Abstract
BackgroundPollen and house dust mite (HDM) subcutaneous immunotherapy (SLIT) and pollen subcutaneous immunotherapy (SCIT) are effective therapies for children with allergic rhinoconjunctivitis (AR). There are no previous direct comparative studies investigating quality of life (QoL) of all three immunotherapy regimes. The aim of this study was to compare QoL and safety in children receiving these immunotherapies for AR.MethodsDemographic characteristics, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and Visual Analogue (VAS) scores were assessed in 249 children undergoing HDM and pollen immunotherapy at a UK specialist paediatric centre between 2007 and 2019.ResultsAll three immunotherapy regimes led to a > 50% improvement in QoL and VAS after 3 years of therapy, with significant improvements by the end of the first year (p < 0.05) and further improvements between 1 and 3 years (p < 0.05). Age, gender, ethnicity and route of administration had no significant bearing on efficacy. Older, polysensitised children and those receiving HDM SLIT were all more likely to discontinue their treatment (all with p < 0.05). The only patient to suffer from anaphylaxis requiring intramuscular adrenaline, and 80% experiencing exacerbations of their asthma had received pollen SCIT.ConclusionsPollen SCIT and pollen and HDM SLIT all lead to significant improvements in QoL. The risk of anaphylaxis is low, but SCIT is associates with a 1 in 5 chance of asthma flares in the days after its administration. Discontinuation of therapy is more frequent in older, polysensitised children, and those undergoing HDM immunotherapy.
Highlights
Allergic rhinitis (AR) is common in both adults and children, with reported prevalence in the UK of up to 40% in population surveys and 11% in general practice [1]
Children were considered for Allergy immunotherapy (AIT) if they were sensitised to one or more of these allergens and their allergic rhinoconjunctivitis (AR) remained poorly controlled despite standard therapy during the previous pollen season, or the previous 3 months in patients with house dust mite (HDM) allergy
Male Female Ethnicity White European Other AR symptoms Eyes only Nose only Eyes + nose Allergen sensitisationa Grass pollen Tree pollen Grass & tree HDM HDM & grass HDM & tree HDM, grass & tree Mono-sensitised to AIT Yes No Medication Oral antihistamines OA + adjunct Systemics Other atopic disease Asthma Eczema Asthma + Eczema Baseline Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) Median (IQR) Baseline Visual analogue score (VAS) Median (IQR)
Summary
Allergic rhinitis (AR) is common in both adults and children, with reported prevalence in the UK of up to 40% in population surveys and 11% in general practice [1]. With its origins dating back to 1911, subcutaneous immunotherapy (SCIT) involves the injection of allergen extract by trained clinicians. Sublingual immunotherapy (SLIT) was developed and first accepted by the World Health Organisation as a treatment modality for pollen allergy in 1998. More recently house dust mite (HDM) SLIT has become available, allowing a second common aeroallergen to be treated without the need for injections [8, 9]. Pollen and house dust mite (HDM) subcutaneous immunotherapy (SLIT) and pollen subcutaneous immunotherapy (SCIT) are effective therapies for children with allergic rhinoconjunctivitis (AR). There are no previous direct comparative studies investigating quality of life (QoL) of all three immunotherapy regimes.
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