotherapy (SLIT) in mild persistent asthma for up to 5 years.
  
  
  METHODS
  Patients with mild persistent asthma and rhinitis due to grass pollen were enrolled in an open randomized controlled trial. After a run-in season, they were randomized to either budesonide, 800 microg/d, in the pollen season or continuous grass SLIT for 5 years. All patients received rescue medications. Symptoms were evaluated by diary cards filled out from May to July at baseline and after 3 and 5 years. In-season nasal eosinophils and bronchial hyperresponsiveness were also assessed.
  
  
  RESULTS
  Fifty-one patients were enrolled and 46 completed the study. The bronchial symptom scores and the use of bronchodilators decreased significantly in both groups, but the improvement was greater in the SLIT patients at 3 and 5 years. The nasal symptom score and the intake of nasal steroids decreased only in the SLIT group, and the difference vs the budesonide group was always significant. In the SLIT group vs the budesonide group, a statistically significant decrease of nasal eosinophils was found at 3 and 5 years (P < .01). The bronchial hyperresponsiveness improved significantly only in the SLIT group.
  
  
  CONCLUSIONS
  In patients with grass pollen-induced asthma, in the long term SLIT was equally effective as inhaled budesonide in treating bronchial symptoms and provided an additional benefit in treating rhinitis symptoms and bronchial hyperresponsiveness.
authors.affiliation: Pneumology Unit, Macchi Hospital Foundation, Cuasso al Monte, Varese, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Marogna
authors.forename: Igino
authors.initials: I
authors.lastname: Spadolini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Massolo
authors.forename: Daniele
authors.initials: D
authors.lastname: Berra
authors.forename: Pietro
authors.initials: P
authors.lastname: Zanon
authors.forename: Elena
authors.initials: E
authors.lastname: Chiodini
authors.forename: Giorgio Walter
authors.initials: GW
authors.lastname: Canonica
authors.forename: Giovanni
authors.initials: G
authors.lastname: Passalacqua
mesh_terms: D000280:Administration, Inhalation; D000286:Administration, Sublingual; D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000008:administration & dosage / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy / Q000276:immunology / Q000628:therapy*; D019819:Budesonide / Q000008:administration & dosage / Q000627:therapeutic use*; D003888:Desensitization, Immunologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D006109:Poaceae / Q000276:immunology; D011058:Pollen / Q000276:immunology; D006255:Rhinitis, Allergic, Seasonal / Q000188:drug therapy / Q000276:immunology / Q000628:therapy*; D055815:Young Adult
chemical_list: D000485:Allergens; D000893:Anti-Inflammatory Agents; D019819:Budesonide