Dermatologists: Now you are able to treat your atopic dermatitis patients with sublingual immunotherapy (SLIT). Emerging treatments for atopic dermatitis (AD), including sublingual immunotherapy, have recently been evaluated. In the year 2000, Mastrandrea et al. reported that patients who completed a three-year treatment of SLIT had a complete disappearance of skin lesions at a six-year follow-up in 70% of patients with mild to moderate AD. Also, in a 2003 study, Bordignon et al. reported a decrease in skin reactivity after SLIT.
The literature includes an important double-blind, well-controlled study related to SLIT and atopic dermatitis. In a 2007 study, patients in the active group reported a significant reduction in the use of other symptom-relieving medications. The results revealed skin lesion improvement in 64% of SLIT treated patients with moderate to severe AD. There was also a significant reduction in total IgE levels and symptoms in children with AD that were treated for two years. The recommendations of the authors include:
(SLIT in mite-sensitized children with atopic dermatitis: A randomized, double blind, placebo controlled study, Panjo et al., J Allergy Clinical Immunol, 2007, Vol. 120, no. 1, pp.16-170.)
Pulmonologists: With numerous clinical studies demonstrating improvement in asthma and safety of use, it is reasonable to consider SLIT as an option in allergic mediated asthma. During the last 20 years, numerous clinical trials have evaluated the effectiveness of SLIT in the treatment of asthma. In 2006, a meta-analysis was published evaluating the clinical efficacy of SLIT in asthma treatment of adults and children. Inclusion criteria were met in 25 of the 119 published studies. Quality scores were given and data were extracted relative to the follow areas: asthmatic symptoms, use of asthma medications, lung function, and bronchial provocation.
SLIT was seen to significantly reduce asthma severity when looking across all categorical outcomes. In this meta-analysis, medication scores were reviewed in ten studies and found to have a significant reduction in medication use for asthma, allergic rhinitis and conjunctivitis. The analysis of the asthma symptom scores alone did not reveal a significant improvement. Bronchial provocation tests also did not show any major improvement. In conclusion, the authors stated that SLIT is beneficial for asthma, but the magnitude of improvement is not large. Although this meta-analysis did not show a significant reduction in symptom scores, numerous individual studies have reported significant improvement.
(Calamita Z. et al., Efficacy of SLIT in asthma: systematic review of randomized-clinical trials using the Cochrane collaboration method. Allergy, 2006, 61, 1162-1172.)
Ophthalmologists: Treat your conjunctivitis patients with SLIT. Five to twenty-two percent of the United States population has ocular manifestations of allergy for at least one week per year. The spectrum of symptoms can range from acute, perennial or seasonal exacerbations. Symptoms commonly include watery eyes, itchy eyes, redness, soreness, edema, stinging, and burning. Chronic allergic conjunctivitis, AKA vernal keratoconjunctivitis and atopic keratoconjunctivitis have additional complaints of pain and visual changes. Studies have shown that sublingual immunotherapy is an effective treatment for conjunctivitis.
(Casanovas et al, J Investig Allergol Clin Immunol 1994; 4:305-314.)
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