Quality of life improves with sublingual immunotherapy for patients with allergic rhinitis
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Key takeaways:
- The review included 11 trials and more than 6,000 patients.
- Improvements included symptoms, sleep, emotions, problems and activities.
- Scores remained significant after accounting for age and sex.
Sublingual immunotherapy tablets improved quality of life for patients with allergic rhinitis with and without conjunctivitis, according to a review published in The Journal of Allergy and Clinical Immunology: In Practice.
Treatments included tablets for grass, tree, ragweed and house dust mite, Michael S. Blaiss, MD, clinical professor of pediatrics, Medical College of Georgia at Augusta University, and colleagues wrote.
“The efficacy and safety of sublingual immunotherapy (SLIT) tablets is well documented in the literature, but does the patient truly show benefit with this treatment in their quality of life?” Blaiss, who also is a member of the Healio Allergy and Asthma Peer Perspective Board, told Healio.
The researchers analyzed Rhinitis Quality of Life Questionnaire (RQLQ) responses from 11 randomized, double-blind, placebo-controlled trials conducted between 2002 and 2017 that included approximately 6,000 adults as well as 323 adolescents and 109 children.
Generally, patients were classified as in their mid-30s in terms of age with disease durations between 9.9 and 21 years. Also, 75% of these patients were polysensitized.
These trials included five focused on grass (n = 3,179), two that studied ragweed (n = 767), one trial investigating tree allergy (n = 634) and three trials involving house dust mites (n = 2,221).
All 11 trials indicated improvements in overall RQLQ with SLIT, with 10 of them indicating statistically significant differences between SLIT tablets and placebo.
Pooled analyses of all 11 trials indicated highly significant improvements in overall RQLQ with SLIT tablets compared with placebo, the authors said, including –0.2 (95% CI, –0.28 to –0.12) for grass, –0.28 (95% CI, –0.39 to –0.17) for house dust mite, –0.36 (95% CI, –0.55 to –0.17) for ragweed and –0.42 (95% CI, –0.58 to –0.26) for tree.
The magnitude of these improvements in overall RQLQ results is comparable with improvements reported for other SLIT tablets, the authors wrote.
The authors also categorized the overall RQLQ results as consistent with pooled analyses across the seven domains in the questionnaire for all four allergens, significantly favoring active treatment.
“The most surprising and significant results were that all the domains of the RQLQ were significant: activities limitation, sleep problems, nose symptoms, eye symptoms, non-nasal-eye symptoms, practical problems and emotional function,” Blaiss said. “This points to the high value of SLIT tablets for appropriate allergic rhinitis patients.”
Specifically, P values by domain for grass treatment included less than .001 for nasal, ocular, emotional, practical problems and activities alike, as well as .004 for non-nose/eye and .009 for sleep.
For ragweed treatment, P values by domain included .002 for nasal; less than .001 for ocular, non-nose/eye, sleep and activities; less than .001 for emotional, and .003 for practical problems.
P values for tree treatment and house dust mite treatment both included less than .001 for all seven domains.
“To me, the most surprising [finding] is that all domains of the RQLQ showed significant improvement, especially sleep problems and emotional function with SLIT tablets,” Blaiss said. “These two domains contribute much of the underlying misery that encompasses allergic rhinitis in our patients.”
Overall RQLQ scores remained significant with little variation in sensitivity analyses based on age and sex as well, the authors said.
The authors further noted that these significant improvements were seen among patients who had free access to antihistamines and oral and nasal glucocorticosteroids that relieved symptoms during the trial period.
Previous research has found that these medications can improve quality of life based on RQLQ results, the authors wrote, indicating that the significant improvements found in this review were “compelling” as patients experienced a reduced need for symptom-relieving medication with SLIT.
“As we know, many of our patients with allergic rhinitis do not get the relief that they need with medications, have side effects with medication, or are just tired of having to take medications,” Blaiss said. “This study shows us that SLIT tablets don’t only improve clinical symptoms in allergic rhinitis but truly demonstrate improvement of quality of life in those patients.”
Considering the positive impact on sleep in particular, with potential improvements in productivity, the authors said that they are not surprised that SLIT tablets are considered an effective and socioeconomically attractive option for allergic rhinitis.
Based on these findings, the authors concluded that SLIT tablets can be used more frequently to ease symptom burdens and improve quality of life for patients with allergic rhinitis with or without conjunctivitis.
“Patients with allergic rhinitis need to be made aware of this therapy, which can have important major benefits for their condition,” Blaiss said.
For more information:
Michael S. Blaiss, MD, can be reached at michael.blaiss@gmail.com.