Sublingual Immunotherapy For Fungal Sinus Problems

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Immune therapy involving allergens from pollen, dust mite, or fungal (mold) allergens is oftentimes helpful in reducing symptoms from allergic conditions such as asthma, rhinitis, or skin eczema. For many years, allergy shots have been give under the skin (subcutaneous or SCIT). On rare occasions, SCIT has caused severe side effects such as asthma or anaphylactic shock. 

 

Jonathon Melzer et al. Sublingual Immunotherapy for Allergy Fungal Sinusitis. Annals of Otology, Rhinology, and Laryngology. 2015;124:782-7.

Gabrielle Cortellini et al. Sublingual immunotherapy for Alternaria-induced allergic rhinitis: as randomized placebo-controlled trial. Annals of Allergy, Asthma and Immunology. 2010;105:382-6.

In recent years, giving allergens under the tongue (sublingual immunotherapy or SLIT) has been very useful for treating many allergies. SLIT generally has a much lower risk of adverse side effects than SCIT. SLIT can be easily administered by the patients themselves and does not require a weekly physician visit as with SCIT.

SLIT treatment may be useful for patients with allergic fungal sinusitis (AFS). A 2015 retrospective case series was presented of 10 patients with AFS who were treated with SLIT with mold allergens. The patients were treated with allergen extracts from molds they were allergic to such as Aspergillus fumigatus, Mucor racemosus, Alternaria tenuis, Rhizopus nigricans, Curvularia lunata, and Aspergillus niger. No adverse effects of SLIT was reported in any of the 10 patients. Decreases in subjective complaints, exam findings and serum levels of IgE antibodies were seen in the AFS patients treated with sublingual immunotherapy.

A 2010 study examined the effects of sublingual immunotherapy (SLIT) on Alternaria-induced allergic rhinitis. Alternaria is a common outdoor/indoor fungi (especially in Summer and early Fall) which produces large and highly allergenic spores. Exposure to high airborne levels of Alternaria have been linked to significantly higher rates of both asthma and rhinitis. This 10-month study treated patients with Alternaria-induced allergic rhinitis with either Alternaria allergen SLIT (15 patients) or placebo (12 patients).

After 10 months treatment, symptom scores were significantly improved and allergy medication use significantly reduced in the patients receiving the Alternaria immunotherapy as compared to the placebo patients.

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