Effects of high‐dose sublingual immunotherapy on quality of life in patients with cypress‐induced rhinitis: a placebo‐controlled study

Summary The efficacy of specific immunotherapy and particularly of sublingual immunotherapy (SLIT) in subjects allergic to Cupressaceae pollen is well defined, but no study assessed its effects on quality of life (QoL). We evaluated the effectiveness of SLIT with a standardized, high‐dose extract of Juniperus ashei in patients with cypress‐induced rhinitis, using QoL as the major outcome measure. Thirty‐four patients, 20 males and 14 females, mean age 33.8 years, with allergic rhinitis (AR) from cypress pollen were randomly assigned to receive an allergen extract standardized in index of reactivity (IR) of J. ashei (19 patients) or a placebo (15 patients). The schedule was pre‐coseasonal, with a build‐up phase in 12 days and a maintenance treatment with 300 IR a day up to the end of the cypress pollen season. All patients registered in diary cards their symptoms, drug consumption and side‐effects. The QoL was measured before and after SLIT by the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) by Juniper during the peak of the cypress pollen season. QoL significantly improved in respect to baseline in actively ( P =0.017) but not in placebo‐treated patients, and there was a significant difference in favour of actively treated patients during the pollen season ( P =0.02). Actively and placebo‐treated patients had comparable symptom–medication scores in the period from 15 February to 15 March, corresponding to the peak pollen season, but placebo‐treated patients showed an uneven drug consumption compared with actively treated patients. Side‐effects were relatively common, but mostly with local short‐lasting symptoms, and no systemic reaction was reported. These findings show that SLIT with high doses of J. ashei in subjects with cypress‐induced rhinitis significantly improves QoL and confirm previous observations on the disagreement between QoL – which assesses patient's perception – and medical parameters used in trials.