The safety of sublingual-swallow immunotherapy: an analysis of published studies.
ABSTRACT As the main target of sublingual immunotherapy (SLIT) is to reduce at most the occurrence of adverse events (AE), safety represents a critical issue. This aspect deserves particular mention when a higher dose of allergen extract than traditional subcutaneous immunotherapy (SCIT) is required to be effective: that may be up to 500 times that employed for SCIT.
All published controlled studies concerning SLIT-swallow were analysed to evaluate AE rates.
Studies were subdivided in two groups: (i) studies using low allergen dose (LAD), i.e. ranging from 1 to 50 times the dose commonly administered with SCIT, and (ii) studies with high allergen dose (HAD), i.e. ranging from 50 to 500 times the dose administered with SCIT.
Twenty-five studies were altogether analysed: 13 studies belonged to the low-dose group, 12 belonged to the high-dose group. We considered all patients with at least one AE. Local reactions were significantly more frequent in the LAD group than in the HAD group (P<0.0001), while there was no difference in the rate of systemic reactions. Severe systemic reactions were never reported.
This study represents the first analysis of the safety of SLIT concerning the allergen dose employed in the treatment. There is evidence that AE occurrence is substantially not dose-dependent. This fact highlights two main clinical aspects: the elevated tolerability of SLIT in general and the safety of HAD regimen.
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ABSTRACT: Background Although the effectiveness of allergen monotherapy immunotherapy for allergic rhinitis (AR) has been well established by many prior studies, other aspects of immunotherapy are still incompletely documented by high-quality studies. The many published papers describe various results. The aim of the present study was to conduct a meta-analysis on the effectiveness of allergen immunotherapy.MethodsA total of 56 homogeneous studies were included in the analysis. The inclusion criteria used to select articles were as follows: (1) placebo-controlled clinical trials; (2) the use of immunotherapy; (3) participants and/or physicians were or were not blinded to immunotherapy or placebo assignment (single-blinding, double-blinding, or no-blinding studies); and (4) randomization or not of those in the immunotherapy and placebo groups.ResultsBetween 2003 and 2013, 114 placebo-controlled clinical trials were reported in Medline. Studies describing recovery rates in immunotherapy and placebo groups numbered 56. The distribution of such works was homogeneous (heterogeneity chi-square = 16.11; degrees of freedom [df] = 55; p = 1.000). The extent of recovery in immunotherapy groups was 53.671-fold greater than in placebo groups (Mantel-Haenszel [M-H] pooled risk ratio [RR] = 53.671; 95% confidence interval [CI], 36.981 to 77.893; z = 20.96; p < 0.001).Conclusion Our meta-analysis suggests that immunotherapy is associated with a recovery rate 53.671-fold that of placebo.International Forum of Allergy and Rhinology 11/2014; · 1.00 Impact Factor
Article: Immunotherapy in all aspects.[Show abstract] [Hide abstract]
ABSTRACT: Allergen immunotherapy is a form of long-term treatment that decreases symptoms for many people with allergic rhinitis, allergic asthma, conjunctivitis (eye allergy) or stinging insect allergy. In this review, we presented the important topics in immunotherapy. The important aspects of immunotherapy are considered to be "Immunologıcal responses to immunotherapy"; "The principal types of immunotherapy"; "Effectiveness"; "Indications"; "Contraindications"; "Allergen immunotherapy in children"; "Safety"; and "Anaphylactic reactions after immunotherapy". The principal types of immunotherapy are subcutaneous immunotherapy (SCIT) and sublingual immunotherapy. Both of them can be used in indicated cases. When using SCIT, physicians must be more careful because of reported rare fatal cases. The risks and benefits of continuing allergen immunotherapy in patients who have experienced severe systemic reactions should be carefully considered.02/2015;
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ABSTRACT: Allergic rhinitis is an IgE mediated inflammatory response of the nasal membranes induced by allergen exposure. It has previously been classified as seasonal, perrenial and occupational. Typical symptoms of allergic rhinitis in-clude sneezing, rhinorrhoea itching and nasal blockage. The approach to the treatment of allergic rhinitis is broad-ly categorized into allergen avoidance, Intranasal corticosteroids cromolyn sodium, ketotifen, anti-histamines, nasal decongestants, Leukotriene receptor antagonists, immunotherapy and sublingual immunotherapy. The ob-jective of this review to study the pathological nature of allergic rhinitis and the different treatment protocols with respect to non pharmacological and pharmacological management.