A 3-year Course of Subcutaneous Specific Immunotherapy Results in Long-term Prevention of Asthma in Children. Ten Year Follow-up on the PAT-Study

Valovirta, Erkka; Jacobsen, Lars; Niggemann, B.; Dreborg, Sten; Ferdousi, Hosne Ara; Halken, Susanne; Høst, Arne; Nordborg, L.A.; Koivikko, A.; Möller, Christian

doi:10.1016/j.jaci.2006.01.023

Cited by 9 publications

(11 citation statements)

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“…At the 10-year follow-up (7 years after discontinuing immunotherapy) the children in the immunotherapy group had significantly less asthma compared with the control group: 16 out of 48 with asthma in the immunotherapy group compared with 24/29 of the untreated control group (OR = 2.48 [1.1-5.4]) in favor of immunotherapy for prevention of asthma (FIGURE 1) [40]. The authors concluded that immunotherapy for 3 years with standardized allergen extracts of grass and/or birch results in a long-term preventive effect on the development of asthma in children with only seasonal rhinoconjunctivitis.…”

Section: Prevention Of the Development Of Asthmamentioning

confidence: 99%

“…Local reactions are fairly common, with a frequency ranging from 26 to 86% of [39,40]. (B) Retrospective study of 436 nonasthmatic adults: 332 subjects with allergic rhinitis and 104 with no allergic rhinitis or history of atopy at the beginning of the study found that treatment with SCIT was significantly and inversely related to the development of new onset asthma (OR: 0.53; 95% CI: 0.32-0.86) [41].…”

Section: Local Reactionsmentioning

confidence: 99%

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Allergen immunotherapy: immunomodulatory treatment for allergic diseases

Cox¹

2006

Expert Review of Clinical Immunology

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Allergen immunotherapy is currently the only immune-modifying treatment for allergic disease. At the present time it is indicated for the treatment of allergic rhinitis, asthma and venom hypersensitivity. Efficacy appears to be dose dependent, and the immunological mechanisms responsible for the clinical efficacy of immunotherapy are still being elucidated. Immunological changes associated with immunotherapy include induction of T regulatory cells, increase in allergen-specific immunoglobulin G4, increase in interleukin-10 production and downregulation of the T helper 2 response. The disadvantages of allergen immunotherapy include risk of adverse events and patient time and inconvenience. Risks of immunotherapy range from large local reactions to mild systemic reactions, such as rhinitis. Fatalities from immunotherapy injections have been reported at a rate of approximately one fatality per 2.5 million injections. Conventional subcutaneous immunotherapy build-up schedules involve administration of a single-dose increase each visit and it may take several months before a patient achieves the therapeutic maintenance dose. Accelerated schedules, such as rush and cluster, will allow the patient to achieve the maintenance dose sooner but there may be a greater risk of a systemic reaction. The current focus of immunotherapy research is to develop safer and more effective vaccines. Another approach to enhancing immunotherapy safety is through an alternative delivery method. Sublingual immunotherapy is clearly safer than subcutaneous immunotherapy, but further investigation is needed to determine optimal dose and appropriate patient selection.

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Section: Prevention Of the Development Of Asthmamentioning

confidence: 99%

Section: Local Reactionsmentioning

confidence: 99%

Allergen immunotherapy: immunomodulatory treatment for allergic diseases

Cox¹

2006

Expert Review of Clinical Immunology

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“…In the treated group, 19% developed asthma compared with 32% in the untreated group and 60% of the treated group had no asthma compared with 40% of the untreated group. Recently, additional data 22 were presented indicating that preventing the march to asthma continued to persist as long as 10 years after discontinuing immunotherapy (Fig. 4).…”

Section: Long-term Effectsmentioning

confidence: 97%

Allergen immunotherapy: Present and future

Finegold

2007

allergy asthma proc

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In this article the present and future of immunotherapy is discussed under four general headings: (1) present understanding of mechanisms of immunotherapy, (2) present status of clinical efficacy of immunotherapy, (3) changes/challenges of immunotherapy on the horizon, and (4) future of immunotherapy. The mechanisms of immunotherapy are well delineated and show that immunotherapy alters the natural course of allergic disease. There is a reduction in inflammation, nonspecific hyperresponsiveness, prevention of new sensitivities, and progression of allergic rhinitis to asthma. Further efficacy continues after cessation of immunotherapy. Complete asthma control does not occur with pharmacotherapy. There is a need to recognize that adding treatment for asthma's allergic component with immunotherapy may be the solution to achieving the unmet goals of asthma therapy. There are new developments and challenges to the role of immunotherapy on the horizon but, at present, subcutaneous immunotherapy is the specific allergen treatment of choice in the United States.

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“…Several studies have documented a sustained effect of SIT up to 7 years after ending treatment [11][12][13][14] . Based on this evidence a time horizon of 9 years with a cycle length of 1 year was chosen; the grass pollen season had a length of 3 months 17 .…”

Section: Model Structurementioning

confidence: 99%

“…Effects of immunotherapy in terms of symptom scores and SFDs observed after one season were assumed to remain constant and thus extrapolated up to 9 years, based on current results from grass allergen SIT [11][12][13][14] . Patients discontinuing immunotherapy generate costs and outcomes associated with the symptomatic treatment arm.…”

Section: Effect Parametersmentioning

confidence: 99%