Allergen specific sublingual immunotherapy in children with asthma and allergic rhinitis (original) (raw)
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Srpski arhiv za celokupno lekarstvo, 2016
In 1993 the European Academy of Allergy and Clinical Immunology was the first official organization to recognize that sublingual administration could be ?promising route? for allergic desensitization. A few years later, the World Health Organization recommended this therapy as ?a viable alternative to the injection route in adults.? The first meta-analysis showed sublingual allergen specific immunotherapy (SLIT) effectiveness for allergic rhinitis and another study showed SLIT can actually help prevent the development of asthma both in adults and in children. The main goal of this review article is to present insight into the most up-to-date understanding of the clinical efficacy and safety of immunotherapy in the treatment of pediatric patients with allergic rhinitis and asthma. A literature review was performed on PubMed from 1990 to 2015 using the terms ?asthma,? ?allergic rhinitis,? ?children,? ?allergen specific immune therapy.? Evaluating data from double-blind placebo-control...
Asthma Allergy Immunology, 2021
Objective: Allergen-specific immunotherapy (allergen-SIT) is a treatment method with variable efficacy in allergic diseases. This study aimed to investigate the effectiveness of allergen immunotherapy, frequency of LRs and SRs and variables affecting these parameters in patients who underwent allergen-SIT. Materials and Methods: In this study, the recorded data of 81 patients, who received subcutaneous (SCIT) or sublingual (SLIT) allergen immunotherapy for respiratory allergic diseases between 2014 and 2019, were analyzed. In asthma and/or allergic rhinoconjunctivitis (ARC) patients, the effectiveness of treatment was evaluated by analysing the change rates in disease symptom, medication and combined scores (symptom + medication) and visual analog score (VAS). Treatment success was defined by the degree of decrease in scores as; high response above 50%; low response between 20-50%; and failure <20%.Results: The mean age of allergen-SIT initiation was 11.4± 3.1 years. Diagnostic d...
Subcutaneous and Sublingual Immunotherapy in Allergic Asthma in Children
Frontiers in Pediatrics, 2017
This review presents up-to-date understanding of immunotherapy in the treatment of children with allergic asthma. The principal types of allergen immunotherapy (AIT) are subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). Both of them are indicated for patients with allergic rhinitis and/or asthma, who have evidence of clinically relevant allergen-specific IgE, and significant symptoms despite reasonable avoidance measures and/or maximal medical therapy. Studies have shown a significant decrease in asthma symptom scores and in the use of rescue medication, and a preventive effect on asthma onset. Although the safety profile of SLIT appears to be better than SCIT, the results of some studies and meta-analyses suggest that the efficacy of SCIT is better and that SCIT has an earlier onset than SLIT in children with allergic asthma. Severe, not controlled asthma, and medical error were the most frequent causes of SCIT-induced adverse events.
The Turkish Journal of Pediatrics, 2018
Subcutaneous allergen immunotherapy (SCIT) has been shown to improve clinical course in children with asthma and allergic rhinitis (AR). Systemic and local side-effects may be seen during its administration. The purpose of this study was to evaluate risk factors associated with systemic and local side-effects in children receiving SCIT. We performed a retrospective chart review in the children who received allergen subcutaneous immunotherapy for asthma and/or allergen rhinitis. Demographic data, diagnosis, skin prick test results, presence of additional allergic diseases, the seasonal variation of adverse events in the first and third years of SCIT were recorded. A total of 508 eligible patients were included in the study. Mean age of the children was 10.9±3.2 years, and 65.4% were male. Asthma was present in 21.9% of the children, AR in 44.7%, 33.5% of them had both asthma and AR. According to the skin prick test results, sensitivity to more than one allergen was present in 45.1%, while the most common single-allergen sensitivities were to grass pollen and dermatophagoids (32.5% and 14.4%, respectively). Ratio of systemic and local side-effects was 4.7% and 9.3%, respectively. Local side-effects were more common than systemic reaction. SCIT is a safe treatment modality while using the appropriate dose and with the administration of dose-escalation protocol.
