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Subcutaneous specific immunotherapy and continuous daily antihistamine therapy are highly effective in reducing eosinophilic inflammation and improving nasal mucosal health in patients with persistent house dust mite allergy.
According to a new clinical study, long-term treatment with subcutaneous allergen immunotherapy or continuous oral antihistamines can substantially reverse eosinophilic inflammation in patients with severe persistent allergic rhinitis (AR) caused by house dust mites. The research, led by M Lauriello et al., aimed to compare a two-year course of subcutaneous specific immunotherapy with continuous or on-demand oral antihistamine therapy (cetirizine) in decreasing inflammatory markers in nasal secretions.
A total of 31 patients diagnosed with severe persistent AR and confirmed sensitivity to house dust mite allergens were divided into three groups:
Researchers collected nasal scrapings using cotton-tipped swabs at baseline and after 24 months. Two major inflammatory biomarkers were evaluated via immunohistochemistry:
These markers are commonly linked with chronic allergic inflammation and epithelial damage. All participants successfully completed the two-year study. At baseline, inflammatory cell counts were similar across all treatment groups. However, remarkable clinical improvements were observed in groups A and B. Eosinophils—identified by ECP expression—dropped to zero in both the immunotherapy and continuous antihistamine groups.
No change was seen in the on-demand antihistamine group. ICAM-1 expression markedly decreased in groups A and B, correlating with improved clinical symptoms and reduced tissue inflammation. Group C demonstrated no meaningful reduction in either biomarker. To sum up, subcutaneous immunotherapy demonstrated superior effectiveness in reducing epithelial disruption, suggesting its long-term benefit as a disease-modifying treatment. Meanwhile, continuous cetirizine therapy showed strong anti-inflammatory action and helped control persistent nasal inflammation. The study concludes that both treatment strategies markedly reduce eosinophilic infiltration and adhesion molecule activity, while on-demand antihistamine use is inadequate for chronic symptom management.
ACTA Otorhinolaryngologica Italica
A two-year course of specific immunotherapy or of continuous antihistamine treatment reverse eosinophilic inflammation in severe persistent allergic rhinitis
M Lauriello et al.
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