Addressing the increasing incidence of allergic diseases in young working individuals and their effective management with sublingual immunotherapy in Mumbai
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20261415Keywords:
Allergen immunotherapy, Allergic rhinitis, Patient reported outcomes, Skin prick test, SNOT 22 score, Sublingual immunotherapyAbstract
Background: Allergic diseases are on an increase in office workers and students, as a result of climate change and environmental exposure. Our objective here was to define the role of the skin prick test in identifying common inhalant allergens in allergic rhinitis patients and selecting the allergens for optimum sublingual immunotherapy.
Methods: 773 patients were tested in Mumbai from November 2018 to December 2023 by skin prick test. Sublingual Immunotherapy was initiated in 301 patients. Pre and post-therapy SNOT22 symptom score was noted for 3-6 months in a subset of 50 patients.
Results: It was found that 52% were in the age group 20-40 with almost equal male /female ratio, 95% primarily had allergic rhinitis, house dust mite allergy 84%, pollen allergies were the next most common, 63% each being Prosopis and Amaranthus. 40% opted for sublingual immunotherapy, from which a subset of 50 patients, 35 %, showed significant improvement verified by statistical analysis in the first 6 months.
Conclusions: It was found that 52% were in the age group 20-40 with almost equal male /female ratio, 95% primarily had allergic rhinitis, house dust mite allergy 84%, pollen allergies were the next most common, 63% each being Prosopis and Amaranthus. 40% opted for sublingual immunotherapy, from which a subset of 50 patients, 35%, showed significant improvement verified by statistical analysis in the first 6 months.
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References
Singh AB, Kumar P. Climate change and allergic diseases: an overview review. Front Allerg. 2022;3:964987. DOI: https://doi.org/10.3389/falgy.2022.964987
Pacheco SE, Guidos-Fogelbach G, Annesi-Maesano I, Pawankar R, d'Amato G, Latour-Staffeld P, et al. Climate change and global issues in allergy and immunology. J Allerg Clin Immunol. 2021;148(6):1366-77. DOI: https://doi.org/10.1016/j.jaci.2021.10.011
Ansotegui IJ, Melioli G, Canonica GW, Caraballo L, Villa E, Ebisawa M, et al. IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper. World Allerg Organ J. 2020;13(2):100080. DOI: https://doi.org/10.1016/j.waojou.2019.100080
Nevis IF, Binkley K, Kabali C. Diagnostic accuracy of skin‑prick testing for allergic rhinitis: a systematic review and meta‑analysis. Allerg Asthma Clin Immunol 2016;12(1):20. DOI: https://doi.org/10.1186/s13223-016-0126-0
Pavón-Romero GF, Parra-Vargas MI, Ramírez-Jiménez F, Melgoza-Ruiz E, Serrano-Pérez NH, Teran LM. Allergen immunotherapy: current and future trends. Cells. 2022;11(2):212. DOI: https://doi.org/10.3390/cells11020212
Bousquet J, Schünemann HJ, Togias A, Bachert C, Erhola M, Hellings PW, et al. Next-generation allergic rhinitis and its impact on asthma (ARIA) guidelines for allergic rhinitis based on grading of recommendations assessment, development and evaluation (GRADE) and real-world evidence. Allergy Clin Immunol. 2020;145(1):70-80.e3.
Global Initiative of Asthma. Global Strategy for Asthma Management and Prevention. GINA. 2021. Available from: https://ginasthma.org/wp-content/uploads/2021/05/GINA-Main-Report-2021-V2-WMS.pdf. Accessed on 15 September 2021.
Pfaar O, Bachert C, Bufe A, Buhl R, Ebner C, Eng P, et al. Guideline on allergen-specific immunotherapy in IgE-mediated allergic diseases. Allerg J Int. 2014;23(8):282-319. DOI: https://doi.org/10.1007/s40629-014-0032-2
Chong AX, Alvarado R, Rimmer J, Campbell RG, Kalish L, Png LH, et al. Comparison of allergen immunotherapy alone and in conjunction with turbinate surgery for nasal obstruction in perennial allergic rhinitis patients. Ann Oto Rhino Laryngol. 2024 Jun;133(6):545-53. DOI: https://doi.org/10.1177/00034894241234593
Durham SR, Walker SM, Varga EM, Jacobson MR, O'Brien F, Noble W, et al. Long-term clinical efficacy of grass-pollen immunotherapy Engl J Med. 1999;341(7):468-75. DOI: https://doi.org/10.1056/NEJM199908123410702
Khan AH, Reaney M, Guillemin I, Nelson L, Qin S, Kamat S, et al. Development of Sinonasal Outcome Test (SNOT‐22) domains in chronic rhinosinusitis with nasal polyps. Laryngoscope. 2022;132(5):933-41. DOI: https://doi.org/10.1002/lary.29766
Kennedy JL, Hubbard MA, Huyett P, Patrie JT, Borish L, Payne SC. Sino-nasal outcome test (SNOT-22): a predictor of postsurgical improvement in patients with chronic sinusitis. Ann Allerg Asthma Immunol. 2013;111(4):246-51. DOI: https://doi.org/10.1016/j.anai.2013.06.033
