Title:Off-label Use of Oral Immunotherapy for Rhinoconjunctivitis and Asthma
due to Grass Pollen: A Safe and Effective Alternative in Patients over 65
Years Old: A Series of Case Reports
Volume: 18
Issue: 4
Author(s): Lucía González-Bravo, Jimena Laiseca García, Martina Privitera and Ana Rosado*
Affiliation:
- Allergy Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
Keywords:
Oral immunotheray, off-label, asthma, rhinoconjuctivitis, grass pollen, AIT.
Abstract:
Introduction: Allergic rhinoconjunctivitis and asthma are the most common IgE-mediated
diseases worldwide. Allergen-specific immunotherapy (AIT) is currently the only modifying treatment
for these IgE-mediated diseases in both children and adults. Subcutaneous immunotherapy is
widely used, but in patients over 65 years old, there may be an increased risk of adverse reactions
and a worse response to treatment. Oral immunotherapy (OIT) has been proven to be effective and
safe, but currently, in most countries, it has been licensed only for patients up to 65 years old based
on its technical datasheet. So far, no studies on the efficacy and safety of this type of immunotherapy
in patients older than 65 years old have been published.
Case Presentation: We present four patients older than 65 years old with a diagnosis of moderate
seasonal rhinoconjunctivitis and moderate-persistent seasonal pollen-induced asthma. Off-label use
of oral immunotherapy (OIT) for grass pollen was prescribed due to the severity of their rhinoconjunctivitis
symptoms and the worsening of asthma symptoms during the spring. Improvement in the
rhinoconjunctivitis and asthma symptoms was reported by all patients since the first spring season
and was maintained during the following two years of follow-up. There were no systemic reactions,
and only two patients initially had self-limiting oral pruritus.
Conclusion: Oral immunotherapy for pollens appears to be a convenient, effective, and safe option
in older patients (>65 years) with comorbidities after a three-year treatment. This is, to the best of
our knowledge, the first report on the off-label use of OIT in patients over 65 years old with symptoms
of allergic rhinoconjunctivitis and asthma.
