26 - The efficacy of specific immunotherapy in respiratory allergy - 31/03/08

Introduction: Allergic rhinitis and asthma are global health problems affecting up to 20% and 5% of the population respectively. Unfortunately, prevalence seems to be increasing, thus They are considered in most countries major public health problems in a variety of aspects, including reduced quality of life, lost productivity, missed school days, high costs associated with treatment, and even mortality when it comes to asthma.

Specific immunotherapy (SIT) has been reported to be efficacious in changing the natural history of the disease with effects that sustain after termination of the treatment. Furthermore, SIT is thought to reduce new sensitivities to new allergens.

Purpose: This study was designed to evaluate the efficacy of the specific immunotherapy and to identify the causative allergens for patients treated at Al-assad University Hospital in the last two years.

Setting: An Allergy clinic and satellite clinics in a major University and tertiary care center in the capital of Syria: Damascus.

Patients and methods: Retrospective study between 2003-2005 of 249 patients with well-documented history of rhinitis, conjunctivitis, asthma or combination of 2 or more. A thorough history of allergic diseases and physical exam were performed to all patients. When allergy is suspected based on a structured numbering system, then allergy skin testing was done. If specific allergen(s) was identified, the SIT was considered. Risks and benefits were discussed with the patient, and consent was obtained. Reevaluation was done periodically each month for at least one year.

Results: A total of 265 patients were included. All patients underwent skin allergy testing. 60 patients were given immunotherapy either subcutaneously (SCIT) or sublingually (SLIT). Improvement was estimated subjectively and objectively using detailed questionnaire and scoring system. Patients were 51% males and 49% females. Most were from the capital (65.4%), 57% were smokers. Asthma constituted 46%, and allergic rhinitis was detected in 54%. Overall allergies were pollen-related in 70% of the cases, whereas dust mites were positive in 36% only. In allergic rhinitis, pollens and mites were detected in 40%, and 16% respectively. 65% of asthmatics and 80% of allergic rhinitis patients who received SIT for pollens showed significant improvement. Response to dust mites immunotherapy was higher in both asthma (80%) and allergic rhinitis (90%).

Conclusion: House dust mites and pollens are the most common allergens seen in Syria. SIT was found effective in modifying the disease symptoms and the need for other medications in about two thirds of the carefully selected patients. These results were comparable to those reported in different areas of the world.