Effectiveness of subcutaneous immunotherapy for allergic rhinoconjunctivitis and asthma: A Systematic Review

Erekosima, Nkiruka; Suarez‐Cuervo, Catalina; Ramanathan, Murugappan; Kim, Julia M.; Chelladurai, Yohalakshmi; Segal, Jodi B; Lin, Sandra Y.

doi:10.1002/lary.24295

Cited by 102 publications

(100 citation statements)

References 72 publications

(437 reference statements)

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“…Allergen-specific immunotherapy (AIT) using standardized vaccines is an effective treatment for allergic rhinitis and allergic asthma and is the only treatment addressing the underlying cause of allergic diseases [1,2]. AIT has the potential to modify the development of disease and has a long-term prevention effect on asthma [3].…”

Section: Introductionmentioning

confidence: 99%

The Functional IgE-Blocking Factor Induced by Allergen-Specific Immunotherapy Correlates with IgG4 Antibodies and a Decrease of Symptoms in House Dust Mite-Allergic Children

Zhao

Lai

Tian

et al. 2016

Int Arch Allergy Immunol

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Background: At present, there are no validated biomarkers reflecting or predicting the clinical efficacy of allergen-specific immunotherapy (AIT) . We aimed to investigate the correlations between clinical and immunological responses of patients undergoing house dust mite (HDM) AIT. Methods: Sixty-nine children diagnosed with HDM allergic rhinitis and/or asthma received standardized Dermatophagoidespteronyssinus (Dp) subcutaneous AIT for 12 months. Twenty HDM-allergic children served as an open control group. Clinical symptom and medication scores were recorded and Dp-specific IgE, IgG4 and IgE-blocking factor were measured before AIT and after 4 and 12 months of AIT. Results: Symptom scores decreased after 4 months and continued to decrease during 12 months of AIT. No differences in medication scores were observed between AIT and the control group during the study period. Levels of Dp IgG4 increased after 4 months and correlated to symptom scores at 12 months (r = -0.296, p = 0.013) of AIT. The Dp IgE-blocking factor increased after 4 months of AIT, and correlated with symptom scores at 4 months (r = -0.307, p = 0.010) and 12 months (r = -0.288, p = 0.016) of AIT. A strong correlation between Dp IgE-blocking factor and Dp IgG4 during AIT (4 months: r = 0.680; 12 months: r = 0.636, both p < 0.0001) was observed. Patients with IgE-blocking factor ≥0.2 after 4 months of AIT showed lower symptom scores at 12 months of AIT (p = 0.0093). Conclusions: Subcutaneous HDM AIT results in a decrease of allergic symptoms among HDM-allergic children. IgE-blocking activity increased after 4 months of AIT and correlated with clinical symptoms. A high IgE-blocking factor at an early stage of AIT is associated with fewer symptoms at a later stage of AIT.

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Section: Introductionmentioning

confidence: 99%

The Functional IgE-Blocking Factor Induced by Allergen-Specific Immunotherapy Correlates with IgG4 Antibodies and a Decrease of Symptoms in House Dust Mite-Allergic Children

Zhao

Lai

Tian

et al. 2016

Int Arch Allergy Immunol

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“…This treatment also significantly reduced allergen-induced bronchoconstriction; however, only 20 studies included pulmonary function measurements. A few years later, Erekosima et al [82] carried out a systematic review of randomized controlled trials on the effectiveness and safety of SCIT for allergic rhinoconjunctivitis and asthma. They concluded that there was high-grade evidence that SCIT reduces asthma symptoms and asthma medication in comparison to placebo or usual care.…”

Section: Subcutaneous Immunotherapymentioning

confidence: 99%

“…-SCIT reduces asthma symptoms and asthma medication in comparison to placebo or usual care (LE 1a, grade A) [82]. -SCIT mite-sensitized subjects requires long-term treatment to achieve its clinical benefits (LE 1b, grade A) [83][84][85][86] [92,94].…”

Section: Sublingual Immunotherapymentioning

confidence: 99%

Specific allergen immunotherapy for the treatment of allergic asthma: a review of current evidence

Domínguez‐Ortega

Delgado

Blanco

et al. 2017

J Investig Allergol Clin Immunol

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Asthma is frequently associated with atopy, characterized by the production of specific immunoglobulin E in response to environmental allergens. Currently, two types of allergen immunotherapy (AIT) are used in clinical practice: subcutaneous and sublingual immunotherapy, both accepted as key components of the therapeutic repertoire for allergic rhinitis and conjunctivitis. However, their role in asthma remains controversial. The present document is aimed at providing the clinicians with a review of the evidence on the use of AIT in asthma, focusing on the most relevant aspects of its mechanism of action, its efficacy, and existing data on safety, tolerability, and cost-effectivity, both in pediatric and adult populations. A systematic search of MEDLINE, Cochrane, and Clinical Trials databases from 2000 to April of 2016 was carried out by a panel of experts from the Spanish Allergy and Clinical Immunology Scientific Society. Relevant studies prior to the year 2000 included in ulterior systematic reviews were also considered. More than 4000 articles were identified during the search and 241 were selected to retrieve available evidence on AIT, which was graded according to the Oxford classification. All the group members reviewed the resulting text until the final version reached the consensual agreement. A summary of recommendations on the more relevant topics are proposed. The role of AIT as a valuable therapeutic strategy for prevention of exacerbation and progressive decline in lung function is highlighted. Future research should include specific tools for asthma evaluation when assessing AIT effectiveness in asthmatic patients. ResumenEl asma se asocia frecuentemente con alergia, entendida ésta como la producción de IgE específica frente a alérgenos ambientales. Actualmente, existen dos tipos de inmunoterapia específica con alérgenos (ITE) para la práctica clínica habitual: subcutánea y sublingual, ambas indicadas en el tratamiento de la rinitis y la conjuntivitis alérgicas. Sin embargo, su papel en el asma resulta todavía controvertido. Dominguez-Ortega J, et al.

