Questions that arise in sublingual desensitization therapy.
Which patients can undergo sublingual desensitization therapy?
Patients with allergic asthma, rhinitis, atopic dermatitis, conjunctivitis who test positive for dust mite or household dust mite as an allergen. Patients who have been stable with no significant signs and symptoms within the last week, including those who have been stable during symptomatic medication (other than oral or intravenous hormone use). If the patient is on oral or intravenous hormones, it is recommended that desensitization therapy be started after the condition has stabilized.
Patients may be treated with a combination of glucocorticoids, beta2 agonists, antihistamines, anticholinergics, leukotriene receptor antagonists, theophyllines, decongestants, according to the dosing principles of the GINA or ARIA protocols, with improvement in the condition using step-down therapy.
How to perform sublingual desensitization therapy?
Patients are recommended to undergo combined treatment in the first stage, followed by gradual reduction of allopathic drugs and eventually simple desensitization treatment, with a recommended course of 2-3 years, the longer the course of treatment the more consolidated the desensitization effect.
How to deal with adverse reactions?
Itching and numbness in the mouth and tongue – drink some cool water (warm water) after 10 minutes of sublingual administration.
Gastrointestinal discomfort, mild diarrhea —- some patients will have loose stools, the number of times increased once or twice, but there will not be more than diarrhea, if there is more than diarrhea, it is usually a bacterial infection, will not be the performance of desensitization intolerance.
Headache, fatigue —- will be desensitized at night before going to bed can be carried out. All of the above are transient manifestations that do not require additional treatment, and most patients will relieve themselves.
A small number of patients may experience aggravation of allergy symptoms, such as rash, hives, and mild asthma; it is recommended to add symptomatic drugs, or change the process of desensitization treatment (if allergy symptoms are aggravated during the incremental period, extend the incremental period, for example, use No. 1, No. 2, No. 3 for two weeks each, and double the incremental period. If allergic symptoms appear when using maintenance dose No.4 three drops, it is recommended to use No.4 two drops for one week, then No.4 two drops for one week, followed by No.4 three drops for maintenance. For adults with allergic symptoms, it is recommended to use one drop of No. 5 for one to two weeks before increasing to two drops of maintenance. Note: The more intolerant and sensitive patients appear in the pre-treatment, the better the healing effect tends to be.
What is the mechanism of action of sublingual desensitization therapy?
The sublingual mucosa, like other mucosal systems of the GI tract, has many antigen-presenting cells, mainly Langerhans cells. Due to the thin tissue of the sublingual mucosa, these Langerhans cells located on the mucosal surface will capture the signal of the presence of allergens when they come into contact with antigens, and the allergen vaccine can be rapidly absorbed, thus initiating a desensitization reaction. Also, sublingual desensitization prevents the vaccine from being destroyed in the stomach by various digestive enzymes and gastric acid. The submucosal tissue is rich in lymphocytes and B cells; after capturing the allergen, Langham’s cells migrate to the submucosal lymphoid tissue or nearby lymph nodes to regulate the Th1/Th2 lymphocyte balance and induce B cells to produce blocking antibodies IgG4, thus playing an immunomodulatory role.
Can sublingual desensitization be performed in children who have been vaccinated?
Although it is recommended in the instruction manual that children need to interrupt desensitization treatment before and after vaccination, it has been proven in extensive clinical practice in China and abroad that desensitization treatment does not affect the effectiveness of vaccination in children. However, some vaccines may cause temperature changes or depression in a few patients after vaccination. If abnormal body temperature occurs, it is recommended that treatment be continued after the body temperature has normalized.
How should I continue treatment after stopping the drug?
If a patient discontinues the drug for more than 4 weeks, whether it is discontinued during the incremental or maintenance period, the desensitization is restarted. (Intolerance can occur)
If the patient is in the maintenance phase and stops within three days, no dose change is necessary and the patient can continue.
