House dust mite sublingual immunotherapy is safe and appears to be effective in moderate, persistent asthma

• Published in: Allergy (Copenhagen) Vol. 69; no. 9; pp. 1181 - 1188
• Main Authors: Wang, L., Yin, J., Fadel, R., Montagut, A., de Beaumont, O., Devillier, P.
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.09.2014
• Subjects: Adolescent; Adult; Allergens - administration & dosage; Allergens - immunology; Animals; Antigens, Dermatophagoides - administration & dosage; Antigens, Dermatophagoides - immunology; Asthma; Asthma - etiology; Asthma - immunology; Asthma - prevention & control; Clinical outcomes; control; Dermatophagoides farinae; Dermatophagoides pteronyssinus; Double-Blind Method; Female; house dust mite; Humans; Immunotherapy; Male; Middle Aged; Pyroglyphidae; sublingual immunotherapy; Sublingual Immunotherapy - methods; Young Adult; asthma; control; sublingual immunotherapy; house dust mite
• ISSN: 0105-4538; 1398-9995; 1398-9995
• DOI: 10.1111/all.12188

Background The efficacy and safety of sublingual immunotherapy in house dust mite–induced asthma have yet to be firmly established. We report the results of a double‐blind, placebo‐controlled, randomized clinical trial performed in mainland China. Methods After a three‐month baseline period, 484 asthmatic adults were randomized 2 : 1 to 12 months of daily treatment with either an aqueous, standardized, 300 index of reactivity mixture of Dermatophagoides pteronyssinus and Dermatophagoides farinae extracts or a placebo. The primary efficacy criterion was well‐controlled asthma for at least 16 of the last 20 weeks of treatment. Results In the active (n = 308) and placebo (n = 157) groups, well‐controlled asthma was achieved by 85.4% and 81.5% of the patients, respectively (P = 0.244). A subsequent post hoc analysis by asthma severity revealed significant clinical benefits in actively treated subjects with moderate, persistent asthma at baseline [401–800 μg budesonide/day (n = 175)], with greater achievement of well‐controlled asthma (80.5% and 66.1% for the active treatment and placebo groups, respectively; P = 0.021) and totally controlled asthma (54.0% and 33.9%, respectively, P = 0.008), a higher percentage of patients with an asthma control questionnaire score < 0.75 (56.6% and 40.0%, respectively; P = 0.039) and a greater mean reduction in inhaled corticosteroid use (218.5 μg and 126.2 μg, respectively; P = 0.004). The active vs placebo differences in disease control and corticosteroid use were not significant for mild, persistent asthma. No treatment‐related serious adverse events were reported. Conclusions Sublingual mite allergen immunotherapy was well tolerated in adult asthmatics and effectively controlled disease in patients with moderate (but not mild) persistent asthma (ClinicalTrials.gov: NCT00660452).