Allergen immunotherapy: an updated review of safety

Abstract

Purpose of review Allergen immunotherapy is the only modality that can modify the immune response upon exposure to aeroallergens and venom allergens. This review will update the allergist on recent studies evaluating safety of sublingual and subcutaneous allergen immunotherapy. Recent findings Multiple clinical trials and retrospective studies have been published evaluating overall safety of these therapies. The risk of systemic reactions with subcutaneous immunotherapy remains quite low, but near-fatal and fatal anaphylaxis does occur, requiring physicians to be aware of potential risks for such events. Sublingual immunotherapy has a high incidence of local site application reactions, but severe anaphylactic events are very uncommon. Summary Subcutaneous immunotherapy and sublingual immunotherapy are beneficial in treating allergic rhinitis and venom hypersensitivity but should be administered only by physicians familiar with potential risk factors and able to manage treatment-related local and systemic allergic reactions.

Allergen Immunotherapy in Pediatric Asthma: A Pragmatic Point of View

“…Many aspects should be considered in clinical practice—an EAACI position paper listed the contraindications to AIT [ 5 ]. Moreover, a series of recommendations should carefully comply in clinical practice, as reported in many official documents [ 77 , 78 , 79 ]. If AIT is prescribed and administered correctly and prudently, AIT, mainly SLIT, is safe and well-tolerated also in children with allergic asthma.…”

Two decades with omalizumab: what we still have to learn

“…After identification of the major risk factors (and particularly the high risk associated with uncontrolled asthma when the allergen extract is injected), the prevalence of severe reactions is very low. 61 However, in patients who develop such reactions, switching to other routes of administration (especially the safer sublingual route) or withdrawal of AIT could prevent further reactions. 62 This strategy denies the patient treatment that could modify the natural history of allergy.…”

Differential DNA methylation in allergen-specific immunotherapy of asthma

“…Cochrane systematic reviews and meta-analyses have demonstrated that the frequencies of rescue medication use and clinical symptoms are reduced in patients with allergic asthma and allergic rhinitis after SLIT and SCIT. 6 SLIT had a lower incidence of systemic reactions but a higher incidence of local site reactions than SCIT and is therefore strongly recommended in the treatment of allergic rhinitis. 6 The CD4 + CD25 + Foxp3 + Treg cells induced by tolerogenic dendritic cells (DCs) in the oral mucosa mediate immune tolerance, thus improving the clinical efficacy after SLIT.…”

“… 6 SLIT had a lower incidence of systemic reactions but a higher incidence of local site reactions than SCIT and is therefore strongly recommended in the treatment of allergic rhinitis. 6 The CD4 + CD25 + Foxp3 + Treg cells induced by tolerogenic dendritic cells (DCs) in the oral mucosa mediate immune tolerance, thus improving the clinical efficacy after SLIT. 7 SLIT has no risk of severe systemic reactions, which is considered an advantage over SCIT, because allergens are mostly captured by tolerogenic DCs before they reach the mast cells during SLIT.…”

“… 7 SLIT has no risk of severe systemic reactions, which is considered an advantage over SCIT, because allergens are mostly captured by tolerogenic DCs before they reach the mast cells during SLIT. 6 It has been suggested that SCIT contributes to the phenotypic deviation of Th2 cell responses to a protective Th1 profile, which enables SCIT to manifest earlier IFN-γ secretion than SLIT. 7 A recent study indicated that Dermatophagoides pteronyssinus (Der p)-specific IgG4 levels in asthma treated with SCIT were almost 30 times higher than those in asthma treated with SLIT.…”