Comparative clinical efficacy and immunological modulation of subcutaneous vs. sublingual allergen immunotherapy in children with house dust mite-induced allergic asthma: a retrospective cohort study.

OBJECTIVES

The current study compared the clinical efficacy and immunological effects of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) in children with house dust mite (HDM)-induced allergic asthma and explored immune markers associated with treatment response.

METHODS

The study retrospectively included 125 children with HDM-induced allergic asthma, of which 53 patients received SCIT and 72 patients received SLIT. Clinical outcomes, pulmonary function, and immunological parameters were evaluated at baseline and after 12 months of treatment. Immunological assessments included total IgE, HDM-specific IgE, IgG4, cytokines, peripheral eosinophils, and fractional exhaled nitric oxide (FeNO). Multivariable regression and correlation analyses were performed to identify factors associated with clinical improvement.

RESULTS

Both SCIT and SLIT significantly improved asthma control and pulmonary function. ACT scores increased, whereas FeNO levels and eosinophil counts decreased in both groups. IgG4 and IL-10 levels increased significantly, while IL-4 and IL-5 decreased. No significant differences were observed between SCIT and SLIT in the magnitude of these improvements. In exploratory regression analyses, changes in IgG4, IL-10, and IL-4 were associated with improvement in asthma control.

CONCLUSIONS

In this retrospective cohort, SCIT and SLIT were associated with similar improvements in asthma control, selected pulmonary-function measures, and immune markers over the 12-month observation period. Changes in concomitant asthma medications during follow-up could not be accounted for and may have influenced the observed outcomes. The study did not assess the long-term sustainability of these benefits or post-treatment effects; therefore, longer prospective follow-up is required to evaluate the comparative long-term efficacy of the two treatment modalities.