1. TEENAGER AND HIS THREE ATTEMPTS OF SUBLINGUAL
ALLERGEN SPECIFIC IMMUNOTHERAPY
Linauskiene K. (1), Buterleviciute N. (1,2,3), Nakrosyte G. (1), Rudzeviciene O. (1,3)
1 - Vilnius University Faculty of Medicine, Vilnius, Lithuania, 2 - Vilnius University Hospital Santariskiu
Klinikos, Vilnius, Lithuania, 3 - Vilnius University Children‘s Hospital, Affiliate of Vilnius University Hospital
Santariskiu Klinikos, Vilnius, Lithuania
Background
In sublingual specific allergen immunotherapy (SLIT),
most adverse reactions are local and transient and
usually do not lead to interruption or cessation of
treatment.*
Allergen specific immunotherapy (ASIT) was started
with Staloral Betulaceae (Stallergenes) at the age of 9
year in 2008. It was discontinued due to local side
effects after 2 months.
ASIT was tried to start again in the next year and
discontinued again due to local side affects.
Last autumn the patient came with strong will to continue
ASIT because it was effective and improved his everyday
life quality besides its side effects. Skin prick test and
specific IgE were positive to house dust mites, birch, alder,
hazel, grasses, mugwort, cat and dog dander. Specific IgE
were performed (Fig.1). According to patient, the worst
symptoms are from March to May.
Specific immunotherapy with Staloral Betulaceae
(Stallergenes®) was started in 2014-10-27 by “Rush”
protocol (Fig.2), maintenance dose 300 IR ml 4 drops was
achieved. Fatigue, headache, throat ache, swelling under
tongue and diarrhea appeared after three weeks. The most
suspected reason was viral infection, so we recommended
to continue ASIT with reduced dose increasing doses
gradually and premedication with Loratidin 10 mg once a
day. Patient felt better after few days, the maintenance dose
was achieved and ASIT is continued till this time without
side effect.
A case report
We present a case of a sixteen year old boy with
allergy history from infancy. Atopic dermatitis was
diagnosed at the age of 3 months and treated with local
corticosteroids and emollients. Later food allergy
appeared. Allergic rhinoconjunctivitis began at the age
of 4 years. Symptoms (runny nose, blocked nose, red
eyes, swelling eyelids, tearing) appear in the early
spring and last till late autumn. Treatment with
intranasal steroids and antihistamines was started but
has not sufficient efficacy. Allergic bronchial asthma was
diagnosed in 2007, managed with Flixotide 100 µg 2
times per day.
Conclusion
Local side affects are common during build-up phase of
SLIT. This could be the reason of SLIT discontinuation.
Collaboration with patient is essential. Proper education
and regular follow-up help to achieve the best results.
*Calderón MA, Simons FE, Malling HJ, et all. Sublingual allergen immunotherapy: mode of action and its relationship with the safety
profile. Allergy. 2012 Mar;67(3):302-11.
Fig. 2 Rush protocolFig. 1 Specific IgE results (OPTIGEN)
Allergen LU UNITS CLASS
>300
>300
>300
>300
>300
>300
48
22
0
13
0
0
0
0
0
0
117
207
>300
6
4
4
4
4
4
4
1
0
0
0
0
0
0
0
0
0
2
3
4
0
Time DropsDaysPhase
Build-up dose
Maintenance
dose
1st
day
≥2nd
day
T0
T30
T60
T90
T120
T0
1
2
4
6
8
4
Alder
Hazelnut
Birch, white
Mugwort
Timothy grass
Rye
Plantain
Ash
Penicillium
Alternaria
Cladosporium
Aspergillus
Hamster
Guinea Pig
Rabbit Epithelium
Horse
Cat Dander-Epithelium
Dog Dander
Dust Mites:
D. farinae
D. pteronyssinus