A Controlled Trial of Immunotherapy for Asthma in Allergic Children

Adkinson, N. F.; Eggleston, Peyton A.; Eney, D.; Goldstein, Eugene O.; Schuberth, Kenneth C.; Bacon, John; Hamilton, Robert G.; Weiss, Michael E.; Arshad, Hasan; Meinert, Curtis L.; Tonascia, James; Wheeler, Barbara

doi:10.1056/nejm199701303360502

Cited by 304 publications

(170 citation statements)

References 20 publications

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“…[6][7][8][9][10] Study and Population Characteristics for SCIT Thirteen studies including 920 children aged 3 to 18 years evaluated SCIT for clinical outcomes. The primary diagnosis was asthma in 7 studies, 6,7,[11][12][13][14][15] rhinoconjunctivitis in 1 study, 16 and asthma with rhinitis/rhinoconjunctivitis in 5 studies. 8,9,[17][18][19] The majority of studies used a single allergen for SCIT.…”

Section: Resultsmentioning

confidence: 99%

“…In contrast, 1 study with a low risk of bias enrolled 121 children with moderate to severe asthma already receiving appropriate asthma medications and found no improvement, compared with placebo, with SCIT using multiple allergens. 15 The overall strength of evidence is moderate that SCIT using a single allergen improves asthma symptoms relative to placebo or pharmacotherapy. However, there is low-grade evidence that SCIT using multiple allergens does not improve asthma symptoms in subjects with moderate to severe asthmatics.…”

Section: Asthmamentioning

confidence: 99%

“…Six RCTs with 550 subjects evaluated SCIT for control of asthma symptoms relative to placebo 11,15,18,19 or pharmacotherapy 13,17 (Table 1; Supplemental Appendix Table 4). Four studies evaluated a single allergen 11,13,18,19 and 2 used multiple allergens.…”

Section: Asthmamentioning

confidence: 99%

“…Four studies evaluated a single allergen 11,13,18,19 and 2 used multiple allergens. 15,17 Singleallergen SCIT studies demonstrated improvement in asthma symptoms, compared with placebo or pharmacotherapy, with moderate to strong magnitudes of effect. In contrast, 1 study with a low risk of bias enrolled 121 children with moderate to severe asthma already receiving appropriate asthma medications and found no improvement, compared with placebo, with SCIT using multiple allergens.…”

Section: Asthmamentioning

confidence: 99%

“…Four studies with 470 participants evaluated SCIT for improvement of asthma medication usage (Supplemental Appendix Table 5), 11,13,15,17 and 2 studies with 80 participants evaluated combined asthma and rhinitis/rhinoconjunctivitis medication usage (Supplemental Appendix Table 6). 18,19 Four single-allergen studies demonstrated greater reduction in medication usage for asthma with or without rhinoconjunctivitis in the SCIT group than in the comparator.…”

Section: Asthmamentioning

confidence: 99%

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Allergen-Specific Immunotherapy for Pediatric Asthma and Rhinoconjunctivitis: A Systematic Review

Kim¹,

Lin²,

et al. 2013

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BACKGROUND AND OBJECTIVE: Subcutaneous immunotherapy (SCIT) is approved in the United States for the treatment of pediatric asthma and rhinitis; sublingual immunotherapy (SLIT) does not have regulatory approval but is used in clinical practice. The objective of this study was to systematically review the evidence regarding the efficacy and safety of SCIT and SLIT for the treatment of pediatric asthma and allergic rhinoconjunctivitis. METHODS:Two independent reviewers selected articles for inclusion, extracted data, and graded the strength of evidence for each clinical outcome. All studies were randomized controlled trials of children with allergic asthma or rhinoconjunctivitis treated with SCIT or an aqueous formulation of SLIT. Data sources were Medline, Embase, LILACS, CENTRAL, and the Cochrane Central Register of Controlled Trials through May 2012. RESULTS:In 13 trials, 920 children received SCIT or usual care; in 18 studies, 1583 children received SLIT or usual care. Three studies compared SCIT with SLIT head-to-head in 135 children. The strength of evidence is moderate that SCIT improves asthma and rhinitis symptoms and low that SCIT improves conjunctivitis symptoms and asthma medication scores. Strength of evidence is high that SLIT improves asthma symptoms and moderate that SLIT improves rhinitis and conjunctivitis symptoms and decreases medication usage. The evidence is low to support SCIT over SLIT for improving asthma or rhinitis symptoms or medication usage. Local reactions were frequent with SCIT and SLIT. There was 1 report of anaphylaxis with SCIT.CONCLUSIONS: Evidence supports the efficacy of both SCIT and SLIT for the treatment of asthma and rhinitis in children. Pediatrics

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Section: Resultsmentioning

confidence: 99%

Section: Asthmamentioning

confidence: 99%

Section: Asthmamentioning

confidence: 99%

Section: Asthmamentioning

confidence: 99%

Section: Asthmamentioning

confidence: 99%

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Allergen-Specific Immunotherapy for Pediatric Asthma and Rhinoconjunctivitis: A Systematic Review

Kim¹,

Lin²,

et al. 2013

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Immunotherapy With Allergens

Weber¹

1997

JAMA

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Allergen immunotherapy has been shown to be efficacious in numerous studies for the clinical indications of allergic asthma and rhinitis, as well as hymenoptera venom hypersensitivity. How allergen immunotherapy improves clinical symptoms is still not entirely clear. Decreases in specific IgE follow a complex cascade of effects: a shifting of the cytokine milieu from T(H)2 to T(H)1 predominance, with resultant decrease in interleukin 4, decreased recruitment and activation of eosinophils, and decreased proliferation of mast cells. Allergen exposure has a lessened ability to stimulate an inflammatory cell response, with decreased target organ hyperreactivity. Since allergen immunotherapy is not without risk, the decision needs to be made whether injection therapy is safe and provides benefit not achievable by medical management. The continued clarification of optimal allergen concentrations through careful studies of standardized extracts will allow better control of adverse events by limiting unnecessarily potent mixtures.

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Third International Pediatric Consensus statement on the management of childhood asthma

1998

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A Controlled Trial of Immunotherapy for Asthma in Allergic Children

Abstract: Immunotherapy with injections of allergens for over two years was of no discernible benefit in allergic children with perennial asthma who were receiving appropriate medical treatment.

Cited by 304 publications

References 20 publications

Allergen-Specific Immunotherapy for Pediatric Asthma and Rhinoconjunctivitis: A Systematic Review

Allergen-Specific Immunotherapy for Pediatric Asthma and Rhinoconjunctivitis: A Systematic Review

Immunotherapy With Allergens

Third International Pediatric Consensus statement on the management of childhood asthma

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