Efficacy of subcutaneous and sublingual immunotherapy with grass allergens for seasonal allergic rhinitis: A meta-analysis–based comparison

Bona, Danilo Di; Plaia, Antonella; Leto-Barone, Maria Stefania; Piana, Simona La; Lorenzo, Gabriele Di

doi:10.1016/j.jaci.2012.08.012

Cited by 143 publications

(144 citation statements)

References 53 publications

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“…Although mild and self‐limited, these aspects make compliance more difficult to achieve, especially in children 3. Different meta‐analysis seems to indicate that SLIT has lower clinical efficacy than SCIT, but these data are only based on indirect evidence and not on head‐to‐head comparisons 4, 5…”

Section: Introductionmentioning

confidence: 99%

Oral myeloid cells uptake allergoids coupled to mannan driving Th1/Treg responses upon sublingual delivery in mice

Soria

López-Relaño

Viñuela

et al. 2018

Allergy

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BackgroundPolymerized allergoids coupled to nonoxidized mannan (PM‐allergoids) may represent novel vaccines targeting dendritic cells (DCs). PM‐allergoids are better captured by DCs than native allergens and favor Th1/Treg cell responses upon subcutaneous injection. Herein we have studied in mice the in vivo immunogenicity of PM‐allergoids administered sublingually in comparison with native allergens.MethodsThree immunization protocols (4‐8 weeks long) were used in Balb/c mice. Serum antibody levels were tested by ELISA. Cell responses (proliferation, cytokines, and Tregs) were assayed by flow cytometry in spleen and lymph nodes (LNs). Allergen uptake was measured by flow cytometry in myeloid sublingual cells.ResultsA quick antibody response and higher IgG2a/IgE ratio were observed with PM‐allergoids. Moreover, stronger specific proliferative responses were seen in both submandibular LNs and spleen cells assayed in vitro. This was accompanied by a higher IFNγ/IL‐4 ratio with a quick IL‐10 production by submandibular LN cells. An increase in CD4+ CD25high FOXP3+ Treg cells was detected in LNs and spleen of mice treated with PM‐allergoids. These allergoids were better captured than native allergens by antigen‐presenting (CD45+ MHC‐II +) cells obtained from the sublingual mucosa, including DCs (CD11b+) and macrophages (CD64+). Importantly, all the differential effects induced by PM‐allergoids were abolished when using oxidized instead of nonoxidized PM‐allergoids.ConclusionOur results demonstrate for the first time that PM‐allergoids administered through the sublingual route promote the generation of Th1 and FOXP3+ Treg cells in a greater extent than native allergens by mechanisms that might well involve their better uptake by oral antigen‐presenting cells.

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Section: Introductionmentioning

confidence: 99%

Oral myeloid cells uptake allergoids coupled to mannan driving Th1/Treg responses upon sublingual delivery in mice

Soria

López-Relaño

Viñuela

et al. 2018

Allergy

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“…Furthermore, the benefit of AIT was mainly reported in studies with shorter follow-up, while studies with longer follow-up, which is critical for this specific outcome, did not show any difference. No study reported on the possible correlation between the onset of new sensitizations and the primary clinical benefit of AIT (very small for SLIT), (3,50,51) that is, the reduction in symptom or medication scores, rendering any inference impossible as to the primary efficacy and long-term benefit of AIT.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of allergen immunotherapy in reducing the likelihood of developing new allergen sensitizations: a systematic review

Bona

Plaia

Leto-Barone

et al. 2017

Allergy

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Background: Guidelines and position papers indicate that allergen immunotherapy (AIT) is the only disease-modifying treatment, including prevention of the onset of new allergen sensitizations. However, this preventive effect was shown by only a few observational studies. Our aim was to systematically review the efficacy of AIT in preventing the onset of new allergen sensitizations. Methods: Computerized bibliographic searches of Medline, EMBASE, and the Cochrane Library (through June 2015) were supplemented with manual searches of reference lists. Observational studies or randomized controlled trials with a longterm observation period were included. Paired reviewers extracted data about study characteristics and assessed biases. The end point was the risk difference in the onset of new allergen sensitizations between patients treated with AIT and pharmacotherapy. The strength of the evidence was graded based on the risk of bias, consistency, and magnitude of effect, according to the GRADE Working Group's guide. Results: Eighteen studies (1049 children, 10 057 adults) met the inclusion criteria. The risk of bias was high in all but one study. Low evidence supports the position that AIT prevents the onset of new allergen sensitizations, with 10 of 18 studies reporting a reduction in the onset of new sensitizations in patients treated with AIT vs placebo. Small studies and studies with a shorter follow-up showed the highest benefit of AIT. Conclusions: The overall evidence provides a low-grade level of the evidence supporting the efficacy of AIT in preventing the onset of new allergen sensitizations, but high-quality studies could change this estimate.

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“…Therefore, to clarify this issue, we performed and published a meta-analysis to compare SCIT and SLIT with a fairly large number of double-blind, placebo-controlled trials on SCIT and SLIT (updating the previous published meta-analysis) [101] in patients with seasonal allergic rhinitis to grass pollens [105]. This meta-analysis of data from 36 RCTs, 10 with SLIT drops [ These studies included a total of 3014 patients treated with immunotherapy and 2768 controls who received placebo.…”

Section: Sublingual Immunotherapymentioning

confidence: 99%

“…However, trials directly comparing the two different routes of immunotherapy are needed to confirm these data [105]. An ideal comparative study would be a randomized, placebo-controlled, double-blind, double-dummy study that enrolls a large number of patients from a single center or a single country or a few countries with similar pollen exposure and patients of similar ethnicity.…”

Section: Sublingual Immunotherapymentioning

confidence: 99%

Unmet Needs in Understanding Sublingual Immunotherapy to Grass Pollen

Lorenzo¹,

Leto-Barone²,

Piana³

et al. 2017

Immunotherapy - Myths, Reality, Ideas, Future

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The lack of medication for allergy symptoms at the end of the last millennium has been the promoter of the idea of treating allergies as if you were treating an infectious disease, by vaccination prophylaxis. Two forms of AIT 1) subcutaneous immunotherapy (SCIT) and 2) sublingual immunotherapy (SLIT) are used in the world. Considerable interest has emerged in SLIT both scientifically and especially financially. SLIT is not a new treatment modality. First description dates back to 1900 when H. Curtis. It was relatively widely used until the late 1970's mainly in US by homeopathic therapists.A number of case series describing experience with the oral route were published during the 1920s and 1930s, but it seems to have been perceived not as efficacious nor as well tolerated as subcutaneous immunotherapy. The companies producing allergen immunotherapy have an alliance with important opinion leaders on both shores of the Atlantic.If SLIT did not work for 40 years, why should it work for respiratory allergic diseases today? This question is the mother of all questions in the field of respiratory allergic diseases. The purpose of this chapter is to provide past and current information about immunotherapy, and discuss controversies over efficacy and safety, and dosing considerations for SLIT to grass.

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Efficacy of subcutaneous and sublingual immunotherapy with grass allergens for seasonal allergic rhinitis: A meta-analysis–based comparison

Cited by 143 publications

References 53 publications

Oral myeloid cells uptake allergoids coupled to mannan driving Th1/Treg responses upon sublingual delivery in mice

Oral myeloid cells uptake allergoids coupled to mannan driving Th1/Treg responses upon sublingual delivery in mice

Efficacy of allergen immunotherapy in reducing the likelihood of developing new allergen sensitizations: a systematic review

Unmet Needs in Understanding Sublingual Immunotherapy to Grass Pollen

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