The contribution of sublingual immunotherapy to the achievement of control in birch-related mild persistent asthma: A real-life randomized trial.

Background: Asthma control represents the main goal of asthma management and differentstrategies aim to avoid the long term downsides of inhaled corticosteroids. We investigated inreal-life conditions the contribution of sublingual immunotherapy in achieving the control ofbirch-related mild persistent asthma compared to two usual step-up therapeutic options.Methods: A three-year open randomised study included 84 asthmatics, uncontrolled during theprevious birch pollen season, despite a treatment with budesonide 400 g/day. Patients ran-domly received budesonide 800 g/day, budesonide 1600 g/day, budesonide 400 g/day plusmontelukast 10 g/day and budesonide 400 g/day plus carbamylated allergoid of betulaceaepre-coseasonally. Asthma Control test, combined allergy symptoms and medications score,albuterol consumption, lung function, nasal eosinophils and nasal steroids usage were assessedas changes from the first to last pollen season.Result: Seventy-six patients concluded the study. All options, except budesonide 800 g/day,produced an improvement of mean monthly Asthma Control test (p < 0.05). Patients undergoinglow-dose budesonide plus immunotherapy achieved, after three years, an appreciable control(ACT mean score 24). A significant improvement was seen in all groups for allergy symptomsplus medications and bronchial reactivity. Albuterol consumption and lung function improvedin all but the first group. Only budesonide plus immunotherapy reduced nasal eosinophils andnasal steroids usage. Two mild self-resolving adverse events were reported.