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“…The preventive benefits of AIT may be greater if initiated early in the course of the allergic disease [21,22]. AIT administered subcutaneously (subcutaneous immunotherapy [SCIT]) has demonstrated efficacy at reducing the symptoms of AR caused by plant pollens, and the use of symptomatic pharmacotherapy in patients with AR and ARC [23,24]. However, the necessity for multiple injections over a period of years, and the possibility of serious systemic side effects or life-threatening anaphylaxis, especially in patients with comorbid asthma [25], has prompted the development of alternative routes of administration.…”

mentioning

confidence: 99%

Five-grass-pollen sublingual immunotherapy tablet for the treatment of grass-pollen-induced allergic rhinoconjunctivitis: 5 years of experience

Didier

Wahn

Horak

et al. 2014

Expert Review of Clinical Immunology

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OralairÒ (OA) (Stallergenes, Antony, France) is a unique pre-and co-seasonal 5-grass-pollen sublingual immunotherapy tablet launched in 2008, and now approved in 31 countries worldwide for the treatment of grass-pollen allergic rhinitis and rhinoconjunctivitis. OA is the first oral treatment with a consistent, well-balanced allergen extract that mimics natural exposure and sensitization. A wealth of data exists from over 5 years of clinical and realworld experience demonstrating the efficacy and safety of OA for grass-pollen-allergy treatment. OA is highly effective from the first pollen season in all patient subgroups, including children and those with comorbid mild asthma, irrespective of sensitization status and symptom severity. OA also has sustained long-term benefits for symptom control and quality of life. This article provides an overview of the pharmacodynamics and pharmacology of OA; its efficacy, safety, tolerability and cost-effectiveness for the treatment of allergic rhinitis and rhinoconjunctivitis and its role in clinical practice. Allergic rhinitis (AR) is a common chronic inflammatory illness, characterized by rhinorrhea, nasal congestion, sneezing, nasal and ocular pruritis and watery eyes [1]. Inhalation of allergens by sensitized individuals triggers the IgE-mediated release of inflammatory mediators and cytokines, leading to a rapid appearance of symptoms [2]. AR has historically been classified as 'seasonal' or 'perennial' depending on whether symptoms occur with seasonal exposure to aeroallergens or are present throughout the year. Seasonal AR is most commonly attributed to plant pollen and other outdoor allergens, while perennial AR is associated with indoor allergens, such as dust mites, mold, cockroaches and pet dander, although it can also be associated with pollen in areas where this is prevalent year-round [3,4].In 2001, the WHO-sponsored Allergic Rhinitis and its Impact on Asthma meeting produced guidelines proposing an alternative classification of the condition into 'intermittent' or 'persistent' AR, and grading symptoms as 'mild' or 'moderate/severe' [5]. Globally, the prevalence of seasonal ('hay fever') and perennial AR ranges from 7 to 42 and 1 to 13%, respectively, with the former being more common in children than adults [6]. The length of exposure to seasonal allergens is dependent on geographic location and climatic conditions [4]; in Europe, the main pollen season typically occurs from March to July, with slight variations according to latitude [7].Approximately 500 million people worldwide [6], including an estimated 30-60 million in the USA [4] 1309Drug Profile suffer from AR, and its prevalence is increasing in most countries [2]. It is estimated that from 10 to 30% of adults and up to 40% of the pediatric population have AR [3,9]. While AR does not directly lead to mortality, it places a considerable burden on affected individuals, who often have a reduced quality of life (QoL), compared with non-sufferers [10]. The physical symptoms of AR can cause sleep disturbance...

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Effectiveness of subcutaneous immunotherapy for allergic rhinoconjunctivitis and asthma: A Systematic Review

Abstract: Generally moderate to strong evidence supports the effectiveness of SCIT for treatment of allergic rhinitis and asthma, particularly with single-allergen immunotherapy regimens. Adverse reactions to SCIT are common, but no deaths were reported in the included studies.

Cited by 102 publications

References 72 publications

The Functional IgE-Blocking Factor Induced by Allergen-Specific Immunotherapy Correlates with IgG4 Antibodies and a Decrease of Symptoms in House Dust Mite-Allergic Children

The Functional IgE-Blocking Factor Induced by Allergen-Specific Immunotherapy Correlates with IgG4 Antibodies and a Decrease of Symptoms in House Dust Mite-Allergic Children

Specific allergen immunotherapy for the treatment of allergic asthma: a review of current evidence

Five-grass-pollen sublingual immunotherapy tablet for the treatment of grass-pollen-induced allergic rhinoconjunctivitis: 5 years of experience

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