Efficiency of antifungal sublingual allergen-specific immunotherapy in patients under and over 50 years old with mild persistent and moderate bronchial asthma

Authors

DOI:

https://doi.org/10.15587/2519-4798.2017.100270

Keywords:

bronchial asthma, elderly patients, fungal allergy, the sublingual allergen-specific immunotherapy

Abstract

In Ukraine, the relative contraindication for allergen-specific immunotherapy (ASIT) in patients with bronchial asthma (BA) is age 50 years and older, which is substantiated by its efficiency reduce with age. The use of antifungal sublingual ASIT and its efficiency in older patients remain poorly investigated.

Aim – research of antifungal sublingual allergen-specific immunotherapy (with mixed-allergens of household mold) in patients with mild and moderate bronchial asthma depending on the age (up to 50 years and older).

Methods. A prospective, open, controlled, parallel, single-center study with clinical-functional and allergological examination in 45 patients with asthma in the remission stage with positive skin tests to fungal mixed-allergens was carried out. The patients were divided into 2 groups depending on the age: 27 patients from 20 to 50 years inclusive (mean age 39.6 ± 1.1 years) were included in the 1st group (the control group); 18 patients from 51 to 71 years old (mean age 57.1 ± 1.4 years) comprised the 2nd group (primary). The treatment was performed using sublingual method with fungal mixed-allergens (household mold mixture) (Aspergillus fumigatus, Aspergillus niger, Penicillium sp., Mucor sp., Rhizopus sp.) during the year.

Results. The patients with mild persistent and moderate asthma over 50 years old initially differed from the younger patients by slightly worse functional respiratory rates (FEV1), and a lower percentage of patients with mild and uncontrolled asthma. The sublingual ASIT was effective regardless of age, including the patients over 50 years old. The results were confirmed by a positive dynamics of respiratory function indicators, decrease in skin sensitivity to fungal mixed-allergens, asthma transformation into controlled form in 83-89% of the patients. In the patients older than 50 years, the respiratory function dynamics was less pronounced. None of the patients had severe adverse effects. Mild adverse reactions occurred regardless of age in 96-98% of the patients with asthma, most often in the form of cough, runny nose, sneezing, sore throat, and skin itching.

Conclusion. The sublingual ASIT with antifungal mixed-allergens in the interior premises in adult patients with mild persistent and moderate bronchial asthma is effective regardless of age, including the patients aged over 50, which was confirmed by improved respiration function, decreased skin sensitivity to fungal allergens, and improved life quality after 12 months therapy. Mild adverse effects happened regardless of age in 96-98% of the patients with asthma

Author Biographies

Liudmyla Petrenko, Clinical Hospital "Feofania" Zabolotnoho str., 21, Kyiv, Ukraine, 03680

Doctor allergist, pulmonologist

Elena Rekalova, National Institute of phthisiology and pulmonology named after F. G. Yanovsky NAMS of Ukraine M. Amosova str., 10, Kyiv, Ukraine, 03680

MD, Head of Laboratory

Laboratory of Clinical Immunology 

References

  1. Cardona, V., Guilarte, M., Luengo, O., Labrador-Horrillo, M., Sala-Cunill, A., Garriga, T. (2011). Allergic diseases in the elderly. Clinical and Translational Allergy, 1 (1), 11. doi: 10.1186/2045-7022-1-11
  2. Baptistella, E., Maniglia, S., Malucelli, D., Rispoli, D., Pruner de Silva, T., Becker, R. et. al. (2013). Allergen-Specific Immunotherapy in Patients 55 Years and Older: Results and Review of Literature. International Archives of Otorhinolaryngology, 17 (04), 375–379. doi: 10.1055/s-0033-1353138
  3. Al-Alawi, M., Hassan, T., Chotirmall, S. H. (2014). Advances in the Diagnosis and Management of Asthma in Older Adults. The American Journal of Medicine, 127 (5), 370–378. doi: 10.1016/j.amjmed.2013.12.013
  4. Battaglia, S., Benfante, A., Scichilone, N. (2015). Asthma in the older adult: presentation, considerations and clinical management. Expert Review of Clinical Immunology, 11 (12), 1297–1308. doi: 10.1586/1744666x.2015.1087850
  5. Todo Bom, A., Mota Pinto, A. (2009). Allergic respiratory diseases in the elderly. Respiratory Medicine, 103 (11), 1614–1622. doi: 10.1016/j.rmed.2009.06.003
  6. Milgrom, H., Huang, H. (2014). Allergic Disorders at a Venerable Age: A Mini-Review. Gerontology, 60 (2), 99–107. doi: 10.1159/000355307
  7. Ventura, M. T., Scichilone, N., Gelardi, M., Patella, V., Ridolo, E. (2015). Management of allergic disease in the elderly: key considerations, recommendations and emerging therapies. Expert Review of Clinical Immunology, 11 (11), 1219–1228. doi: 10.1586/1744666x.2015.1081564
  8. Asero, R. (2004). Efficacy of Injection Immunotherapy with Ragweed and Birch Pollen in Elderly Patients. International Archives of Allergy and Immunology, 135 (4), 332–335. doi: 10.1159/000082328
  9. Marogna, M., Bruno, M. E., Massolo, A., Falagiani, P. (2008). Sublingual immunotherapy for allergic respiratory disease in elderly patients: a retrospective study. Eur Ann Allergy Clin Immunol, 40 (1), 22–29.
  10. Bozek, A. (2016). Pharmacological Management of Allergic Rhinitis in the Elderly. Drugs & Aging, 34 (1), 21–28. doi: 10.1007/s40266-016-0425-7
  11. Simon-Nobbe, B., Denk, U., Poll, V., Rid, R., Breitenbach, M. (2007). The Spectrum of Fungal Allergy. International Archives of Allergy and Immunology, 145 (1), 58–86. doi: 10.1159/000107578
  12. Twaroch, T. E., Curin, M., Valenta, R., Swoboda, I. (2015). Mold Allergens in Respiratory Allergy: From Structure to Therapy. Allergy, Asthma & Immunology Research, 7 (3), 205. doi: 10.4168/aair.2015.7.3.205
  13. Knutsen, A. P., Bush, R. K., Demain, J. G., Denning, D. W., Dixit, A., Fairs, A. et. al. (2012). Fungi and allergic lower respiratory tract diseases. Journal of Allergy and Clinical Immunology, 129 (2), 280–291. doi: 10.1016/j.jaci.2011.12.970
  14. Denning, D. W., Pashley, C., Hartl, D., Wardlaw, A., Godet, C., Del Giacco, S. et. al. (2014). Fungal allergy in asthma–state of the art and research needs. Clinical and Translational Allergy, 4 (1), 14. doi: 10.1186/2045-7022-4-14

Published

2017-04-29

How to Cite

Petrenko, L., & Rekalova, E. (2017). Efficiency of antifungal sublingual allergen-specific immunotherapy in patients under and over 50 years old with mild persistent and moderate bronchial asthma. ScienceRise: Medical Science, (4 (12), 36–41. https://doi.org/10.15587/2519-4798.2017.100270

Issue

Section

Medical Science