title: Effect of adjuvanted and standard sublingual immunotherapy on respiratory function in pure rhinitis due to house dust mite over a 5-year period.
abstract: BACKGROUND
  Allergen-specific immunotherapy (AIT) still remains the only causal treatment for IgE mediated respiratory diseases (rhinitis/asthma) In addition to the observed clinical decrease in symptoms, AIT can provide a long-lasting and preventive effect. In particular it can modify the progression from rhinitis to asthma.
  
  
  METHODS
  The study was observational, open, non randomized, controlled, prospective and performed in a real-life setting. Patients with pure mite-induced allergic rhinitis were followed-up, receiving adjuvanted SLIT (aSLIT), standard SLIT (sSLIT) or drug treatment alone, according to their preference starting between 2008 and 2009. The possible onset of asthma, changes in pulmonary function and bronchial hyperreactivity (BHR) were assessed over a 5-year horizon. Also the onset of new sensitizations and symptoms-medication score (SMS) were evaluated.
  
  
  RESULTS
  One hundred forty two patients fulfilling the inclusion criteria were assessed at baseline, and 124 had the 5-year evaluation (age range 8-57, 69 male). After 5 years of treatment, new sensitizations appeared differentially among treatments with 58.1% of new sensitizations in the drug treatment group, 13.2% in the sSLIT patients, and 8.1% in the aSLIT patients. At the end of 5 years, SMS significantly changed (P< 0.001) in all groups, with a negative trend for controls, as compared to the SLIT treatments. The SMS decreased in both SLIT groups at 5 years, with no change in patients on drug treatment alone. The use of salbutamol (absent at baseline), showed an overall increase only in the group receiving drugs alone with a significant difference at 5 years (P< 0.001). Considering the MCh challenge, there was a difference among treatments (P< 0.001) in PD20 after 5 years: the control group had a lower PD20 at 5 years. No significant difference in PD20 was detected between sSLIT and aSLIT. The FEV1 significantly decreased in controls, with no change in the sSLIT group and a significant increase in aSLIT as compared to sSLIT.
  
  
  CONCLUSIONS
  Despite the limitations inherent to a real-life setting study (absence of randomization and control, small sample size, lack of intermediate timepoint assessment) the results of this study evidenced that the investigated SLIT product, either adjuvanted or not, had a positive effect on the evolution of respiratory allergy due to house dust mite.
  
  
  CONCLUSIONS
  In the real life setting, considering a 5-year period, aSLIT and sSLIT reduced the onset of new sensistizations and maintained intact the pulmonary function, as compared to patients receiving drug treatment alone.
authors.affiliation: Pneumology Unit, Cuasso al Monte, Macchi Hospital Foundation, Varese, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Marogna
authors.affiliation: Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Alberta, Canada.|O'Brien Institute for Public Health, University of Calgary, Alberta, Canada.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Massolo
authors.affiliation: Department of Internal Medicine, Allergy and Respiratory Diseases, IRCCS San Martino-IST-University of Genoa, Pad. Maragliano, Ospedale San Martino, L.go R. Benzi 10, 16133 Genova, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Passalacqua
keywords: Adjuvants; Allergic asthma; Allergic rhinitis; House dust mite; Sublingual immunotherapy