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

Abstract Background Sublingual 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 recommende...

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Autores principales:	Anne K. Ellis, Lori Connors, Marie-Josee Francoeur, Douglas P. Mack
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Allergic rhinitis Angioedema H-1 antihistamine Local allergic reactions Platelet activating factor Pruritus Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/a2e45985b40742ac9c5a77071c8d668f
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spelling	oai:doaj.org-article:a2e45985b40742ac9c5a77071c8d668f2021-12-05T12:23:23ZRupatadine to prevent local allergic reactions to sublingual allergy immunotherapy: a case series10.1186/s13223-021-00630-61710-1492https://doaj.org/article/a2e45985b40742ac9c5a77071c8d668f2021-12-01T00:00:00Zhttps://doi.org/10.1186/s13223-021-00630-6https://doaj.org/toc/1710-1492Abstract Background Sublingual 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 presentations Five 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. Conclusions In 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.Anne K. EllisLori ConnorsMarie-Josee FrancoeurDouglas P. MackBMCarticleAllergic rhinitisAngioedemaH-1 antihistamineLocal allergic reactionsPlatelet activating factorPruritusImmunologic diseases. AllergyRC581-607ENAllergy, Asthma & Clinical Immunology, Vol 17, Iss 1, Pp 1-6 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Allergic rhinitis Angioedema H-1 antihistamine Local allergic reactions Platelet activating factor Pruritus Immunologic diseases. Allergy RC581-607
spellingShingle	Allergic rhinitis Angioedema H-1 antihistamine Local allergic reactions Platelet activating factor Pruritus Immunologic diseases. Allergy RC581-607 Anne K. Ellis Lori Connors Marie-Josee Francoeur Douglas P. Mack Rupatadine to prevent local allergic reactions to sublingual allergy immunotherapy: a case series
description	Abstract Background Sublingual 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 presentations Five 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. Conclusions In 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.
format	article
author	Anne K. Ellis Lori Connors Marie-Josee Francoeur Douglas P. Mack
author_facet	Anne K. Ellis Lori Connors Marie-Josee Francoeur Douglas P. Mack
author_sort	Anne K. Ellis
title	Rupatadine to prevent local allergic reactions to sublingual allergy immunotherapy: a case series
title_short	Rupatadine to prevent local allergic reactions to sublingual allergy immunotherapy: a case series
title_full	Rupatadine to prevent local allergic reactions to sublingual allergy immunotherapy: a case series
title_fullStr	Rupatadine to prevent local allergic reactions to sublingual allergy immunotherapy: a case series
title_full_unstemmed	Rupatadine to prevent local allergic reactions to sublingual allergy immunotherapy: a case series
title_sort	rupatadine to prevent local allergic reactions to sublingual allergy immunotherapy: a case series
publisher	BMC
publishDate	2021
url	https://doaj.org/article/a2e45985b40742ac9c5a77071c8d668f
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Rupatadine to prevent local allergic reactions to sublingual allergy immunotherapy: a case series

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