Sublingual immunotherapy in children with allergic polysensitization

Abstract

Polysensitization is quite frequent in allergic children and may cause difficulties for the allergist in prescribing allergen-specific immunotherapy. This study aimed at evaluating the clinical effectiveness of 1 year of sublingual immunotherapy (SLIT) in a cohort of Italian allergic children with polysensitization. This open study was performed on 51 polysensitized children (34 boys; mean age, 11.8 years; range, 5.2-17.7 years) with allergic rhinitis and/or mild to moderate asthma. All of them were treated with SLIT for 1 year. The kind and the number of prescribed allergen extracts, the type of diagnosis, the severity of symptoms, and the use of drugs were evaluated at baseline and after 1 year. The adverse events to SLIT were also evaluated. Forty-two children were treated with a single extract, four with two different extracts and three with a mix of allergens. SLIT treatment induced a significant reduction in the number of sensitizations (p = 0.018); significant improvement of allergic rhinitis classification and severity; significant reduction of ocular, nasal, and bronchial symptoms (p < 0.01 for all); and drugs use (p < 0.01 for all drugs). No systemic reactions to SLIT were observed. This open study provides evidence that polysensitization is not an obstacle for prescribing SLIT in polysensitized children. Indeed, SLIT efficacy on clinical parameters is significant after 1 year and the therapy is safe.

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

“…Specially in childhood, SLIT offers practical advantages over subcutaneous therapy because injections can be avoided, the treatment is generally well tolerated [147], and the risk of severe allergic reactions seems to be negligible [148][149][150][151], even when multiple allergens [152,153] or ultra-rush and/or high-dose regimens [154,155] are used. In addition, SLIT can be administered at home rather than at a health center, thus facilitating, theoretically at least, compliance.…”

Sublingual Immunotherapy in Patients with Allergic Rhinoconjunctivitis

“…In another study involving polysensitized individuals, Ciprandi et al [6] evaluated the clinical effectiveness of 1 year of SLIT using an open study design. Fifty-one polysensitized Italian children (34 boys; mean age, 11.8 years; range, 5.2-17.7 years) with allergic rhinitis and/or mild to moderate asthma were studied.…”

Allergen Extract Analysis and Quality Control

“…In fact, although allergen specific immunotherapy with single allergen components is not yet commercially available, yet the limits of extract-based diagnosis are certainly capable to negatively affect the management of extract-based immunotherapy. Most allergists do not prescribe immunotherapy to patients with a polysensitization pattern, without investigating whether this pattern is ascribed to a real multiple allergies rather that to cross-reactivity via panallergens, despite the fact that clinical benefits have been reported in immunotherapytreated polysensitized subjects (Ciprandi et al, 2010a;Ciprandi et al, 2010b). Thus, the present knowledge of the pathogenesis of allergic diseases has dramatically improved on the ground of increased cloning of allergen components but it is still waiting a thorough change in the clinical management of patients, due to the poor application of molecular allergology to the principles of allergen standardization.…”