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| Case Studies |
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The following case studies are offered as examples of patients treated by sublingual immunotherapy. The unique issues associated with each are characteristic of many of the patients who have sought treatment after chronic problems were unresolved through traditional methods of treatment.
Case Study #1
Chronic sinusitis with perennial nasal allergy and nasal polyps
Case Study #2
Nasal allergy with chronic pneumonitis (farmer's lung) and thyroiditis
Case Study #3
Atopic dermatis with perennial nasal allergy
Case Study #1
Condition: Chronic sinusitis, perennial nasal allergy and nasal polyps
History: This 52-year-old white female had a history of chronic sinusitis with perennial nasal allergy and several attempts at desensitization using allergy injections. She had several sinus surgery procedures for chronic sinusitis and removal of nasal polyps. She was first seen October 13, 2000 and volunteered that she has been "sick all her life." She complained of nasal stuffiness, sinus pressure, ear pressure, and constant post nasal drainage. She had episodes of asthma which were particularly bad in July when boating on a lake. She frequently felt short of breath with wheezing and had sinus headaches through the frontal and maxillary areas. She had the diagnosis of celiac disease made through a blood test and avoids wheat and gluten. She had eczema as a child and still has occasional patches on the elbows.
On examination, she had small nasal polyps bilaterally with much lymphoid hyperplasia in the posterior pharynx and post nasal drainage. The exam was otherwise normal. Her previous allergy treatment was at a University Hospital and she had been treated with antihistamines and topical nasal steroids as well as Atrovent and Albuterol lung inhalers.
Skin testing: She reacted quite strongly to dust and dust mites and to the molds and formalin, but did not react to ragweed mixture, grass mixture, or Midwest tree mixture. Progress note: The patient was started on treatment 10/14/00 with sublingual antigens appropriate for the testing results for dust, dust mite, alternaria, Cladosporium, aspergillus, Penicillium, and four other mold mixtures. (She also reacted to formaldehyde, and this was included in the sublingual antigen.) She was given Sporanox capsules twice weekly for yeast and mold colonization. She will continue the sublingual antigens and will be seen again in four to six months.
Progress notes: When seen 11-21-00, she showed a very dramatic response. Treatment was effective in just five weeks. Primary allergic treatment using sublingual antigens and Sporanox to decrease mold and yeast growth rapidly has helped her to do better than she has in years. Sublingual treatment will be continued, and she will be seen every six months until testing of the inhalants is negative or near negative. She will be given antibiotics for any acute respiratory infection and followed with antifungals if needed.
Case Study #2
Condition: Nasal allergy, chronic pneumonitis (farmer's lung) and thyroiditis
History: This 42-year old dairy farmer's wife was first seen on October 9, 1988. She complains of cough and congestion, nasal congestion, burning in the chest with persistent cough. On examination, she showed the signs of nasal allergy and post nasal drainage, along with enlargement of the thyroid to twice normal size. It was interesting that she ran markedly elevated sedimentation rate and had a positive rheumatoid factor when she was first seen. The sed rate was as high as 98.
Testing: On intradermal testing, she showed strong immediate and delayed reactions to most all of the molds tested. This included alternaria, cladosporium, aspergillus, penicillium, candida and three other mold mixtures. She showed initial whealing which developed into strong delayed reactions in 24 to 48 hours. Pollen testing showed minimal reactions but she did react significantly to cattle, house dust, and dust mites. On in-vitro testing of her blood, she reacted with IgE antibodies to wheat and rye and reacted on sublingual challenge testing to ethanol (hydrocarbons), phenol, food yeast, and corn. She was started on a program of primary hyposensitization using oral (sublingual/swallow) antigens to both inhalants and to foods and chemicals. She was also given Flovent and Albuterol inhalers. On thyroid antibody testing 10/0/98, the patient showed high antibody titers to thyroperoxidase at 1444 IU/ml. Her initial TSH was high at 9.33 which would indicate hypothyroidism.
Progress note: With treatment of the thyroiditis with small gradual doses of thyroid extract (natural thyroid), she improved greatly and on 12/1/00, her antibody TPO antibody titer was 730 IU/ml and her TSH was 2.74. When seen on 12/1/00, she was markedly improved, although she still had some days of cough. She was staying out of the barn as much as possible and was given Sporanox to be taken 200 mg twice weekly to decrease colonization of yeast and fungi in the sinuses. Her sed rate was 22, and the rheumatoid factor was negative.
Summary: This case shows a very desirable outcome for a woman with severe farmer's lung, thyroiditis, and likely other autoimmune processes. She was able to be controlled with primary allergic management using desensitization with sublingual treatment.
Case Study #3
Condition: Atopic dermatitis, perennial nasal allergy
History: This 2-year-old white male was seen in November of 1999 because of eczema (atopic dermatitis) since age 3 to 4 months. It had started on the face, but had been on his arms and legs for months. He awakened 3 to 4 times a night because of scratching. Steroid creams had not helped, and he took homeopathic drops a year ago without help. The patient also had nasal stuffiness. On examination, he had moderate shiners with Denny's lines below both eyes, and dry erythematous, scaling patches on both legs and arms.
Testing: He was tested intradermally to three antigens and had very strong reactions to alternaria, dust mite, and T.C.E. mold mixture. On in-vitro specific IgE testing, alternaria showed 2341% of reference, ragweed was 219, dust mite 111. The foods showed egg white at 145, peanut at 120, and milk elevated at 95. He was started on a program of avoidance and hyposensitization using sublingual antigens.
Progress note: He responded and improved considerably in a few months and when seen back in April was much better with his skin clear. At that time, testing cladosporium and aspergillus, he was given these allergens in his sublingual drops. He continued having the sublingual antigens and was given Claritin syrup if needed for allergies. He was last seen in January 2001 with completely clear skin and was tested for a few more mold mixtures which were also positive. He continues taking food antigens for corn, milk, egg, and peanut and inhalant antigens for dust, dust mite, ragweed, grass, trees and multiple molds.
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