11 Efficacy and Tolerability of HDM Injective Immunotherapy With Monomeric Allergoid

BACKGROUND: Subcutaneous immunotherapy (SCIT) is an effective treatment of respiratory allergy and carbamylated monomeric allergoids (monoids), by virtue of their reduced IgE-binding activity, resulted clinically safe by sublingual administration. Purpose of this study was to investigate the efficacy and tolerability of immunotherapy with house dust mites (HDM) monoid administered by injective route in patients with allergic rhinoconjunctivitis (AR). METHODS: A preparation of 0.70 mL of 10 BU/mL containing modified extract with 50% Dermatophagoides pteronyssinus and 50% Dermatophagoides farinae (amount of major allergen: 4 μg of group 1 per milliliter) was delivered monthly for 12 months, following a 5-week build-up induction phase (0.10–0.20–0.30–0.50–0.70 mL), to 58 patients (60% males, mean age 25.1 ± 12.7) suffering from AR due to mites for at least 2 years, whereas 60 patients with similar baseline characteristics were observed as controls. All patients were allowed to assume traditional drug therapy for their condition. At the end of the study changes from baseline in symptoms scores, in number of days with drug assumption, in severity of AR (according to ARIA classification) were compared between the 2 groups; moreover an overall assessment of clinical efficacy and tolerability was based on patients' and physicians' judgements (unsatisfactory, mild, good, optimal). RESULTS: In respect to baseline both groups showed, after 1 year, an improvement in symptoms score (P < 0.001) with a significant difference in favour of SCIT group (P < 0.05). Days of drug intake were significantly lower in patients receiving SCIT (P < 0.05). The number of patients with severe AR decreased in the first group while no variation was observed in controls. The subjective clinical overall assessment was optimal in 31 cases and good in 24 according to physicians' and patients' judgements; similarly 38 patients judged tolerability as optimal and 18 as good, whereas according to physicians it was optimal in 37 patients and good in 19; in only 1 patient the treatment was considered unsatisfactory. CONCLUSIONS: In this prospective controlled study, SCIT with HDM carbamylated allergoid was associated with a significant clinical benefit observed through objective and subjective outcomes; the traditional safety of monomeric allergoids was confirmed by the subjective judgements of tolerability.