Specific immunotherapy in children: the evidence

Department of Pediatrics, University of Catania, Italy.
International journal of immunopathology and pharmacology (Impact Factor: 1.62). 10/2011; 24(4 Suppl):69-78.
Source: PubMed


Specific immunotherapy (SIT) is the only treatment able to not only act on the symptoms of allergy but also act on the causes. At present, SIT may be administered in two forms: subcutaneous (SCIT) and sublingual immunotherapy (SLIT). SCIT represents the standard modality of treatment while SLIT has recently been introduced into clinical practice and today represents an accepted alternative to SCIT. The main advantages of SIT that are lacking with drug treatment are long-lasting clinical effects and alteration of the natural course of the disease. This prevents the new onset of asthma in patients with allergic rhinitis and the onset of new sensitizations. The mechanism of action of both routes is similar; they modify peripheral and mucosal Th2-responses into a prevalent Th1-polarization with subsequent reduction of the allergic inflammatory reaction. Both have long-term effects for years after they have been discontinued, although for SLIT these evidences are insufficient. To date several guidelines have defined indications, controindications, side-effects, and clinical aspect for SCIT and SLIT. New forms of immunotherapy, allergen products and approaches to food allergy and atopic eczema represents the future of SIT.

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    • "These results suggest that long-term SCIT may alleviate asthma symptoms and reduce the required dose of ICS. Previous studies have demonstrated that subcutaneous injection immunotherapy is effective in the treatment of allergic rhinitis and asthma, which may improve the symptom scores by >40% (11–15). A previous study indicated that SCIT treatment may alleviate the clinical symptoms of allergic rhinitis as early as 6 weeks following the initiation of treatment (16). "
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    ABSTRACT: The present study aimed to evaluate the efficacy of three-year subcutaneous SQ-standardized specific immunotherapy (SCIT) in house dust mite (HDM)-allergic children with asthma. Ninety children with allergic asthma to HDMs, with or without allergic rhinitis, were randomly divided into two groups, the treatment group and the control group. The treatment group received SCIT combined with standardized glucocorticoid management and the control group received standardized glucocorticoid management alone for a period of three years. The mean daily dose of inhaled corticosteroids (ICSs), a four-week diary recording the symptom scores of asthma, peak expiratory flow (PEF) measurements, skin prick test results and serum immunoglobulin E (IgE) levels were assessed prior to treatment and following one, two and three years of treatment. The median dose of ICS was reduced in the treatment group after two and three years of treatment compared with that of the control group. After three years of treatment, the discontinuation percentage of ICS in the treatment group was higher than that in the control group. The treatment group demonstrated significantly reduced daytime and night-time asthmatic symptom scores, increased PEF values and reduced serum IgE levels after two and three years of treatment compared with those in the control group (P<0.05). In conclusion, three-year SCIT treatment combined with ICS is an effective immunotherapy for children with allergic asthma and resulted in a reduction of the required ICS dose.
    Full-text · Article · Mar 2014 · Experimental and therapeutic medicine
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    • "A correct knowledge helps to reduce the number of patients that interrupt the therapy before the end, also for its long-efficiency with slow improvements. An adequate paediatrician-family communication could improve the compliance to chronic therapies such as SIT [35] "

    Full-text · Article · Mar 2013
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    • "However, sublingual (oral) immunotherapy (SLIT) is gaining momentum among allergists. SLIT requires further evaluation for ocular allergy relief; it has been shown to control ocular signs and symptoms, although ocular symptoms may respond less well than nasal symptoms [60-65]. Oral antihistamines are commonly used for the therapy of nasal and ocular allergy symptoms. "
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    ABSTRACT: Ocular allergy represents one of the most common conditions encountered by allergists and ophthalmologists. Allergic conjunctivitis is often underdiagnosed and consequently undertreated. Basic and clinical research has provided a better understanding of the cells, mediators, and immunologic events, which occur in ocular allergy. New pharmacological agents have improved the efficacy and safety of ocular allergy treatment. An understanding of the immunologic mechanisms, clinical features, differential diagnosis, and treatment of ocular allergy may be useful to all specialists who deal with these patients. The purpose of this review is to systematically review literature underlining all the forms classified as ocular allergy: seasonal allergic conjunctivitis, perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratocongiuntivitis, contact allergy, and giant papillary conjunctivitis.
    Full-text · Article · Mar 2013 · Italian Journal of Pediatrics
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