Tratamiento de Pacientes Alérgicos por Vía Sublingual – Oral

Conclusiones

Al finalizar este trabajo se pudo concluir que:

• La inmunoterapia sublingual-oral ofrece seguridad y efectividad en el tratamiento del paciente alérgico.
• Todos los pacientes que hicieron correctamente el tratamiento siguiendo las instrucciones pre-establecidas obtuvieron mejoría de su enfermedad alérgica al terminar el estudio.
• No fue posible discriminar en cuanto a las diferentes enfermedades alérgicas tratadas y la respuesta al tratamiento, pues todas respondieron con cese de signos y síntomas antes de los dos meses de iniciado el tratamiento y sin importar el tiempo de evolución de la enfermedad.
• El tiempo empleado en el tratamiento ( 6 meses) es considerablemente corto. Únicamente en dos niños hubo necesidad de prolongar a un año la administración de las gotas sublinguales
• Resaltamos el hecho de que aunque el tiempo de tratamiento establecido es de 6 meses algunos pacientes (niños) suspendieron el tratamiento en períodos de tiempo mas cortos pero igualmente se encuentran en remisión de su enfermedad alérgica.
• Desde el punto de vista paraclínico se encontró una marcada respuesta humoral por inmunoglobulina A secretora en más del 80% de los pacientes, como anticuerpo neutralizante del alergeno en cuestión.
• La inmunoglobulina E que en todos los pacientes tenía títulos elevados al iniciar el tratamiento, tuvo un comportamiento irregular pues sólo un 33 % normalizó sus títulos y por el contrario un 67% permaneció igual o aumentó los títulos de este anticuerpo.
• Como efecto colateral al iniciar el tratamiento se manifestó en un paciente un intenso prurito en garganta yen otro una conjuntivitis muy pruriginosa, en ambos casos remitió el síntoma al indicarle al paciente que no deglutiera el alergeno sino que lo escupiera después de sostenerlo debajo de la lengua por 3 minutos.
• En cuanto a recaídas de la enfermedad después del tratamiento es muy temprano para saber cómo se comportará la enfermedad después de suspendido el tratamiento pues el paciente más antiguo tiene 1 año 7 meses de observación asintomático. Un paciente hizo recaída leve de asma bronquial al año, la cual cedió al reforzar la inmunoterapia con alergenos puros durante 1 mes.
• En dos pacientes fue necesario llevar al doble la dilución de los alergenos administrados, pues con las diluciones preestablecidas (Gráfica 1) presentaron agudización de los síntomas de su enfermedad (asma bronquial en ambos casos).
• El procedimiento fue más dispendioso en niños debido al sabor de los alergenos y debido a esto hubo necesidad de suspender el tratamiento en algunos casos antes de cumplir con el tiempo preestablecido.

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