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Can sublingual allergen immunotherapy modify airway inflammation and remodeling?

Published online: June 19, 2019

House dust mite (HDM) is a major cause of respiratory allergic disease and often implicated as a trigger for allergic asthma (AA) and perennial allergic rhinitis (AR). Allergen immunotherapy (AIT) is the only treatment option for allergic disease with evidence of a disease-modifying effect and may halt progression from rhinitis to asthma. The standardized quality (SQ) HDM sublingual immunotherapy (SLIT) demonstrated favorable safety and efficacy profiles for reducing symptoms and medication in AA and AR but impact on airway inflammation and remodeling is not well studied.

In a recent article published in The Journal of Allergy and Clinical Immunology: In Practice, Hoshino et al. show a disease-modifying effect of SQ-HDM SLIT by assessment of fractional exhaled nitric oxide (FeNO), CT and pulmonary function in patients having AA with AR. Compared to pharmacotherapy, add-on treatment with SQ-HDM SLIT for 48 weeks resulted in a reduction of FeNO, reduction in airway wall thickness and improvement of airflow limitation and clinical symptom scores. Importantly, changes in FeNO and airway wall thickness were significantly correlated with improvements in airflow limitation.

The authors concluded that the addition of SQ-HDM-SLIT provided significant improvement of airflow limitation associated with a decrease in eosinophilic airway inflammation.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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