Abstract
To date, the only disease-modifying treatment strategy for allergic rhinitis and asthma is allergen immunotherapy (AIT). There is evidence that AIT improves allergic rhinitis and asthma, such as reducing symptom severity and medication use and improving of quality of life, with a long-lasting effect after the end of the course. The recent clinical trials evidenced AIT effectiveness and safety in allergic asthma. Consequently, the current version of the GINA (Global Initiative for Asthma) guidelines recommend AIT as an add-on therapy for asthma. There is also evidence that AIT may exert preventive activity on the possible progression from allergic rhinitis to asthma in children and the onset of new sensitizations. The present review provides a pragmatic summary of the clinical indications of AIT in pediatric asthma, including the immunological mechanisms, the predictive biomarkers, and the safety issues in clinical practice.
Highlights
At present, allergen-specific immunotherapy (AIT) remains the only curative treatment of allergic disorders
sublingual immunotherapy (SLIT) is recommended as an add-on treatment option in adult asthmatics sensitized to house dust mites (HDM), with comorbid allergic rhinitis (AR), and having exacerbations despite inhaled corticosteroid (ICS) treatment, with forced expiratory volume in 1 s (FEV1 ) more than 70% predicted, as stated in the latest Global Initiative for Asthma Report (GINA) update [3]
In this context, adding anti-IgE biological therapy could be a suitable option for increasing the effectiveness and the safety of AIT, in Subcutaneous immunotherapy (SCIT) [35,36,37,38]. This significant change in the GINA asthma management strategy draws upon recently published results from a Phase III clinical trial. It evaluated the treatment of HDM allergic asthma with the standardized quality (SQ) HDM SLIT tablet in adults: the addition of HDM SLIT to maintenance therapies improved the requirement for ICS or the time to first exacerbation upon ICS reduction, suggesting that SQ HDM SLIT-tablet treatment may contribute to improving overall asthma control [39,40]
Summary
Allergen-specific immunotherapy (AIT) remains the only curative treatment of allergic disorders. AIT is still the only disease-modifying treatment strategy for allergic diseases, as it induces a long-lasting immunological and clinical tolerance toward the causal allergen [1]. For this reason, the most important worldwide regulatory authorities, such as the Food and Drug Administration (FDA) and European. Subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) are the most used and accepted routes of administration and are effective for both adults and children with respiratory allergies such as allergic rhinitis (AR) and asthma [2,3]. AIT controls allergic symptoms when not responsive to avoidance or pharmacotherapy, reduces medication use, improves the quality of life, and has long-lasting effects after the end of treatment [15]. AIT has effects preventing asthma in AR subjects, mainly if started early in childhood [16]
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