A prospective cohort study of ultra-rush subcutaneous immunotherapy in dust mite-induced allergic rhinitis

TL;DR

This study compares two fast treatment methods for dust mite allergy, finding that the ultra-rush method works as well as the standard fast method with no serious side effects.

Contribution

The study provides the first prospective comparison of UR-SCIT and Cluster SCIT for allergic rhinitis.

Findings

Both UR-SCIT and Cluster SCIT significantly reduced allergy symptoms and improved quality of life after 12 months.

Immunological markers like eosinophils and IL-4, IL-5, IL-13, and IL-33 decreased in both treatment groups.

UR-SCIT and Cluster SCIT had similar safety profiles with no serious adverse events.

Abstract

Allergic rhinitis (AR) is a prevalent disease with a considerable global burden. Allergen immunotherapy (AIT) represents the cornerstone causal treatment for AR. While accelerated schedules such as Cluster Subsutaneous Immunotherapy (Cluster SCIT) shorten the initial buildup phase than Conventional treatment, the even more rapid Ultra-Rush Subcutaneous Immunotherapy (UR-SCIT) lacks a head-to-head, prospective comparison regarding its efficacy and safety.

A total of 57 patients with house dust mite induced AR were included in this study and followed up for 12 months. Allocation to the 2 treatment groups (UR-SCIT and Cluster SCIT) was based on patient preference. Treatment efficacy was assessed using Visual Analogue Scale (VAS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and Combined Symptom and Medication Score (CSMS). Additionally, skin prick test (SPT), nasal allergen challenge (NAC), fractional exhaled nitric oxide (FeNO), and fractional nasal nitric oxide (FnNO) were measured at baseline (M0) and at the 12-month follow-up (M12). Eosinophils (EOS) and eosinophil percentage (EOS%) in blood、serum levels of IL-4, IL-5, IL-10, IL-13, IL-33, total IgE, dust mite-specific IgE (sIgE), dust mite-specific IgG4 (sIgG4),the ratio of sIgG4/sIgE and sIgE/tIgE were detected at months 0, 6, and 12. To evaluate safety, local and systemic adverse reactions were recorded during the treatment period.

In this study, both UR-SCIT and Cluster SCIT groups showed significant reductions in VAS, CSMS, RQLQ and TNSS scores at M12, alongside decreases in SPT grade. Immunological analysis revealed that both groups exhibited reduced levels of EOS, EOS%, IL-4, IL-5, IL-13 and IL-33, while IL-10 levels increased. Changes in EOS count and EOS% levels were correlated with improvements in AR symptoms. SIgG4 levels rose in both groups, but tIgE、sIgE and sIgE/tIgE ratios showed no significant changes. Adverse reaction incidence was similar in both groups, with no serious events reported.

UR-SCIT achieves therapeutic efficacy comparable to Cluster SCIT, with both demonstrating robust symptom control and favorable immunological changes. The similar safety profiles, with no serious adverse events indicate that UR-SCIT is a viable new option for AIT in clinical practice.

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