Seasonal Allergic Rhinitis -Experience In A UK Children’s Hospital

Sismanoglou N., Yong E., Senasinghe H., Bakshi D.

Background

In the UK, up to 10% of 6 year olds are diagnosed with Seasonal Allergic Rhinitis (SAR), with this

number doubling amongst teenagers1.

SAR not only affects the quality of life but also significantly impacts on examination performance in teenagers2.

Desensitisation or immunotherapy involves gradually increasing exposure to the standardized grass pollen extract (Timothy grass, Phleum pratenase) until tolerance is achieved.

Method

This was a retrospective cross-sectional study conducted between 1st March to 30th June 2018. The first dose of sublingual immunotherapy was administered in hospital as per protocol. Questionnaires and telephone/ postal survey were used to collect data. We used the EAACI SAR scoring system, pre and post immunotherapy to assess response3.

Our aim was to assess the impact of grass pollen sublingual immunotherapy on symptom control in children with severe SAR.

Results

28 children undergoing sublingual pollen immunotherapy were enrolled, age range 6–17 years, median age 14 years. 64% children were monosensitised to grass/ tree pollen. 70% patients found the treatment helpful. The combined SAR score before immunotherapy ranged from 4.2 - 5, with median of 4.3 out of 6, implying at least moderate severity of SAR. The median score post treatment was 1.6 indicating reduction of 43%. Patients experienced symptom reduction and required lower doses and frequency of antihistamines and nasal corticosteroid sprays. Examination performance and participation in sports improved. 75% of the children with asthma reported reduced use of anti-asthma medication.

2 of the 3 patients that found the treatment unhelpful, were in their first year of treatment. This is

consistent with published reports, that treatment is more effective if used for at least 18 months. The duration of treatment ranged from 7 months to complete 3 years, median duration of 22.5 months. The short duration is due to recent initiation of immunotherapy and not due to withdrawal from treatment. Patient compliance was high, only 2 patients discontinued therapy for personal reasons.

Conclusion

Sublingual grass pollen immunotherapy in SAR is effective, safe, logistically easy to administer and has a beneficial effect on co-morbid allergic disorders like asthma. Further large scale prospective studies are required to establish the above results.

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