Long-term efficacy of injected allergen immunotherapy for treatment of grass pollen allergy in elderly patients with allergic rhinitis

Bożek, Andrzej; Cudak, Anna; Canonica, Giorgio Walter

doi:10.2500/aap.2020.41.200035

Cited by 23 publications

(30 citation statements)

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“…In 1999, it was reported that 3 years of continuous subcutaneous immunotherapy with grass pollen extract resulted in long-term benefits for 3 years after its discontinuation 21 . Reproduced on several occasions since 22 , 23 , this key observation confirmed the allergen specificity and long-term disease-modifying effects of allergen immunotherapy. Allergen immunotherapy has provided a unique human model to study immunological events underlying long-term antigen-specific tolerance.…”

Section: Brief History Of Allergen Immunotherapysupporting

confidence: 58%

Allergen immunotherapy: past, present and future

2022

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Allergen immunotherapy is a form of therapeutic vaccination for established IgE-mediated hypersensitivity to common allergen sources such as pollens, house dust mites and the venom of stinging insects. The classical protocol, introduced in 1911, involves repeated subcutaneous injection of increasing amounts of allergen extract, followed by maintenance injections over a period of 3 years, achieving a form of allergen-specific tolerance that provides clinical benefit for years after its discontinuation. More recently, administration through the sublingual route has emerged as an effective, safe alternative. Oral immunotherapy for peanut allergy induces effective ‘desensitization’ but not long-term tolerance. Research and clinical trials over the past few decades have elucidated the mechanisms underlying immunotherapy-induced tolerance, involving a reduction of allergen-specific T helper 2 (T H 2) cells, an induction of regulatory T and B cells, and production of IgG and IgA ‘blocking’ antibodies. To better harness these mechanisms, novel strategies are being explored to achieve safer, effective, more convenient regimens and more durable long-term tolerance; these include alternative routes for current immunotherapy approaches, novel adjuvants, use of recombinant allergens (including hypoallergenic variants) and combination of allergens with immune modifiers or monoclonal antibodies targeting the T H 2 cell pathway.

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Section: Brief History Of Allergen Immunotherapysupporting

confidence: 58%

Allergen immunotherapy: past, present and future

2022

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“…All nine assessments investigating effectiveness consistently showed long-term effectiveness for AIT in allergic rhinitis for different time periods; long-term effectiveness for AIT in asthma as well as the asthma preventive effect was proven in most studies (15)(16)(17)(18)(19)21,22,25,26). Therefore, the findings from the RWD summarized here are in line with those observed in RCTs showing long-term effectiveness of AIT in allergic rhinitis and asthma as well as asthma preventive effects (37)(38)(39)(40)(41)(42). Since national and international allergology societies (1,2,44) demand an individual product-based efficacy evaluation respective long-term RWD for more individual AIT preparations are desirable.…”

Section: Rwd Analyses On Ait Long-term Effectssupporting

confidence: 83%

“…In contrast to symptomatic medication, AIT is the only causal treatment option for IgE-mediated allergic diseases and therefore has the potential for long-term effects that last after termination of therapy (1,2). There are a few RCTs showing long-term efficacy for single SCIT and SLIT preparations in allergic rhinitis (37)(38)(39)(40)(41)(42) for up to five years after terminating three years of AIT. In children, one of these trials additionally showed a reduced risk of experiencing asthma symptoms or using asthma medication while there was no difference in time to onset of asthma during the two-year follow-up period (41).…”

Section: Rwd Analyses On Ait Long-term Effectsmentioning

confidence: 99%

Real-world evidence for the long-term effect of allergen immunotherapy: current status on database-derived studies

