Eficácia e segurança da imunoterapia sublingual para ácaros em crianças e adolescentes com rinite alérgica
Efficacy and safety of house dust mite sublingual immunotherapy in children and adolescents with allergic rhinitis
Aline Didoni Fajardo; Juliana Gonçalves Primon; Thalita Gonçalves Picciani; Gabriela Spessatto; Guilherme da Silva Martins; Bruno Hernandes David João; Larissa Machado Carvalho; Angelica Fonseca Noriega; Maitê Milagres Saab; Tayna Padilha Miranda; Cristine Secco Rosário; Laura Maria Lacerda Araujo; Carlos Antônio Riedi; Débora Carla Chong Silva; Renata Calixto; Ruppert Hahnstadt; Herberto J. Chong-Neto; Nelson Augusto Rosário Filho
Resumo
Objetivo: Descrever a eficácia e segurança da imunoterapia com alérgenos sublingual (SLIT) com ácaros em pacientes com rinite alérgica durante um período de 12 meses. Métodos: Estudo experimental aberto, prospectivo que envolveu crianças e adolescentes de 4 a 18 anos com rinite alérgica/asma segundo as diretrizes Allergic Rhinitis and its Impact on Asthma (ARIA), acompanhados nos ambulatórios do Hospital de Clínicas da Universidade Federal do Paraná. Todos os pacientes receberam gotas (750 UBE/dia) de SLIT para Dermatophagoides pteronyssinus (DP) e Blomia tropicalis (BLO) na concentração de 5.000 UBE/mL durante 12 meses. Foram aplicados escores de medicação (RTSS), testes cutâneos para aeroalérgenos entre janeiro de 2022 e janeiro de 2023. Resultados: Vinte participantes com pelo menos 4 (variação de 2 a 10) anos de diagnóstico de RA. A adesão média à SLIT foi de 89%. Houve redução no diâmetro médio da pápula DP de 7 ± 2,9 mm para 4,2 ± 2,1 mm após 12 meses (p = 0,0002), bem como na mediana do diâmetro médio da pápula BLO de 3,7 mm a 3 mm (p = 0,0001). Os pacientes apresentaram redução no consumo de medicamentos de resgate, no escore de sintomas e no escore combinado de sintomas e medicamentos (p < 0,05). A pontuação da escala visual analógica reduziu de 9,3 ± 0,7 para 5,2 ± 1,4 ao final do estudo (p < 0,05). Não houve diferença no controle da asma (p = 0,16). A taxa de efeitos adversos leves foi baixa e não diferiu ao longo do estudo (p = 0,62), e não houve reações anafiláticas. Conclusão: A SLIT pode trazer benefícios em curto prazo em pacientes com RA, reduzindo a necessidade de medicação e melhorando os sintomas nasais. Foi bem tolerada e segura, sem eventos adversos graves.
Palavras-chave
Abstract
Objective: To describe the efficacy and safety of house dust mite sublingual immunotherapy (SLIT) in patients with allergic rhinitis (AR) over a 12-month period. Methods: This is a prospective, open-label study of children and adolescents aged 4 to 18 years with AR/asthma according to the Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines, followed up at the outpatient clinics of the Hospital de Clínicas affiliated with the Federal University of Paraná, southern Brazil. All patients received SLIT drops (750 UBE/day) for Dermatophagoides pteronyssinus (DP) and Blomia tropicalis (BLO) at a concentration of 5000 UBE/mL for 12 months. Symptom and medication scores (RTSS) were assessed and skin prick tests for aeroallergens were performed from January 2022 to January 2023. Results: Twenty participants with an AR diagnosis for at least 4 years (range, 2-10) were included. The mean SLIT adherence rate was 89%. The mean DP wheal diameter reduced from 7.0 (SD 2.9) to 4.2 (SD 2.1) mm after 12 months (p=0.0002), while the median BLO wheal diameter reduced from 3.7 to 3.0 mm (p=0.0001). Patients showed a reduction in rescue medication use, symptom score, and combined symptom and medication scores (p<0.05). The mean visual analog scale score reduced from 9.3 (SD 0.7) to 5.2 (SD 1.4) (p<0.05). There was no difference in asthma control (p=0.16). The rate of mild adverse effects was low and did not differ throughout the study (p=0.62). There were no anaphylactic reactions. Conclusion: SLIT may provide short-term benefits to patients with AR, reducing the need for medication and improving nasal symptoms. SLIT was well tolerated and safe, with no serious adverse events.
Keywords
Referências
1. Brozek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017;140(4):950-8.
2. Alvaro-Lozano M, Akdis CA, Akdis M, Alviani C, Angier E, Arasi S, et al. EAACI allergen immunotherapy user's guide. Pediatr Allergy Immunol. 2020;31(25):1-101.
3. Wilson DR, Torres Lima M, Durham SR. Sublingual immunotherapy for allergic rhinitis: systematic review and meta-analysis. Allergy. 2005;60(1):4-12.
4. Chong Neto HJ, Rosário CS, Rosário BA, Chong FH, Grasselli EA, Silva FC, et al. Allergic rhinitis in preschool children from southern Brazil. Allergy. 2014;69(4):545-7.
5. Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, et al. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol. 2020;146(4):721-67.
6. Devillier P, Fadel R, De Beaumont O. House dust mite sublingual immunotherapy is safe in patients with mild-to-moderate, persistent asthma: a clinical trial. Allergy. 2016;71(2):249-57.
