INJECTIVE VERSUS SUBLINGUAL IMMUNOTHERAPY IN ALTERNARIA-TENUIS ALLERGIC PATIENTS

Little knowledge is available on molds either from the environmental o r clinical points of view. The latter is mainly due to the lack, until recent times, of purified and standardized extracts. Injective immuno therapy, largely used for patients allergic to mites and pollens, is r egarded with some concern for molds. On the other hand, mold-related a llergic symptoms (i.e., from Alternaria tenuis) have in Italy an incid ence of about 5%, mainly in young patients. We have therefore run a pi lot study comparing the efficacy and safety of injective (SIT) and sub lingual (SLIT) immunotherapy by administering the same purified and st andardized extract of Alternaria tenuis to a total of 23 patients for two years, according to an open experimental plan. Excellent tolerance was shown to SLIT, while four (two medium-grade) side effects appeare d with SIT. Clinical improvement, subjectively stated comparing sympto ms (mainly rhinitis) and drug consumption before and after the therapy , confirmed by an increase in the Specific Nasal Provocation threshold , was obtained with both therapies, but with a statistically significa nt difference in favour of SLIT. Skin reactivity and blood Alternaria tenuis specific IgE, total IgG and IgG(4) changed in the SIT-treated g roup while no statistically significant change was shown in the SLIT-t reated group. These results are in good agreement with previous report s on SIT and SLIT with other inhalant allergens (mites, grasses), and suggest the potential use of SLIT for Alternaria allergy, mainly in yo ung patients, when there are concerns about the safety of and complian ce with the traditional injective therapy.