Allergen specific sublingual immunotherapy in children with asthma and allergic rhinitis
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Allergen specific sublingual immunotherapy in children with asthma and allergic rhinitis Ivana Đurić-Filipović, Marco Caminati, Gordana Kostić, Đorđe Filipović, Zorica Živković Belgrade, Serbia reduces the symptoms of allergic diseases and the use of medicaments, and improves the quality of life of children with the diseases.
Data sources: PubMed articles published from 1990 to 2014 were reviewed using the MeSH terms "asthma", "allergic rhinitis", "children", and "immune therapy". Additional articles were identified by hand searching of the references in the initial search.
llergen-specific immunotherapy (AIT) or allergen vaccination is to treat allergic subjects by using increased amounts of allergen(s) (allergenic extract or vaccine) to achieve desensitization that is to reduce the appearance of symptoms during the natural exposure to the allergen.[1] The results of immunotherapy were reported in the beginning of the 19th century,[2] but the interest in the mucosal route was re-examined by a group of German investigators in the 1970s. It is important to point out that many trials with SLIT in the past were small in sample size and/or had an open label design. According to the literature, sublingual application of allergen specific immunotherapy (SLIT) induces three categories of immunological changes: modulation of allergen-specific antibody responses; reduction in recruitment and activation of pro-inflammatory cells; and changes in the pattern of allergen specific T-cell responses.[3] During pollen SLIT, allergen-specific IgE increases in weeks although it is not associated with adverse events. The early increase of allergen-specific IgE is followed by blunting of seasonal rises in IgE and an increase in allergen-specific IgE/IgG4. These elevations are both time and allergen-dose dependent [4] and progressive for at least 2 years[5] although the magnitude is lower than that observed during SCIT. [6,7] Studies showed increases in specific IgG4 in the absence of demonstrable efficacy, [8] whereas others showed no difference in IgG levels, likely related to the lower allergen doses employed[9] particularly in relation to mite SLIT.[10,11] Functional assays showed that a serum obtained after grass pollen SLIT was able to inhibit IgE-binding in vitro.[5]
Results: Numerous studies have shown that sublingual application of allergen specific immunotherapy (SLIT) is an adequate, safe and efficient substitution to subcutaneous route of allergens administration (SCIT) in the treatment of IgE-mediated respiratory tract allergies in children. According to the literature, better clinical efficacy is connected with the duration of treatment and mono sensitized patients. Conclusions: At least 3 years of treatment and stable asthma before the immunotherapy are positive predictors of good clinical efficacy and tolerability of SLIT. SLIT
Author Affiliations: Faculty of Medical Science Kragujevac, Department of Immunology, Svetozara Markovica 69, 34000 Kragujevac, Serbia (Đurić-Filipović I); Unita di Allergologia Centro Regiona
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