BACKGROUND Several studies have suggested that sublingual immunotherapy (SLIT) involves a dose-response relationship and inadequate dosage might not achieve a favorable clinical effect. OBJECTIVE The aim of this prospective study was to investigate the efficacy and safety of increasing SLIT dosage at 6 months in patients with house dust mite-induced allergic rhinitis (AR) who had low response to treatment. METHODS A total of 157 AR participants aged 4-60 years were enrolled and received SLIT with Dermatophagoides farinae drops. After 6 months of SLIT, patients were interviewed and then classified into a high-response (HR) group and a low-response (LR) group based on the combined symptom and medication score (CSMS) reduction rate. Patients with a CSMS reduction rate over 50% were defined as HR and continued the original dose, while patients with a CSMS reduction rate ranging from 20 to 50% were defined as LR and received an increased dose (percentage of dosage increment, 33.33% for patients aged <14 years and 50% for patients aged ≥14 years). Patients with a CSMS reduction rate below 20% were considered nonresponse (NR) and recommended to withdraw from SLIT. CSMS, visual analog scale (VAS), and adverse events were assessed at 0.5, 1, 2, and 3 years during the 3-year treatment. RESULTS A total of 54 and 56 patients completed the treatment in the HR and LR groups, respectively. The CSMS and VAS of both groups decreased significantly at 6 months (p < 0.05). Significant differences between the two groups were found in CSMS and VAS at 6 months and 1 year (p < 0.05), but not in later follow-ups (p > 0.05). The improvement of adults in the LR group was significantly lower than that of children at 6 months (p < 0.05), but there was no difference in later follow-ups (p > 0.05). There was no difference in CSMS or VAS in patients with monosensitization and polysensitization in the same treatment group at 1 year and in subsequent visits (p> 0.05). Overall, 47 patients withdrew from this study due to NR (n = 22) and other reasons (n = 25). CONCLUSIONS Six months might be a critical time point for efficacy assessment and dosage adjustment for AR patients after SLIT. In patients with low response, dosage enhancement within a certain range may enhance the effectiveness of SLIT.

中文翻译：

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低剂量变应性鼻炎患者剂量增加6个月后尘螨舌下免疫疗法的疗效增强：一项前瞻性研究。

背景技术几项研究表明舌下免疫疗法（SLIT）涉及剂量反应关系，剂量不足可能无法达到良好的临床效果。目的这项前瞻性研究的目的是研究在6个月内增加SLIT剂量对房尘螨诱发的过敏性鼻炎（AR）对治疗反应低的患者的疗效和安全性。方法共有157位年龄在4-60岁的AR参与者参加，并接受了SLIT和Dermatophagoides farinae滴剂。在SLIT治疗6个月后，对患者进行了访谈，然后根据症状和药物评分（CSMS）的综合降低率将其分为高反应（HR）组和低反应（LR）组。CSMS降低率超过50％的患者被定义为HR并继续原始剂量，而CSMS降低率为20％至50％的患者被定义为LR并接受增加的剂量（剂量增加的百分比，<14岁的患者为33.33％，≥14岁的患者为50％）。CSMS降低率低于20％的患者被视为无反应（NR），建议退出SLIT。在3年的治疗期间，分别在0.5、1、2和3年评估了CSMS，视觉模拟量表（VAS）和不良事件。结果HR和LR组分别完成了54和56例患者的治疗。两组的CSMS和VAS在6个月时均显着下降（p <0.05）。两组之间在6个月和1年的CSMS和VAS中存在显着差异（p <0.05），但在随后的随访中没有发现（p> 0.05）。LR组的成年人在6个月时的改善显着低于儿童（p <0.05），但以后的随访无差异（p> 0.05）。同一治疗组在1年及以后的随访中，单敏和多敏患者的CSMS或VAS均无差异（p> 0.05）。总体而言，有47例患者由于NR（n = 22）和其他原因（n = 25）而退出了本研究。结论六个月可能是SLIT后AR患者疗效评估和剂量调整的关键时间点。对于低反应患者，在一定范围内增加剂量可以增强SLIT的有效性。同一治疗组在1年及以后的随访中，单敏和多敏患者的CSMS或VAS均无差异（p> 0.05）。总体而言，有47例患者由于NR（n = 22）和其他原因（n = 25）而退出了本研究。结论六个月可能是SLIT后AR患者疗效评估和剂量调整的关键时间点。对于低反应患者，在一定范围内增加剂量可以增强SLIT的有效性。同一治疗组在1年及以后的随访中，单敏和多敏患者的CSMS或VAS均无差异（p> 0.05）。总体而言，有47例患者由于NR（n = 22）和其他原因（n = 25）而退出了本研究。结论六个月可能是SLIT后AR患者疗效评估和剂量调整的关键时间点。对于低反应患者，在一定范围内增加剂量可以增强SLIT的有效性。