Rupatadine to prevent local allergic reactions to sublingual allergy immunotherapy: a case series

Allergy, Asthma & Clinical Immunology

Lori Connors¹  Douglas P. Mack²  Anne K. Ellis³  Marie-Josee Francoeur⁴ 

[1] Department of Medicine, Dalhousie University, Halifax, NS, Canada;Department of Medicine, McMaster University, Hamilton, ON, Canada;Halton Pediatric Allergy, Burlington, ON, Canada;Division of Allergy & Immunology, Department of Medicine, Queen’s University, 76 Stuart St, K7L 2V7, Kingston, ON, Canada;Division of Pediatric Allergy, University of Sherbrooke CISSS Montérégie Centre, Clinique des spécialistes Santé Dix 30, Elna Tiny Tots, Montréal, QC, Canada;

关键词: Allergic rhinitis;    Angioedema;    H-1 antihistamine;    Local allergic reactions;    Platelet activating factor;    Pruritus;    Sublingual immunotherapy;   

DOI  :  10.1186/s13223-021-00630-6

来源: Springer

【 摘 要 】

BackgroundSublingual immunotherapy tablets (SLIT-T) are an effective treatment for allergic rhinitis (AR), but some patients experience local allergic reactions (LAR) in the first few weeks of treatment that can lead to treatment discontinuation. Although oral antihistamines are recommended for the treatment and pretreatment of LAR associated with SLIT-T, there are no clinical trial data to support this recommendation. Rupatadine is an H1 antihistamine that also inhibits platelet activating factor activity. The objective of this case series is to describe real-world clinical situations in which rupatadine was used to treat or mitigate SLIT-T–related LAR.Case presentationsFive cases are presented by the managing allergist and off-label use of rupatadine is their expert opinion only. Patients in all 5 cases were treated with a SLIT-T (e.g. ragweed, tree, grass, or house dust mites) for the management of allergic rhinitis and experienced bothersome LAR with the first SLIT-T administration. In 3 cases, rupatadine 10 mg was administered for the immediate treatment of LAR (either in-office with the first SLIT-T dose or for subsequent LAR experienced at home) and the symptoms resolved. In 3 cases, pretreatment with other second-generation H1 antihistamines was unable to prevent LAR and the patients discontinued the SLIT-T. In these 3 cases, switching to pretreatment with rupatadine allowed the patients to restart and tolerate SLIT-T treatment with minimal or no LAR. In these patients with an established history of LAR, proactive pretreatment with rupatadine in subsequent seasons or with initiation of a different SLIT-T mitigated the previously experienced LARs.ConclusionsIn the cases presented, treatment with rupatadine resolved LAR associated with SLIT-T treatment and rupatadine pretreatment appeared to mitigate subsequent LAR. Rupatadine may be an option to treat or improve the tolerability of the SLIT-T, potentially improving early treatment persistence.

【 授权许可】

CC BY