Clinical practice recommendations for allergen-specific immunotherapy in children: the Italian consensus report

Abstract

Allergen-specific immunotherapy (AIT) is currently recognized as a clinically effective treatment for allergic diseases, with a unique disease-modifying effect. AIT was introduced in clinical practice one century ago, and performed in the early years with allergenic extracts of poor quality and definition. After the mechanism of allergic reaction were recognized, the practice of AIT was refined, leading to remarkable improvement in the efficacy and safety profile of the treatment. Currently AIT is accepted and routinely prescribed worldwide for respiratory allergies and hymenoptera venom allergy. Both the subcutaneous (SCIT) and sublingual (SLIT) routes of administration are used in the pediatric population.AIT is recommended in allergic rhinitis/conjunctivitis with/without allergic asthma, with an evidence of specific IgE-sensitization towards clinically relevant inhalant allergens. Long-term studies provided evidence that AIT can also prevent the onset of asthma and of new sensitizations. The favorable response to AIT is strictly linked to adherence to treatment, that lasts 3–5 years. Therefore, several factors should be carefully evaluated before starting this intervention, including the severity of symptoms, pharmacotherapy requirements and children and caregivers’ preference and compliance.In recent years, there have been increasing interest in the role of AIT for the treatment of IgE-associated food allergy and extrinsic atopic dermatitis. A growing body of evidence shows that oral immunotherapy represents a promising treatment option for IgE-associated food allergy. On the contrary, there are still controversies on the effectiveness of AIT for patients with atopic dermatitis.This consensus document was promoted by the Italian Society of Pediatric Allergy and Immunology (SIAIP) to provide evidence-based recommendations on AIT in order to implement and optimize current prescription practices of this treatment for allergic children.

Pediatric respiratory tract diseases: Chronological trends and perspectives

“…In order to reduce RTD hospitalizations, new treatments such as allergen-specific immunotherapy is promising. 33 In conclusion, this study provides useful information about pediatric RTD hospitalizations, thereby facilitating a greater understanding of this pathology, and, consequently, the implementation of these proven and evidence-based interventions. To direct future research, local health policy and guidelines could benefit from annual clinical records of health service use for respiratory diseases.…”

“…Additionally, smoking prevention and standardized management programs for RTD should be implemented in developing countries as early as possible. In order to reduce RTD hospitalizations, new treatments such as allergen‐specific immunotherapy is promising …”

Use of Sublingual Immunotherapy for Aeroallergens in Children with Asthma

“…Patients with suspected or confirmed infection with COVID-19 should discontinue the treatment [ 94 ]. Finally, in children with rhinoconjunctivitis caused by grass or birch, it has been shown that some SLIT products can be a feasible option not only for controlling symptoms, but also for preventing the onset of asthma [ 13 , 95 ]. A minimum of 3 years course is generally recommended to obtain a preventive effect [ 93 ].…”

“…Subsequently, a remarkable number of clinical studies on SLIT was published showing indirectly an efficacy not far from that of SCIT [ 8 , 9 ] even if head-to-head studies are lacking. SLIT has been quickly recognized in official documents as an alternative to SCIT in respiratory allergy at variance from other routes [ 10 , 11 , 12 , 13 , 14 ]. Furthermore, SLIT has been used for other allergy-driven diseases, such as atopic dermatitis [ 15 ].…”

Tratamiento de la rinitis alérgica en pediatría en Argentina. Documento de actualización

“…La IT es una opción terapéutica en pacientes con RA o rinoconjuntivitis con/sin asma alérgica con evidencia de sensibilización específica a IgE hacia aeroalérgenos clínicamente relevantes. 96,98,126 Está indicada en presencia de síntomas moderados a graves que interfieran con las actividades diarias habituales o el sueño a pesar de las medidas de evitación y la farmacoterapia (guías ARIA). 8,96,98 Dado que la IT es específica para los alérgenos utilizados, su eficacia depende de una identificación adecuada del o los alérgenos desencadenantes.…”