What immunotherapy options are available in India for conditions like allergic rhinitis and asthma?

Immunotherapy Options Available in India for Allergic Rhinitis and Asthma

Both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) are effective treatment options available in India for allergic rhinitis and asthma, with demonstrated ability to modify disease progression and provide long-term symptom relief beyond the treatment period. 1

Types of Allergen Immunotherapy Available

• Subcutaneous Immunotherapy (SCIT): Involves injections of allergen extracts, administered in clinical settings under medical supervision 1
• Sublingual Immunotherapy (SLIT): Available in two forms:
  • Tablet formulations - placed under the tongue and absorbed 1
  • Aqueous/drop formulations - placed under the tongue and either swallowed or spat out 2

Clinical Indications for Immunotherapy

For Allergic Rhinitis:

• Patients with moderate to severe symptoms inadequately controlled by conventional medications 1
• Those who experience unacceptable side effects from pharmacotherapy 1
• Patients wishing to avoid long-term medication use 1
• Those with demonstrable evidence of specific IgE antibodies to clinically relevant allergens 1

For Allergic Asthma:

• Patients with stable, controlled asthma (uncontrolled asthma is a contraindication) 1
• Those with coexisting allergic rhinitis and asthma 1
• Patients with demonstrable specific IgE sensitivity to relevant inhalant allergens 1

Allergens Available for Immunotherapy in India

Immunotherapy is effective for the following allergens, which are commonly used in India:

• House dust mites 1, 3
• Pollens (grass, ragweed, tree) 1, 3
• Animal danders 1
• Fungal allergens 1
• Cockroach 1

Benefits of Immunotherapy

• Disease modification: Unlike pharmacotherapy, immunotherapy can alter the natural course of allergic disease 1, 4
• Long-term efficacy: Benefits may persist for years after discontinuation of treatment 1
• Prevention of new sensitizations: Reduces risk of developing sensitivity to additional allergens 1, 4
• Prevention of asthma: May prevent progression from allergic rhinitis to asthma 1, 5
• Improved quality of life: Reduces symptom severity and medication requirements 2, 6

Treatment Protocol

• Duration: Minimum of 3 years of treatment is recommended for optimal clinical benefit 1
• For seasonal allergies: Pre- and co-seasonal immunotherapy is recommended for SLIT 1
• Allergen selection: Treatment should be limited to clinically relevant allergens confirmed by testing and patient history 1
• Dosing schedule: Includes an initial build-up phase followed by a maintenance phase 7

Safety Considerations

Contraindications:

• Uncontrolled asthma 1
• Pregnancy (relative contraindication) 1
• Patients unable to tolerate injectable epinephrine 1
• Concomitant beta-blocker use (relative contraindication) 1
• History of anaphylaxis (relative contraindication) 1
• Significant cardiovascular disease 1

Adverse Reactions:

• Local reactions are common but generally not a reason to discontinue therapy 1
• Systemic reactions including anaphylaxis are rare but possible, especially with SCIT 1, 7
• SLIT has a better safety profile with fewer systemic reactions compared to SCIT 3

Practical Considerations in India

• Immunotherapy should be administered under the supervision of trained allergists/immunologists 4
• Patient education about the differences between SCIT and SLIT, including risks, benefits, convenience, and costs, is essential 1
• For SCIT, facilities for managing potential systemic reactions must be available 7
• Regular follow-up to assess efficacy and adjust treatment as needed is important 1

When to Refer to an Allergist/Immunologist

• Prolonged manifestations of rhinitis despite conventional treatment 4
• Complications such as sinusitis, nasal polyposis, or otitis media 4
• When considering immunotherapy as a treatment option 4
• Comorbid conditions like asthma or chronic sinusitis 4