4. Discussion
DLE, fever, fatigue, rash, pruritus, nasal congestion, allergic disease, nose symptoms
DLE, RARE HEADACHE, DISEASE
AR is the most common allergic disease, and treatment options for this persistent disease are limited; therefore, there is a continuous search for new and safe treatment options.Owing to its mechanism of action that diminishes the Th2-inflammatory response,The total RQLQ scores in our study showed clinically significant improvements, surpassing the minimal required 0.5-point change in score, aside from showing statistical significance after 11 weeks of DLE treatment. The QoL improvement observed in this study was well above the required MID and exceeded that of other immunomodulators, such as specific immunotherapy and probiotics. A real-world clinical study of sublingual and subcutaneous immunotherapy that used RQLQ as a primary endpoint reported MID after 6 months of subcutaneous immunotherapy.As each patient was compared with her/himself, the type of standard treatment was irrelevant even if it remained unchanged. Despite the differences in the number of AR medications taken, we found no difference in QoL improvement between patients taking one, two, three, or four different AR medications. According to the guidelines, patients with persistent symptoms of AR require one or two medications (nasal steroids with or without oral antihistamines), not including immunotherapy. A third medication (leukotriene antagonist) may benefit pediatric patients with AR, and some may occasionally use local vasoconstrictors.All 7 domains (daily activity limitation, sleep problems, nose symptoms, eye symptoms, non-hay fever symptoms, practical problems, and emotional function) in the RQLQ questionnaire showed statistical and clinical improvements during DLE treatment. Each of the 28 individual items in the questionnaire also showed statistical and clinical improvement. Bousquet et alThe main symptoms of AR are sneezing, nasal congestion, pruritus, and nasal secretion.Despite the DLE dose reduction in each phase, we observed a significant improvement in the RQLQ scores over time, suggesting that DLE dosing once a week may be adequate for most patients. However, we cannot exclude the possibility that a higher initial dose is beneficial. Additional studies comparing the efficacies of different doses are required to resolve this issue.The most common AE associated with the use of DLE are headache, increased disease symptoms, rash, and fatigue, which are present in less than 2% of DLE users.The limitations of this study include the small number of subjects, lack of a control group, and the fact that only QoL was evaluated. Due to the sample size and lack of a control group, no definite conclusions can be made regarding efficacy of DLE until larger, controlled, multicenter studies involving different populations are done. Nonetheless, this study provides encouraging results in favor of continuing the study of DLE as a possible treatment option for AR. QoL is one of the many tools available for assessing patients with AR.