Effectiveness of high dose sublingual immunotherapy to induce a stepdown of seasonal asthma: a pilot study

Voltolini, Susanna; Troise, C; Incorvaia, Cristoforo; Bignardi, Donatella; Cara, Giuseppe Di; Marcucci, Francesco; Grutta, Stefania La; Frati, Franco

doi:10.1185/03007990903431886

Cited by 22 publications

(30 citation statements)

References 10 publications

(15 reference statements)

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“…Skin prick tests were performed in all patients to demonstrate specific sensitivity. Allergy symptoms were described as moderate to severe in 6 out of 11 trials, [189][190][191][195][196][197] with no indication of severity given in 5 out of 11 trials. 25,158,[192][193][194] Seven studies 25,189,190,192,193,195,197 stated that some patients also had asthma symptoms.…”

Section: Main Study Characteristics and Risk Of Bias (Sublingual Immumentioning

confidence: 99%

“…Allergy symptoms were described as moderate to severe in 6 out of 11 trials, [189][190][191][195][196][197] with no indication of severity given in 5 out of 11 trials. 25,158,[192][193][194] Seven studies 25,189,190,192,193,195,197 stated that some patients also had asthma symptoms. Two trials specified that patients were treatment naive, 190,191 four reported no details, 25,158,189,197 and in five trials [192][193][194][195][196] it was stated that patients had not received SIT within the last 3-5 years, although it was unclear if any patients had ever been treated with SIT.…”

Section: Main Study Characteristics and Risk Of Bias (Sublingual Immumentioning

confidence: 99%

“…The main study and population characteristics, and assessment of risk of bias, are detailed for each of the 11 new studies 25,158,[189][190][191][192][193][194][195][196][197][198][199] in Appendix 6. All studies were double-blind placebo-controlled RCTs.…”

Section: Main Study Characteristics and Risk Of Bias (Sublingual Immumentioning

confidence: 99%

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A systematic review and economic evaluation of subcutaneous and sublingual allergen immunotherapy in adults and children with seasonal allergic rhinitis

Meadows

Kaambwa²,

Novielli³

et al. 2013

Health Technol Assess

132

140

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Section: Main Study Characteristics and Risk Of Bias (Sublingual Immumentioning

confidence: 99%

Section: Main Study Characteristics and Risk Of Bias (Sublingual Immumentioning

confidence: 99%

See 1 more Smart Citation

A systematic review and economic evaluation of subcutaneous and sublingual allergen immunotherapy in adults and children with seasonal allergic rhinitis

Meadows

Kaambwa²,

Novielli³

et al. 2013

Health Technol Assess

132

140

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“…In asthmatic patients, who were more commonly polysensitized, the mean clinical score significantly decreased after two consecutive pollen seasons [122]. Three different randomized studies including birch pollen allergic patients with asthma demonstrated that SLIT was able to step down (GINA criteria) seasonal pollen-induced asthma severity [123], its addition to background treatment provided a greater clinical benefit than montelukast [124], and together with low-dose ICS was effective in maintaining long-term seasonal asthma control [125]. High-dose pollen SLIT was associated with a significant improvement in patients with severe allergic rhinitis, and the effect was also identified in the subgroup of patients suffering from concomitant asthma in terms of reduction of global asthma symptoms and asthma medication score [126].…”

Section: Sublingual Immunotherapymentioning

confidence: 99%

Specific allergen immunotherapy for the treatment of allergic asthma: a review of current evidence

Domínguez‐Ortega

Delgado

Blanco

et al. 2017

J Investig Allergol Clin Immunol

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Asthma is frequently associated with atopy, characterized by the production of specific immunoglobulin E in response to environmental allergens. Currently, two types of allergen immunotherapy (AIT) are used in clinical practice: subcutaneous and sublingual immunotherapy, both accepted as key components of the therapeutic repertoire for allergic rhinitis and conjunctivitis. However, their role in asthma remains controversial. The present document is aimed at providing the clinicians with a review of the evidence on the use of AIT in asthma, focusing on the most relevant aspects of its mechanism of action, its efficacy, and existing data on safety, tolerability, and cost-effectivity, both in pediatric and adult populations. A systematic search of MEDLINE, Cochrane, and Clinical Trials databases from 2000 to April of 2016 was carried out by a panel of experts from the Spanish Allergy and Clinical Immunology Scientific Society. Relevant studies prior to the year 2000 included in ulterior systematic reviews were also considered. More than 4000 articles were identified during the search and 241 were selected to retrieve available evidence on AIT, which was graded according to the Oxford classification. All the group members reviewed the resulting text until the final version reached the consensual agreement. A summary of recommendations on the more relevant topics are proposed. The role of AIT as a valuable therapeutic strategy for prevention of exacerbation and progressive decline in lung function is highlighted. Future research should include specific tools for asthma evaluation when assessing AIT effectiveness in asthmatic patients. ResumenEl asma se asocia frecuentemente con alergia, entendida ésta como la producción de IgE específica frente a alérgenos ambientales. Actualmente, existen dos tipos de inmunoterapia específica con alérgenos (ITE) para la práctica clínica habitual: subcutánea y sublingual, ambas indicadas en el tratamiento de la rinitis y la conjuntivitis alérgicas. Sin embargo, su papel en el asma resulta todavía controvertido. Dominguez-Ortega J, et al.

