Few studies have compared the effects of immunotherapy and inhaled steroids. The main limitation is the long duration required to fully appreciate the effects of immunotherapy.Patients with mild persistent asthma and rhinitis due to grass pollen were enrolled in an open randomized controlled trial.
They were randomized to either budesonide, 800 microg/d, in the pollen season or continuous grass SLIT for 5 years.
The bronchial symptom scores and the use of bronchodilators decreased significantly in both groups, but the improvement was greater in the SLIT patients at 3 and 5 years.
The nasal symptom score and the intake of nasal steroids decreased only in the SLIT group.
The bronchial hyperresponsiveness improved significantly only in the SLIT group.
The authors concluded that in patients with grass pollen-induced asthma, in the long term SLIT was equally effective as inhaled budesonide in treating bronchial symptoms and provided an additional benefit in treating rhinitis symptoms and bronchial hyperresponsiveness.
Comment: It may not be "fair" to compare the seasonal use of budesonide to the continuous use of SLIT.
References:
Long-term comparison of sublingual immunotherapy vs inhaled budesonide in patients with mild persistent asthma due to grass pollen. Marogna M, Spadolini I, Massolo A, Berra D, Zanon P, Chiodini E, Canonica GW, Passalacqua G. Ann Allergy Asthma Immunol. 2009 Jan;102(1):69-75.
Talking Points on Sublingual Immunotherapy (SLIT) for Physicians Practicing in the United States. ACAAI.
Image source: Fountain grass (Pennisetum setaceum) flowers in Waterloo, Ontario, Wikipedia,
Giligone, Creative Commons Attribution-ShareAlike 3.0 License.
Sublingual immunotherapy is an extremely complex issue in the U.S. - AAAAI http://goo.gl/wVOKr
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