Clinical efficacy and safety of sublingual immunotherapy with tree pollen extract in children

Turku Allergy Centre, Turku, Finland.
Allergy (Impact Factor: 6.03). 10/2006; 61(10):1177-83. DOI: 10.1111/j.1398-9995.2006.01190.x
Source: PubMed


Subcutaneous immunotherapy has been the principal approach of immunotherapy in the treatment of allergic diseases. Several clinical studies with birch, alder or hazel pollen extract conducted as subcutaneous immunotherapy have been published suggesting a well-tolerated and clinically effective treatment. Only a few clinical studies of sublingual immunotherapy (SLIT) with these allergens have been published. This study investigated the clinical efficacy, safety and dose-response relationship of SLIT in children suffering from rhinoconjunctivitis with/without asthma.
Eighty-eight children (5-15 years) with a history of tree pollen-induced allergic rhinoconjunctivitis with/without seasonal asthma for >or=2 years were included. Allergy to tree pollen was confirmed by positive skin-prick test, positive specific IgE and positive conjunctival provocation test. The extract used was a glycerinated mixture of Betula verrucosa, Corylus avellana and Alnus glutinosa 100,000 SQ-U/ml. Children were randomized into three groups receiving SLIT 5 days a week for up to 18 months; dose group 1: accumulated weekly dose of 24,000 SQ-U; dose group 2: accumulated weekly dose of 200,000 SQ-U; and placebo.
In the birch pollen season, dose group 2 showed a significant reduction of symptom (P = 0.01) and medication scores (P = 0.04) compared with placebo. Dose group 1 showed a significant reduction of symptom scores (P = 0.03). There were no statistical differences between dose groups 1 and 2. All children tolerated the treatment well.
SLIT with tree pollen extract provided dose-dependent benefits in tree pollen-allergic children in terms of significantly reduced symptoms and medication use. The treatment was well tolerated.

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Available from: Lars Jacobsen, Sep 19, 2014
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    • "Na podstawie dostępnych badań można przyjąć, że największą skutecznością cechują się szczepionki zawierające alergeny pyłku traw i brzozy [9] [54]. Szczególnie istotny jest długotrwały efekt kliniczny utrzymujący się po zaprzestaniu SLIT, który wykazano u pacjentów leczonych z powodu uczulenia na pyłek traw oraz roztocze kurzu domowego [50] [55]. "
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    ABSTRACT: SLIT (sublingual immunotherapy) is a therapeutic method aiming at producing allergen-specific tolerance of the immune system to a gradually increasing dose of an allergen that is administered sublingually. SLIT initiates similar immune mechanisms as does subcutaneous immunotherapy (SCIT). The aim of the study at this position is to update the current knowledge on sublingual immunotherapy. Randomized double-blind, placebo-controlled (RDBPC) studies that compared both immunotherapy forms point to an advantage of SCIT over SLIT in decreasing symptoms of asthma and allergic rhinitis, a comparable effect of both the methods on immune parameters (sIgE, IL-10) and upper respiratory tract inflammations and an advantage of SCIT over SLIT with respect to lower respiratory tract inflammations as based on provocation tests. At present, there are no grounds for recommending SLIT in food allergy. In view of the high safety profile and absence of anxiety-provoking infections, SLIT may be the method that is more often selected in children as compared to adults. On the other hand, immune mechanisms and results of clinical trials provide an argument for preferential employment of SCIT in adults. It should be borne in mind, however, that SLIT is effective if a good quality vaccine with a high allergen dose, is employed for at least three years. National and international reports indicate the necessity of conducting further clinical trials, especially including a direct comparison between SCIT and SLIT with respect to effectiveness and safety.
    Full-text · Article · Mar 2014
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    • "Sublingual immunotherapy (SLIT), the administration of an allergen via the oral mucosa, has also been confirmed to reduce the incidence of new asthma cases [10]. The lower frequency of side effects and the relative convenience make SLIT a more acceptable treatment for children [11]. "
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    ABSTRACT: Background Allergen-specific immunotherapy has been demonstrated to have potential for the treatment of allergic diseases. Transgenic animals are currently the best available bioreactors to produce recombinant proteins, which can be secreted in milk. It has not been clearly demonstrated whether milk from transgenic animals expressing recombinant allergens has immunomodulatory effects on allergic asthma. Methods We aimed to determine whether the oral administration of milk containing a mite allergen can down-regulate allergen-specific airway inflammation. Transgenic CD-1 mice that express a recombinant group 2 allergen from Dermatophagoides pteronyssinus (Dp2) in their milk were generated using an embryonic gene-microinjection technique. Mouse pups were fed transgenic Dp2-containing milk or wild-type milk. Subsequently, these mice were sensitized and challenged with Dp2 to induce allergic airway inflammation. Results Upon sensitization and challenge, mice fed transgenic Dp2 milk had decreased T-helper 2 (Th2) and increased T-helper 1 (Th1) responses in the airway compared with mice fed wild-type milk. Moreover, pre-treatment with transgenic Dp2 milk attenuated airway inflammation and decreased airway hyper-responsiveness. Conclusions This study provides new evidence that oral administration of transgenic milk containing the Dp2 allergen down-regulated and moderately protected against allergic airway inflammation. Milk from transgenic animals expressing allergens may have potential use in the prevention of allergic asthma.
    Full-text · Article · Jun 2013 · Allergy Asthma and Clinical Immunology
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    • "month study of 2 different doses of SLIT for tree-pollen allergy in 88 children suffering seasonal allergic rhinitis, confirmed by skin prick test, specific serum IgE, and conjunctival allergen challenge. Eighteen months of SLIT with tree pollen extract provided dose-dependent benefits in terms of significantly reduced symptoms and medication use.(Valovirta E et al., 2006) Two adequately powered, well-designed double blind placebo controlled (DBPC) randomized controlled trial (RCTs) have now been published, both showing a clear effect of allergen tablets in childhood. A statistically significant reduction in rhinitis symptoms (28%) and medication (64%) score was shown during the pollen season in 114 chil"

    Full-text · Chapter · Mar 2012
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