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“…Another important indicator is provided by data showing that AIT is able to influence the parameters commonly used in the assessment of asthma severity. This is true for the steroid-sparing effect, reported with both SCIT 15 and SLIT 16 , and for the ability of SLIT to induce a stepdown of asthma 17 . As argued by Custovic et al, high-level exposure to sensitizing allergens is an important factor in increasing the risk of exacerbation of asthma, especially when combined with respiratory virus infections, which are related to the risk of severe exacerbations resulting in hospital admission, both in adults and children 18 .…”

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confidence: 90%

In the strategies to prevent asthma exacerbations, allergic asthma needs specific treatment

Incorvaia¹,

Ridolo

2015

Current Medical Research and Opinion

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No generally accepted definition of asthma exacerbation is thus far available, though in 2012 an expert committee endorsed by the National Institute of Health proposed such definition as ''a worsening of asthma requiring the use of systemic corticosteroids to prevent a serious outcome''. Graham and Eid reviewed the impact of asthma exacerbations, and noted that, analysing the outcomes with existing treatments, many patients with asthma remain symptomatic and experience exacerbations. This requires the introduction of new strategies to more effectively reduce the exacerbation risk, based on correct diagnosis, stopping smoking, correct inhaler technique, consistent adherence, weight management, and gaining control with the addition of medication''. Indeed, as allergic asthma is the most common form, a specific approach by allergen immunotherapy should receive more attention. Actually, the efficacy of immunotherapy in allergic asthma, by the subcutaneous or the sublingual route, is supported by robust meta-analyses. The most important allergen source causing asthma is the house dust mite, but an increasing role for molds is apparent due to the ongoing climate change.Thus far, there is no generally accepted definition of asthma exacerbation. In 2012, an expert committee endorsed by the National Institute of Health (NIH) reviewed all the available literature and found no dominant definition of exacerbation. The most widely used definitions included three components, all related to treatment rather than symptoms, based on systemic use of corticosteroids, asthma-specific emergency department visits or hospitalization, and use of short-acting b-agonists (SABAs) as quick-relief medications, respectively. The working group participants proposed that the definition of 'asthma exacerbation' be ''a worsening of asthma requiring the use of systemic corticosteroids to prevent a serious outcome''. As core outcomes, they proposed inclusion and separate reporting of several essential variables of an exacerbation and the development of a standardized, component-based definition of 'exacerbation' with clear thresholds of severity for each component 1 . In addition, it was suggested that the term 'exacerbation' should be distinguished from the terms 'not well controlled asthma' or 'uncontrolled asthma', which are measures of chronic disease activity. Indeed, according to the Global Initiative on Asthma (GINA) ''Poor asthma control itself substantially increases the risk of exacerbations. However, several additional independent risk factors have been identified, i.e. factors that, when present, increase the patient's risk of exacerbation even if symptoms are few'' 2 . The article by Graham and Eid in the present issue reviews the impact of asthma exacerbations, and the current and future treatment strategies to establish asthma control and reduce the risk of future exacerbations 3 . The authors analyse the outcomes with existing treatments, concluding that many patients ! 2015

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Effectiveness of high dose sublingual immunotherapy to induce a stepdown of seasonal asthma: a pilot study

Abstract: Background:There is ample evidence to support the efficacy of sublingual immunotherapy (SLIT) on allergic rhinitis, while there is less solid data regarding asthma. We evaluated the effects of a high dose birch SLIT on birchinduced rhinitis and asthma in a controlled study.

Cited by 22 publications

References 10 publications

A systematic review and economic evaluation of subcutaneous and sublingual allergen immunotherapy in adults and children with seasonal allergic rhinitis

A systematic review and economic evaluation of subcutaneous and sublingual allergen immunotherapy in adults and children with seasonal allergic rhinitis

Specific allergen immunotherapy for the treatment of allergic asthma: a review of current evidence

In the strategies to prevent asthma exacerbations, allergic asthma needs specific treatment

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