7. Carvalho A, Sgnori DJ, Rosário Fº NA. Prevalência do padrão facial em crianças com rinite alérgica persistente. Orthod SciPract. 2020;13(51):907.
8. Aarestrup FM, Taketomi EA, Santos Galvão CES, Gagete E, Arruda ACNM, Alves GB, et al. Good clinical practice recommendations in allergen immunotherapy: Position paper of the Brazilian Association of Allergy and Immunology - ASBAI. World Allergy Organ J. 2022;15(10):100697.
9. Canonica GW, Cox L, Pawankar R, Baena-Cagnani CE, Blaiss M, Bonini S, et al. Sublingual immunotherapy: World Allergy Organization position paper 2013 update. World Allergy Organ J. 2014;7(1):6.
10. Bufe A, Eberle P, Franke-Beckmann E, Funck J, Kimmig M, Klimek L, et al. Safety and efficacy in children of an SQ-standardized grass allergen tablet for sublingual immunotherapy. J Allergy Clin Immunol. 2009;123(1):167-73.
11. Nolte H, Bernstein DI, Nelson HS, Kleine-Tebbe J, Sussman GL, Seitzberg D, et al. Efficacy of house dust mite sublingual immunotherapy tablet in North American adolescents and adults in a randomized, placebo-controlled trial. J Allergy Clin Immunol. 2016;138(6):1631-8.
12. Aarestrup FM, Lira GV de AG, Taketomi EA, Gagete E, Rosário Filho NA, Rizzo MC, et al. Brazilian guidelines for allergen immunotherapy in the treatment of allergic rhinitis. Rev Assoc Med Bras [Internet]. 2023;69(5):e2023D695.
13. Radulovic S, Wilson D, Calderon M, Durham S. Systematic rewiews of sublingual immunotherapy (SLIT). Allergy. 2011;66(6):740-52.
14. Pfaar O, Kleine-Tebbe J, Hörmann K, Klimek L. Allergen-specific immunotherapy: which outcome measures are useful in monitoring clinical trials? 2011. Immunol Allergy Clin North Am. 2011;31(2):289309.
15. Cardona V, Ansotegui IJ, Ebisawa M, El-Gamal Y, Rivas MF, Fineman S, et al. World allergy organization anaphylaxis guidance 2020. World Allergy Organ J. 2020;13(10):100472.
16. Lin SY, Erekosima N, Kim JM, Ramanathan M, Suarez-Cuervo C, Chelladurai Y, et al. Sublingual immunotherapy for the treatment of allergic rhinoconjunctivitis and asthma: a systematic review. JAMA. 2013;309(12):127888.
17. Canonica GW, Cox L, Pawankar R, BaenaCagnani CE, Blaiss M, Bonini S, et al. Sublingual immunotherapy: World Allergy Organization position paper 2013 update. World Allergy Organ J. 2014;7(1):6.
18. Pfaar O, Bachert C, Bufe A, Buhl R, Ebner C, Eng P, et al. Guideline on allergen-specific immunotherapy in IgE-mediated allergic diseases: S2k Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergy and Environmental Medicine (GPA), the Medical Association of German Allergologists (AeDA), the Austrian Society for Allergy and Immunology (ÖGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Dermatology (DDG), the German Society of Oto- Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), the German Society of Pediatrics and Adolescent Medicine (DGKJ), the Society for Pediatric Pneumology (GPP), the German Respiratory Society (DGP), the German Association of ENT Surgeons (BV-HNO), the Professional Federation of Paediatricians and Youth Doctors (BVKJ), the Federal Association of Pulmonologists (BDP) and the German Dermatologists Association (BVDD). Allergo J Int. 2014;23(8):282-319.
19. Position paper: Immunotherapy with hymenoptera venoms. (EAACI) The European Academy of Allergology and Clinical Immunology. Allergy. 1993;48(14 Suppl):36-46.
20. Del Cuvillo A, Santos V, Montoro J, Bartra J, Davila I, Ferrer M, et al. Allergic rhinitis severity can be assessed using a visual analogue scale in mild, moderate and severe. Rhinology. 2017;55(1):34-38.
21. Chen S, Zeng X, Wang L, Chen B, Chen L, Wu S, et al. [Effects of house dust mite sublingual immunotherapy in children with allergic rhinitis and asthma]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Aug;50(8):627-31. Chinese.
22. Bahceciler NN, Galip N, Babayigit A. Steroid sparing effect of sublingual immunotherapy: real life study in mono/polisensitized children with asthma. Immunotherapy. 2017;9(15):12639.
23. Lin Z, Liu Q, Li T, Chen D, Chen D, Xu R. The effects of house dust mite sublingual immunotherapy in patients with allergic rhinitis according to duration. Int Forum Allergy Rhinol. 2016;6(1):82-7.
24. Hamada S, Kobayashi Y, Sakamoto D, Shimamura A, Kuroda K, Kawachi R, et al. Long- term sublingual immunotherapy provides better effects for patients with Japanese cedar pollinosis. Auris Nasus Larynx. 2021;48(4):646-52.
25. Akdis CA, Akdis M. Mechanisms of allergen-specific immunotherapy and immune tolerance to allergens. World Allergy Organ J. 2015;8(1):17.
Submetido em:
03/05/2024
Aceito em:
12/05/2024
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email