For children who discontinue within one week, use No. 4 one drop for three days, then No. 4 two drops for three days, and resume No. 4 three drops for maintenance on the seventh day. For adults, use No. 5 one drop for one week and then return to No. 5 two drops for maintenance.
For children who have been off the drug for less than three weeks, use No. 4 one drop for one week, then No. 4 two drops for one week, and resume maintenance dosing on the third week. Adults on #5 one drop for two weeks then revert to #5 two drop maintenance dose.
Patients who are discontinuing in increments and stopping within one week, please decrease the dose by three levels. For example, if the dose is discontinued for four days after 4 drops of No. 2, reduce the dose to 1 drop of No. 2 and start the increment. If you stop the medication for more than one week, decrement No. 1, and it is recommended to start again after stopping the medication for more than two weeks.
How to avoid contact with allergens?
Dust mites are arthropods that are difficult to see with the naked eye and feed mainly on human and animal dander. They are pervasive, live mites, dead mites, and mite excrement are all very powerful allergens that fly into the air when making beds, folding quilts, or sweeping floors, and cause allergic reactions when inhaled by people with allergies.
Dust mites like a warm and humid environment, so it is important to keep the room clean and dry to prevent mites.
Quilts, bed sheets, pillows, cloth sofas, carpets, stuffed toys, and air conditioning filters are all places where mites hide.
It is recommended to wash bedding weekly with water above 55°C or iron it with an iron and expose it directly to the sunlight, which is also very effective.
Patients are advised to use latex pillows, cloud silk or silk quilts. No cloth sofas, no playing with stuffed toys, no carpets in the house, and less indoor arrangements that tend to accumulate dust.
The home air conditioner filter must be cleaned promptly before use, and subsequently cleaned regularly every week.
Let children sleep alone as early as possible, because adult beds have a lot of dander on them, which can lead to the presence of a large number of dust mites.
How to distinguish between poor effect or intolerance?
Ineffective: no significant improvement after more than 3 months of medication (condition has not worsened). It is recommended to increase the dose, for example, try four drops of No. 4 or one drop of No. 5 for pediatric patients and two drops of No. 5 for maintenance. Adult patients are maintained with three or four drops of No. 5.
Intolerance: the use of the drug to a certain stage, the emergence of allergic symptoms aggravated (not changed living environment or not occurring respiratory inflammation), usually appear in the incremental period, the middle of the gear change. It is recommended to reduce the dose, extend the incremental period or add symptomatic drugs. If allergic symptoms worsen when taking the maintenance dose, then the maintenance dose can be reduced to two drops or one drop of #4 for pediatric patients and to one drop of #5 for adult patients.
When is it necessary to interrupt sublingual desensitization?
Patients with abnormal body temperature or severe asthma attacks. If you have a cold, diarrhea, etc., you can combine treatment without interrupting sublingual desensitization.
How do I end the desensitization treatment? (as long as the symptoms are controlled)
By the end of 2 – 3 years, it is ended directly.
After 2 – 3 years, gradually lengthen the duration of the medication, from a maintenance dose once every 2-3 days to once a week, and finally insist on taking it once every 2 weeks. (Lifetime desensitization is recommended abroad)
Changdi ingredients: dust mite allergenic active protein, saline, glycerin. (slightly sweet)
How to use: Put the drug drops under the tongue and swallow after containing 1-3 minutes, once a day, fixed time to give the drug.
You can drink or eat normally ten minutes after taking the medication. If you are also taking controlled medication, you should take it after rinsing your mouth after taking controlled medication.
The onset of action: Generally, it takes 1-3 months for rhinitis patients, 2-6 months for asthma patients and 3-6 months for atopic dermatitis patients to take effect.
Children’s immune system is more plastic and the effect of desensitization treatment will be more significant to prevent patients with rhinitis from developing asthma and patients with asthma from gradually evolving into chronic obstructive pulmonary disease or pulmonary heart disease.
Cost: Children will need roughly about 3,000 RMB a year. Adults roughly need about 2800 yuan