Effect of high-dose sublingual immunotherapy on respiratory infections in children allergic to house dust mite

Abstract

BackgroundAllergic rhinitis is characterized by eosinophil inflammation. Allergic inflammation may induce susceptibility to respiratory infections (RI). House dust mite (HDM) sensitization is very frequent in childhood. Allergen immunotherapy may cure allergy as it restores a physiologic immune and clinical tolerance to allergen and exerts anti-inflammatory activity.ObjectiveThis study investigated whether six-month high-dose, such as 300 IR (index of reactivity), HDM-sublingual immunotherapy (SLIT) could affect RI in allergic children.MethodsGlobally, 40 HDM allergic children (18 males; mean age, 9.3 years) were subdivided in 2 groups: 20 treated by symptomatic drugs (group 1) and 20 by high-dose HDM-SLIT (group 2), since September 2012 to April 2013. The daily maintenance dose of HDM-SLIT was 4 pressures corresponding to 24, 4.8, and 60 µg, respectively of the major allergens Dermatophagoides pteronyssinus (Der p) 1, Der p 2, and Dermatophagoides farinae (Der f) 1. RI was diagnosed when at least 2 symptoms or signs, and fever were present for at least 48 hours. A family pediatrician provided diagnosis on a clinical ground.ResultsSLIT-treated children had significantly (p = 0.01) less RI episodes (3.5) than control group (5.45). About secondary outcomes, SLIT-treated children had less episodes of pharyngo-tonsillitis (p < 0.05) and bronchitis (p < 0.005), and snoring (p < 0.05) than control group. In addition, SLIT-treated children had less fever (p < 0.01) and took fewer medications, such as antibiotics (p < 0.05) and fever-reducers (p < 0.01), than control group.ConclusionThis preliminary study might suggest that also a short course (6 months) of high-dose SLIT, titrated in µg of major allergens, could reduce RI in allergic children.

Clinical Evidence and Biomarkers Linking Allergy and Acute or Chronic Rhinosinusitis in Children: a Systematic Review

“…Outcome: Symptoms; inflammatory cells and ICAM-1 measured by nasal scraping Terfenadine treatment reduces ICAM-1 expression on nasal epithelial cells; children treated with terfenadine had significantly fewer extra visits and school absences than the placebo group Yes (Level I) Fasce 1996 [ 14 ] Double-blind, placebo controlled randomized study N = 20 children (5–14 years old) with mite allergy Cetirizine vs placebo for 15 days. Nasal scrapings were performed to evaluate inflammatory cell infiltration and ICAM-I expression on epithelial cells Cetirizine-treated children showed a significant reduction (or even total absence) of ICAM-I expression on epithelial cells ( p = 0.002) and a reduction trend in inflammatory cell counts compared with placebo Yes (Level I) Barebri 2015 [ 25 ] Prospective case control observational study, not randomized N = 40 HDM allergic children (9.3 years) Patients were subdivided in 2 groups: 20 treated by symptomatic drugs and 20 by high-dose HDM-SLIT SLIT-treated children had significantly ( p = 0.01) less RI episodes (3.5) than control group (5.45) Yes (Level II) Barberi 2018 [ 24 ] Retrospective analysis N = 33 HDM allergic children (9.3 years) Investigate whether 3 year high-dose HDM-SLIT affects respiratory infections in children with allergic rhinitis SLIT-treated children had significantly fewer RI episodes than symptomatically treated children. In addition, they had less fever and took fewer medications, such as antibiotics and antipyretics Yes (Level IV) HDM , house dust mites; SLIT , sub-lingual immunotherapy; URTI , upper respiratory tract infections; RI , respiratory infections; ICAM , intercellular adhesion molecule …”

“…Authors [ 14 , 23 ] demonstrated that children treated with cetirizine had a significant reduction in ICAM-I expression on epithelial cells, thus preventing possible relapse of rhinovirus infections and diminishing both the number and severity of recurrent respiratory infections in children. Barberi et al [ 24 ••, 25 ] demonstrated that children treated with sublingual immunotherapy (SLIT) had significantly fewer respiratory infections (RI) than symptomatically treated children. In addition, SLIT-treated children had less fever episodes per year and took fewer medications vs. symptomatically treated children.…”

Coronavirus disease 2019 and allergen immunotherapy

“…10 However, in general, real-life evidence indicates that allergy augments and AIT reduces the frequency of respiratory tract infections. 11 The first cause of frequent respiratory infections in childhood is respiratory allergy. Thus, improving the control of allergic diseases should be beneficial during a pandemic.…”

The Clinical Efficacy of Sublingual Allergen-Specific Immunotherapy in Children Aged 3-5 Years

“…The efficacy of ASIT in the treatment of allergic diseases of adults and children has been proven and it is represented by the results of numerous randomized double-blind placebo-controlled studies which have resulted in the issuance of the corresponding European and international non-binding Perhaps Immunotherapy that is recommended to the patients having allergic bronchial asthma, food allergy and manifestations of insect allergy [8][9][10]. The treatment of children with the use of immunotherapy methods is discussed in these articles [11,12]. In addition to the method of sublingual allergen immunotherapy [11,[13][14][15].…”