Local nasal immunotherapy and bronchial hyperreactivity in seasonal allergic rhinitis: An observational pilot study

The clinical efficacy of local nasal immunotherapy (LNIT) in patients with allergic rhinitis is amply documented The aim of the study was to determine the effect on bronchial hyperresponsiveness (BHR) assessed at baseline and after 3 years of LNIT or pharmacological treatment alone. Forty-three rand omized patients with allergic oculorhinitis were enrolled (26 positive to G raminaceae and 17 to Parietaria judaica pollens). AII patients were asked w hether they were willing to follow a 3-year treatment course involving pres easonal LNIT with a powder extract of Graminaceae or Parietaria pollens. Tw enty-four patients (16 allergic to Graminaceae and eight to Parietaria) sel ected LNIT; and the other 19 opted for symptomatic pharmacological treatmen t only. The latter was considered the control group. On the basis of positi ve or negative bronchial hyperresponsiveness and the LNIT; four subgroups w ere established and followed in open conditions, during which a record was kept of symptom scores, drug use, spirometry and methacholine test findings . After 3 years, patients treated with LNIT had a significant reduction of symptoms and drug intake. In the controls, symptoms worsened, thus requirin g more drugs to control them. Bronchial hyperresponsiveness significantly i mproved in hyperreactive patients receiving LNIT; 10 of whom were no longer hyperreactive and one at a higher threshold. Among controls, bronchial hyp erresponsiveness did not change, with the exception of three nonreactive pa tients who became hyperreactive, one of them with asthma. These findings co nfirm the efficacy of LNIT in allergic rhinitis suggesting that it might ha ve systemic activity interfering with bronchial hyperresponsiveness and hen ce the onset of bronchial asthma.