Vogelberg¹,

Klimek

Brüggenjürgen

et al. 2022

Preprint

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Background: Randomized controlled trials (RCTs) are the gold-standard for benefit-risk assessments during drug approval processes. Real-word data (RWD) and the resulting real-world evidence (RWE) are becoming increasingly important for assessing the effectiveness of drug products after marketing authorization showing how RCT results are transferred into real life care. The effectiveness of allergen immunotherapy (AIT) has been assessed in several RWE studies based on large prescription databases. Methods: We performed a literature search for retrospective cohort assessments of prescription databases in Europe to provide an overview on the methodology, long-term effectiveness outcomes and adherence to AIT. Results: 13 respective publications were selected. AIT was more effective in reducing the progression of allergic rhinitis (AR) compared to a non-AIT control group receiving only symptomatic treatment for AR for up to 6 years. The development and progression of asthma was hampered for most endpoints in patients treated with most preparations compared to the non-AIT group, receiving only anti-asthmatic medication. The results for “time to onset” of asthma were inconsistent. Adherence to AIT decreased during the recommended 3-years treatment period, however in most studies higher adherence to subcutaneous than to sublingual AIT was shown. Conclusion: The analysis of long-term effectiveness outcomes of the RWE studies based on prescription databases confirms the long-term efficacy of AIT demonstrated in RCTs. Progression of rhinitis and asthma symptoms as well as delayed onset of asthma triggered by different allergens, real life adherence to the treatment shows differences in particular application routes.

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“…Studies conducted on patients with respiratory allergic diseases on the effectiveness of ASIT in monosensitization [9], demonstrated good results in relation to polysensitized patients [10]. To date, application of multicomponent ASIT, combined with the use of vitamin D, in relation to polysensitized patients requires a thorough study via with a clear selection of therapy, and such study should employ the method of molecular allergy diagnostics.…”

Section: Introductionmentioning

confidence: 99%

Allergen-Specific Immunotherapy In Combination With Vitamin D In Patients With Seasonal Allergic Rhinitis

et al. 2022

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Introduction — Currently, over 500 million people suffer from allergic rhinitis worldwide. For many decades, allergen-specific immunotherapy (ASIT) was the only effective treatment for seasonal allergic rhinitis. The development of molecular allergy diagnostics via ISAC technology allows identifying true and cross-reactive allergens, thereby increasing the information content in selecting an appropriate ASIT. For many years, studies have been conducted on the immunomodulatory effect of vitamin D. These studies revealed the presence of a link between allergic rhinitis and vitamin D deficiency. In this regard, there is a strong need to assess the status of the population in terms of vitamin D for further examination of the effect of the vitamin D inclusion in the treatment regimen on the efficacy of ASIT. Objective — To evaluate the efficacy of ASIT in combination with vitamin D in polysensitized patients with seasonal allergic rhinitis in Karaganda Oblast, Kazakhstan. Material and Methods — Randomized controlled open-label study was conducted during July 2019 – September 2020 at Divera Allergy Center in Karaganda. Patients received sublingual ASIT: the experimental group received ASIT in combination with vitamin D, while comparison group received ASIT in accordance with the standard scheme. Clinical efficacy was monitored by assessing the severity of symptoms and the content of allergen-specific immunoglobulin E. ISAC test was employed to determine the allergen-specific immunoglobulin E. The significance of intergroup differences was determined by statistical methods: the nonparametric Mann-Whitney test for comparing independent groups and the Wilcoxon test for comparing dependent groups. Results — Vitamin D deficiency was revealed in the blood serum of patients in both groups (median value of 16.32 ng/ml and 15.65 ng/ml, respectively). An overall symptom severity score after treatment demonstrated statistically significant changes between the two groups (p=0.777; Mann-Whitney criterion). In the experimental group, the median of overall symptom severity score declined by 46% (from 11 points to 6 points), and in the comparison group by 22% (from 11.5 points to 9 points). Conclusion — As a result of our study, it was established that the adapted scheme of ASIT in combination with vitamin D in polysensitized patients with seasonal allergic rhinitis in Karaganda Oblast (Kazakhstan) was more effective, compared with the conventional scheme of ASIT. Hence, in patients with seasonal allergic rhinitis in the regions with known vitamin D deficiency, it is necessary to determine the vitamin D content with the purpose of its subsequent inclusion in the complex ASIT-based therapy.

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Long-term efficacy of injected allergen immunotherapy for treatment of grass pollen allergy in elderly patients with allergic rhinitis

Cited by 23 publications

References 0 publications

Allergen immunotherapy: past, present and future

Allergen immunotherapy: past, present and future

Real-world evidence for the long-term effect of allergen immunotherapy: current status on database-derived studies

Allergen-Specific Immunotherapy In Combination With Vitamin D In Patients With Seasonal Allergic Rhinitis

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