The safety of sublingual immunotherapy with one or multiple pollen allergens in children
Allergy, 2008
Sublingual immunotherapy (SLIT) is now recognized as a viable alternative to the classical injection route (1, 2) and it is currently used in everyday clinical practice in several European Countries. In addition to the well-demonstrated clinical efficacy (3), one of the distinguishing features of SLIT is its good safety profile, which has been repeatedly confirmed in both clinical trials (4) and postmarketing surveys (5-7). In this regard, it is well recognized from the literature that systemic and/or severe side-effects are exceptional, and these side-effects usually do not differ between placebo and treated groups (8). Nonetheless, it is true that all clinical trials were performed with a single allergen extract and so was performed in the postmarketing surveys. This is because of the fact that, at least in Europe, there is the tendency to prescribe immunotherapy for one allergen, which is recognized as the responsible for the disease (9). On the contrary, the vast majority of patients are polysensitized (10) and different allergens can cause their symptoms, so that a vaccination with multiple allergens is often required and justified. Of note, the administration of multiple allergens is a common practice in the USA and other countries (11). Very recently, concerns of the safety of SLIT when different allergens are given together have been raised, based on isolated case reports (12, 13). Certainly, this aspect becomes one of primary relevance in children who are, in principle, the ideal candidates to SLIT, especially based on safety considerations. In other words, it is essential to know if in children the administration of more than one allergen may increase the occurrence of adverse events. For this reason, we compared in a postmarketing survey, by means of proper diary cards, the rate of sideeffects in paediatric patients receiving SLIT either with single or multiple allergens. Methods Consecutive paediatric patients with respiratory allergy due to pollens, seen in the period 2004-2007 receiving SLIT for multiple allergens and matched patients treated with one single allergen were followed-up in this postmarketing survey. Inclusion criteria were those for prescribing SLIT according to guidelines (2). In particular, SLIT was given to those children suffering from respiratory allergy Background: Since the majority of allergic patients are polysensitized, it is often necessary to prescribe immunotherapy with multiple allergens. It is crucial to know if the administration of multiple allergens with sublingual immunotherapy (SLIT) increases the risk of side-effects in children. Methods: Consecutive children with respiratory allergy because of pollens, receiving SLIT for multiple or single allergens were followed-up in a postmarketing survey. Inclusion criteria were those for prescribing SLIT according to guidelines. Parents recorded in a diary card the side-effects (eye symptoms, rhinitis/ear itching, asthma, oral itching/swelling, nausea, vomiting, abdominal pain, diarrhoea, urticaria, angioedema and anaphylaxis). The side-effects were graded as mild, moderate and severe. Results: Four hundred and thirty-three children (285 male, age range 3-18 years) receiving SLIT were surveyed. Of them, 179 received a single extract, and 254 multiple allergens. The total number of doses given was 40 169 (17 143 with single allergen). Overall, 178 episodes were reported. Of them, 76 occurred with the single allergen (42.46% patients, 4.43/1000 doses) and 102 (40.3% patients, 4.42/1000 doses) with multiple allergens (P = NS). 165 episodes (92.5%) were mild and self-resolving and were equally distributed in the two groups. In 13 cases, the events were judged of moderate severity and medical advice was required. Three patients discontinued SLIT, despite the local side-effects being mild. No emergency treatment was required at all. Conclusion: The use of multiple allergens for SLIT does not increase the rate of side-effects in children.
Safety of allergen‐specific immunotherapy in children
Pediatric Allergy and Immunology, 2022
Allergen-specific immunotherapy (AIT) is the only curative treatment of allergic rhinitis and allergic asthma as it has a disease-modifying effect. AIT protocol is generally based on the administration of increasing doses of the causal allergen (building-up phase), followed by a three-year maintenance schedule. AIT induces long-lasting effects after its suspension and affects the natural course of the IgE-mediated allergy, preventing new sensitizations and the disease progression. 1 In 1911, Leonhard Noon and John Freeman, the AIT pioneers, inoculated grass pollen extracts in patients with allergic rhinitis. In the last years, several studies have been published to highlight the safety and efficacy of AIT. The concept of personalized medicine as a diagnostic and therapeutic approach is currently
Allergen immunotherapy for the treatment of allergic rhinitis and/or asthma: an umbrella review
CMAJ open, 2017
Allergic rhinitis and asthma are important public health concerns, yet there is no consensus about the benefits and harms of allergen-specific immunotherapy to treat these conditions. We performed an umbrella review of systematic reviews summarizing the current evidence for the benefits and harms of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). We searched MEDLINE, Embase, the Cochrane Library and the grey literature from Jan. 1, 2010 to Nov. 20, 2016 for systematic reviews of randomized controlled trials or prospectively controlled studies involving children or adults with allergic rhinitis or asthma. Outcomes were summarized narratively (benefits: total combined symptom-medication score, symptom score, medication score, disease-specific quality of life, adherence; harms: anaphylaxis, death, local and systemic reactions). Twenty-three systematic reviews were included. SCIT and SLIT were more effective than placebo for most outcomes. SCIT was better than SLI...
Immunotherapy in the Treatment of Allergic Rhinitis in Children
Cureus
Allergic rhinitis (AR) is an inflammation of the nasal membranes characterized by multiple allergic symptoms. It is a widespread health problem that affects patients' ability to engage in social and physical activity, which lowers their quality of life. The pathophysiology of AR is complex and requires sensitization and the development of a specific immune response to the allergen. Allergen-specific immunotherapy (AIT) is a therapeutic method that induces specific immune tolerance to allergens. The objectives of this review are to demonstrate the mechanism of action of immunotherapy, explain how it alleviates clinical symptoms of allergic rhinitis, list the indications and contraindications of immunotherapy in the treatment of allergic rhinitis, and identify different modalities of allergen immunotherapy, their disease-modifying effects, as well as their potential risks and benefits. The review of the literature highlights that T-cell and B-cell responses to inhaled allergens are altered by AIT, which decreases both early and late reactions to allergen exposure. To induce clinical and immunologic tolerance, especially in the pediatric age, escalating dosages of the causing allergen are administered subcutaneously or sublingually. AIT is indicated for severe persistent AR when avoidance measures and medications are inadequate to control the symptoms. To conclude, AIT is a disease-modifying therapy that is safe and effective for the treatment of allergic rhinitis. It is indicated when the symptoms are uncontrolled or when there are undesirable effects from pharmacotherapy.
Allergen immunotherapy in children and adolescents with respiratory diseases
Acta Bio Medica : Atenei Parmensis, 2020
To date, the only disease-modifying treatment strategy for allergic rhinitis and asthma is allergen immunotherapy (AIT). There is evidence that AIT improves allergic rhinitis and asthma, such as reducing symptom severity and medication use and improving of quality of life, with a long-lasting effect after the end of the course. The recent clinical trials evidenced AIT effectiveness and safety in allergic asthma. Consequently, the current version of the GINA (Global Initiative for Asthma) guidelines recommend AIT as an add-on therapy for asthma. There is also evidence that AIT may exert preventive activity on the possible progression from allergic rhinitis to asthma in children and the onset of new sensitizations. (www.actabiomedica.it)