Comparison of clinical efficacy and safety subcutaneous and sublingual immunotherapy in Kuwaiti schoolchildren with seasonal allergic rhinitis

Nermina Arifhodžić, Mona Al Ahmad, Radhakrishna Panicker, Nasser Al Ahmed, Nasser Fakim, Fadia Mahmoud


Objective - To compare the clinical efficacy and safety of sublingual immunotherapy (SLIT) vs. subcutaneous immunotherapy (SCIT) in Kuwaiti schoolchildren with seasonal allergic rhinitis (SAR), sensitive to pollens of Salsola kali and Bermuda grass.

Patients and methods - The study was single blinded. Patients and Methods: Eight-two schoolchildren, 9-14 years old, diagnosed with SAR due to sensitization to local pollen allergens (Salsola kali, Bermuda grass or both), who fulfilled the inclusion criteria, were randomly selected (1:1) to receive either SLIT (n=38), Staloral; Stallergenes SA, Antony France, or SCIT (n= 44), Alustal, from the same manufacturer, as a 3 year treatment course. Twenty-five patients from the SLIT and 34 from the SCIT group completed the treatment. Clinical efficacy was evaluated on a yearly basis, during the pollination period, by total clinical symptom scores (TCSS) and reduction in medication consumption. Adherence to the treatment, as well as safety profile of both modes of immunotherapy was compared.

Results - There was no difference in adherence to the treatment between the 2 groups. Our study demonstrated that SCIT had a tendency for faster clinical improvement than SLIT, but at the end both were equally effective. Significant reduction in drug use (>50%) in the 1st treatment year was seen only in the SCIT group (p <0.02). In the end, there was no significant difference between the two groups (p <0.4). A mild systemic reaction (grade 2) was seen in 1 patient in the SCIT group, while local reactions were seen in both groups.

Conclusion - Our study demonstrates that SLIT is a valid alternative to SCIT in terms of clinical efficacy and safety, and can be safely used in schoolchildren sensitive to pollen allergens.


AIT=Allergen immunotherapy; SLIT=Sublingual immunotherapy; SCIT= Subcutaneous immunotherapy; SAR=Seasonal allergic rhinitis

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