Daigle BJ, Rekkerth DJ. Practical recommendations for mixing allergy immunotherapy extracts. Allerg Rhinol. 2015;6(1):ar-2015. DOI: https://doi.org/10.2500/ar.2015.6.0111
Chester JG, Bremberg MG, Reisacher WR. Patient preferences for route of allergy immunotherapy: a comparison of four delivery methods. Int Forum Allerg Rhinol. 2016;6(5):454-9. DOI: https://doi.org/10.1002/alr.21707
Calderón MA, Simons FER, Malling HJ, Lockey RF, Moingeon P, Demoly P. Sublingual allergen immunotherapy: mode of action and its relationship with the safety profile. Allergy. 2012;67(3):302-11. DOI: https://doi.org/10.1111/j.1398-9995.2011.02761.x
Murrison LM, Brandt EB, Myers JB, Hershey GKK. Environmental exposures and mechanisms in allergy and asthma development. J Clin Invest. 2019;129(4):1504-15. DOI: https://doi.org/10.1172/JCI124612
Kumar R, Kumar M, Bisht I, Singh K. Prevalence of aeroallergens in patients of bronchial asthma and/or allergic rhinitis in India based on skin prick test reactivity. Indian J Allerg Asthma Immunol. 2017;31(2):45-55. DOI: https://doi.org/10.4103/ijaai.ijaai_23_17
Sing AB, Kumar P. Aerial pollen diversity in India and their clinical significance in allergic diseases. Indian J Clin Biochem. 2004;19(2):190-201. DOI: https://doi.org/10.1007/BF02894284
Farioli L, Losappio LM, Giuffrida MG, Pravettoni V, Micarelli G, Nichelatti M, et al. Mite-induced asthma and IgE levels to shrimp, mite, tropomyosin, arginine kinase, and Der p 10 are the most relevant risk factors for challenge-proven shrimp allergy. Int Arch Allerg Immunol. 2017;174(3-4):133-43. DOI: https://doi.org/10.1159/000481985
Gómeza RM, Croceb VH, Zernottic ME, Muiñod JC. Active smoking effect in allergic rhinitis. World Allerg Organ J. 2021;14:100504. DOI: https://doi.org/10.1016/j.waojou.2020.100504
Sánchez-Pérez S, Comas-Basté O, Costa-Catala J, Iduriaga-Platero I, Veciana-Nogués MT, Vidal-Carou MC, et al. The rate of histamine degradation by diamine oxidase is compromised by other biogenic amines. Front Nutr. 2022;9:897028. DOI: https://doi.org/10.3389/fnut.2022.897028
Agache A, Akdis C. Precision medicine and phenotypes, endotypes, genotypes, regiotypes, and theratypes of allergic diseases. J Clin Invest. 2019;129(4):1493-503. DOI: https://doi.org/10.1172/JCI124611
Pfaar O, Bonini S, Cardona V, Demoly P, Jakob T, Jutel M, et al. Perspectives in allergen immunotherapy: 2017 and beyond. Allergy. 2018;73:5-23. DOI: https://doi.org/10.1111/all.13355
Sellaturay P, Nasser S, Ewan P. The incidence and features of systemic reactions to skin prick tests. Ann Allerg Asthma Immunol. 2015;115(3):229-33. DOI: https://doi.org/10.1016/j.anai.2015.07.005
Bhattacharya K, Sircar G, Dasgupta A, Gupta Bhattacharya S. Spectrum of allergens and allergen biology in India. Int Arch Allerg Immunol. 2018;177(3):219-37. DOI: https://doi.org/10.1159/000490805
Reinmuth-Selzle K, Kampf CJ, Lucas K, Lang-Yona N, Fröhlich-Nowoisky J, Shiraiwa M, et al. Air pollution and climate change effects on allergies in the anthropocene: abundance, interaction, and modification of allergens and adjuvants. Environ Sci Tech. 2017;51(8):4119-41. DOI: https://doi.org/10.1021/acs.est.6b04908
Caballer BD, Rodríguez M, Fraj J, Cerecedo I, Antolín-Amérigo D, Colás C. Allergic rhinitis and its impact on work productivity in primary care practice and a comparison with other common diseases: the cross-sectional study to evaluate work productivity in allergic rhinitis compared with other common diseases (CAPRI) study. Am J Rhinol Allerg. 2012;26(5):390-4. DOI: https://doi.org/10.2500/ajra.2012.26.3799
Rasool R, Shera IA, Nissar S, Shah ZA, Nayak N, Siddiqi MA, et al. Role of skin prick test in allergic disorders: a prospective study in Kashmiri population in light of review. Indian J Dermatol. 2013;58(1):12-7. DOI: https://doi.org/10.4103/0019-5154.105276
Demoly P, Emminger W, Rehm D, Backer V, Tommerup L, Kleine-Tebbe J. Effective treatment of house dust mite–induced allergic rhinitis with 2 doses of the SQ HDM SLIT-tablet: results from a randomized, double-blind, placebo-controlled phase III trial. J Allerg Clin Immunol. 2016;137(2):444-51. DOI: https://doi.org/10.1016/j.jaci.2015.06.036
Lim FL, Hashim Z, Than LT, Md Said S, Hisham Hashim J, Norbäck D. Asthma, airway symptoms and rhinitis in office workers in Malaysia: associations with house dust mite (HDM) allergy, cat allergy and levels of house dust mite allergens in office dust. PloS One. 2015;10(4):e0124905. DOI: https://doi.org/10.1371/journal.pone.0124905
Larsen JN, Broge L, Jacobi H. Allergy immunotherapy: the future of allergy treatment. Drug Discov Today. 2016;21(1):26-37. DOI: https://doi.org/10.1016/j.drudis.2015.07.010