Eficácia clínica da imunoterapia nasal comparada com imunoterapia sublingual em pacientes com rinite alérgica

A eficacia da imunoterapia (IT) com extratos alergenicos em pacientes com rinite alergica (RA) tem sido demonstrada por via subcutânea ou sublingual, nao existindo comprovacao da eficacia terapeutica da IT topica nasal. Objetivo: Comparar a eficacia da IT sublingual com a IT to¬pica nasal em pacientes com RA. Pacientes e Metodo: Quarenta individuos com RA persistente, leve ou moderada, foram divididos em dois grupos em estudo prospectivo, duplo-cego, randomizado, com duracao de doze meses. O grupo I utilizou IT topica nasal com extratos alergenicos de acaros da poeira domiciliar + placebo sublingual e o grupo II foi submetido a IT sublingual com extratos alergenicos + placebo topico nasal. Foram realizadas oito avaliacoes durante o estudo, determinando-se a gravidade da RA e o consumo de medicamentos, alem das alteracoes das mucosas nasais ao exame fisico. Niveis de IgE e IgG4 anti-Oermatophagoides pteronyssinus foram determinados em amostras de soro de 22 pacientes, antes e apos tratamento. Resultados: Vinte e cinco pacientes concluiram o estudo (grupo I, n=l1 e grupo lI, n=14). Reducao significante na gravidade da RA e no consumo de medicamentos foi observada apos tratamento nos dois grupos, enquanto que a reducao nas alteracoes da mucosa nasal so foi observada no grupo Il. Nao se observaram alteracoes significantes nos niveis de IgE e IgG4 anti-D. pteronyssinus nos dois grupos. Conclusao: Ambos os procedimentos de IT (sublingual e nasal) sao eficazes na reducao dos sintomas e do consumo de medicamentos de pacientes com RA por alergenos de acaros da poeira domiciliar. No grupo de pacientes que receberam IT sublingual, houve reducao nas alteracoes da mucosa nasal.(AU) Several studies have demonstrated the efficacy of subcutaneous or sublingual immunotherapy (IT) with allergen extracts for the treatment of perennial allergic rhinitis (AR), but there are no actual data on nasal IT efficacy. Aim: Evaluate the efficacy of topical nasal IT compared to sublingual IT in AR patients. Patients and Methods: Forty patients with mild or mederate perennial AR were selected to participate on this prospective, one-year follow-up, doubleblind randomized study. They were divided in 2 groups: group I (n=20) was treated with sublingual IT containing mite allergen extracts plus placebo on nasal mucosa and group II (n=20) was treated with topical nasal IT containing mite allergen extracts plus placebo via sublingual. A total of eight evaluations were performed during the follow-up to determine rhinitis severity and medicine consumption, as well as abnormalities of nasal mucosa. IgE and IgG4 antibodies anti-Oermatophagoides pteronyssinus were determined in serum samples of 22 subjects before and after IT. Results: Twenty-five subjects concluded the study (group I, n=l1 and group lI, n=14). There was a significant reduction on rhinitis severity and medicine consumption before and after the treatment in both groups. In addition there was a significant reduction on nasal mucosa abnormalities before and after treatment in group II patients. There were no changes on leveis of IgE or IgG4 antibodies anti-D. pteronyssinus before and after IT in both groups. Conclusion: The efficacy of sublingual and nasal IT was demonstrated in patients with AR, by reducing symptoms and medicine consumption. In addition, sublingual IT also reduced nasal mucosa abnormalities.(AU)