Sublingual immunotherapy in allergic conjuctivitis with house dust and dust mite allergies DR VIPUL SHAH

SLIT IN CONJUCTIVITIS WORK DONE AND COMPILED BY DR VIPUL SHAHJ’ OTHER WORKERS DR ASHOK GUPTA SR EYE CONSULTANT MRS POONAM KUMAR ALLERGY AND IMMUNOTHERAPY COUSELAR DR SUMAN KUMAR ENT AND ALLERGHY SPECIALIST

BACKGROUND Allergic conjunctivitis is many times an ophthalmologist’s nightmare. Anti allergic eye drops, which often contain corticosteroids, may temporarily bring relief of symptoms but may bring an early cataract, among other side effects

BACKGROUND Allergic ocular symptoms, are common and represent an important feature associted with allergic rhinitis Sublingual Immunotherapy (SLIT) is an effective and well-tolerated treatment for allergic rhinitis, but its effects on symptoms of ocular allergy have not been well established.  

Immunotherapy Immunotherapy (commonly referred to as "allergy shots") is a safe and effective treatment for patients with allergies It is based on the premise that people who receive injections of a specific allergen will lose sensitivity to that allergen. The most common allergens for which shots are given are house dust, cat dander, grass pollen

Candidates Candidates for Immunotherapy. Immunotherapy may be given to anyone over age 7 with allergies that do not get better with medication. Immunotherapy is safe for pregnant women who are already receiving it, although half-strength doses are generally recommended, and it should not be started during pregnancy

Oral Forms Trials are underway to test forms of immunotherapy taken by mouth as an alternative to allergy shots. These methods include using a pill taken by mouth or a sublingual (under-the-tongue) tablet. Although oral and sublingual immunotherapy is prescribed in many countries in Europe and South America, it is not approved in the United States and is not considered accepted therapy at this time.

Objectives To evaluate the efficacy of SLIT compared with placebo for reductions in ocular symptoms,  

Selection criteria Randomised controlled trials placebo controlled, which evaluated the efficacy of SLIT in patients with symptoms of allergic rhino conjunctivitis (ARC) or allergic conjunctivitis (AC).  

Data collection and analysis The primary outcome was the total ocular symptom scores. Secondary endpoints included individual ocular symptom scores (such as itchy eyes, red eyes, watery eyes, swollen eyes), ocular medication scores (eye drops) and conjunctival immediate allergen sensitivity

trials Forty-two trials (Sublingual immunotherapy induced a significant reduction in both total ocular symptom scores) and individual ocular symptom scores for red eyes itchy and watery eyes compared to placebo. Those participants having active treatment showed an increase in the threshold dose for the conjunctival allergen provocation test 

DATA Those participants having active treatment showed an increase in the threshold dose for the conjunctival allergen provocation test 

SLIT Overall, SLIT is moderately effective in reducing total and individual ocular symptom scores in participants with ARC and AC..

NEED TO EVALUATE SLIT There is a need for further large rigorously designed studies that study long-term effectiveness after discontinuation of treatment and establish the cost-effectiveness of SLIT.

ALLERGIC CONJUCTIVITIS

ALLERGIC CONJUCTIVITIS

STUDY DONE AT ENT AND ALLERGHY CENTRE (india)panchkula Years 2004-2007, and follow up period for 3 years(and 1-years after finishing the slit) a total of 88 patients with rhinoconjunctivitis were randomly allocated to placebo and medium-dose extract of house dust or dust mite induced allergic conjuctivitis

Results active treatment groups achieved a 72% reduction in total rhinoconjunctivitis symptom scores compared with placebo

Conclusion Standardized glycerinated was safe and can induce favorable clinical and immunologic changes in ragweed-sensitive subjects. However, additional trials are needed to establish efficacy.

Immunotherapy works best    Immunotherapy works best when environmental controls are first implemented to minimize exposure to allergens, especially at home If patients sensitive to animal dander are unwilling to banish pets, immunotherapy may be a waste of time and money.

WE NEED MORE DATAS TO MAKE THE SLIT AS ALTERNATIVE TO PHARMACOTHRAPY WE NEED MORE DATAS AND MORE PEOPLE AND RESEARCHERS TO DO WORK ON IT ANMT ITS OUTCOME IN VARIOUS ALLERGIC DISEASESES EFFECTING EVERY ORGAN

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