Optimal duration of allergen immunotherapy in children with dust mite respiratory allergy

Arroabarren, E.; Tabar, A. I.; Echechipía, S.; Cambra, Koldo; García, Blanca E.; Alvarez-Puebla, M J

doi:10.1111/pai.12296

Cited by 25 publications

(25 citation statements)

References 27 publications

(47 reference statements)

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“…Additional data analyses stratified by study completion status (not shown in the paper) revealed, that the number of patients lost to follow‐up after the first year was independent of the treatment outcome: Patients documented for only 12 months showed the same 12 months efficacy and tolerability (vs. baseline) as patients completing the full 24 month study course. However, from this finding it cannot be concluded that AIT can be generally terminated after one year of treatment since additional and long‐lasting benefits of a longer treatment period may be expected .…”

Section: Discussionmentioning

confidence: 88%

House dust mite-specific immunotherapy with two licensed vaccines: Outcome under clinical routine conditions

Mahler

Klein

Sager

et al. 2017

Immunity, Inflammation and Disease

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IntroductionHouse dust mite (HDM) allergens are major causes for the development of allergic diseases. A disease modifying effect and clinical benefit of allergen immunotherapy (AIT) has been demonstrated in a number of clinical trials. Clinical trials, however, are carried out in selected populations under specific conditions based on inclusion and exclusion criteria and may not represent the entire patient population from medical practice. Objective of this study conducted in patients with HDM allergy was to systematically collect information about the benefit of AIT under clinical routine conditions.MethodsIn this prospective, multi‐center non‐interventional study, 220 patients (117 adults, 103 children) with HDM allergy receiving subcutaneous AIT with Depigoid® were monitored for 2 years. Organ‐specific key symptoms, health‐related quality of life (QoL), and the use of concomitant anti‐allergic medication were assessed at baseline and after 12 and 24 months. Effectiveness and tolerability of the AIT was assessed by physicians and patients. Occurrence of adverse events (AEs) was continuously monitored.ResultsTwo hundred and nineteen patients (116 adults, 103 children) were evaluated. A major improvement of the total symptom‐score was observed after 24 (12) months in 76% (72%) and 80% (79%) of adults and children, respectively, accompanied by a reduction in concomitant anti‐allergic medication and a pronounced improvement in QoL. The effectiveness and tolerability of the AIT was estimated as very good/good by 80–90% of physicians and patients. AEs were observed in 4/117 adults (3.4%) and in 7/103 children (6.8%). Serious AEs were reported in three adults and one child: A grade‐II anaphylactic reaction (one adult) controlled by oral antihistamines (no hospitalization) classified as “definitely,” three others as not (2) or possibly (1) drug‐related.ConclusionsThe data collected from 220 patients confirm the efficacy, tolerability/safety, and acceptance of AIT with Depigoid® in adults and children with HDM allergy under routine clinical conditions.

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Section: Discussionmentioning

confidence: 88%

House dust mite-specific immunotherapy with two licensed vaccines: Outcome under clinical routine conditions

Mahler

Klein

Sager

et al. 2017

Immunity, Inflammation and Disease

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“…178 Similarly, children randomized to 3 or 5 years HDM SCIT had similar outcomes at 5 years. 179 So, in summary, for patients with AR, a minimum of 3 years of AIT is recommended to achieve long-term efficacy after treatment discontinuation (Grade A) ( Table 7).…”

Section: How Long Ait Sh Ould Be Contin Ued For In Ar?mentioning

confidence: 99%

EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

Roberts

Pfaar

Akdiş

et al. 2017

Allergy

564

705

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drawn on data from a systematic review of the literature, more recent published studies and multistakeholder expert clinical opinion. This Guideline is aimed at healthcare professionals who are encouraged to take the recommendations into account in the context of delivering clinical care. This Guideline is not a substitute for professional clinical judgment, which professionals need to exercise in the context of delivering personalised healthcare. AbstractAllergic rhinoconjunctivitis (AR) is an allergic disorder of the nose and eyes affecting about a fifth of the general population. Symptoms of AR can be controlled with allergen avoidance measures and pharmacotherapy. However, many patients continue to have ongoing symptoms and an impaired quality of life; pharmacotherapy may also induce some side-effects. Allergen immunotherapy (AIT) represents the only currently available treatment that targets the underlying pathophysiology, and it may have a disease-modifying effect. Either the subcutaneous (SCIT) or sublingual (SLIT) routes may be used. This Guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on AIT for AR and is part of the EAACI presidential project "EAACI Guidelines on Allergen Immunotherapy." It aims to provide evidence-based clinical recommendations and has been informed by a formal systematic review and meta-analysis. Its generation has followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach.The process included involvement of the full range of stakeholders. In general, broad evidence for the clinical efficacy of AIT for AR exists but a product-specific evaluation of evidence is recommended. In general, SCIT and SLIT are recommended for both seasonal and perennial AR for its short-term benefit. The strongest evidence for long-term benefit is documented for grass AIT (especially for the grass 766 | ROBERTS, PFAAR ET AL. tablets) where long-term benefit is seen. To achieve long-term efficacy, it is recommended that a minimum of 3 years of therapy is used. Many gaps in the evidence base exist, particularly around long-term benefit and use in children. | ME TH ODOLOGYThis Guideline was produced using the Appraisal of Guidelines forResearch & Evaluation (AGREE II) approach, 17,18 a structured approach to guideline production (see Table S1). This is designed to ensure appropriate representation of the full range of stakeholders, a careful search for and critical appraisal of the relevant literature, a systematic approach to the formulation and presentation of recommendations and steps to ensure that the risk of bias is minimized at each step of the process. The process started on April 2015 beginning with detailed face-to-face discussions agreeing on the process and the key clinical areas to address, followed by face-to-face meetings, and regular web conferences in which professional and lay representatives participated. | Clarifying the scope and purpose of the guidelinesThe scope of this EAACI Guideline is multifaceted...

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“…Both treatment durations produced excellent results in terms of asthma remission (50% at 3 years and 54% at 5 years); these rates of asthma remission were significantly higher when compared with those detected in the control group (3.3%). A specific analysis that evaluated the clinical efficacy of 3 vs. 5 year of SCIT in children with HDM respiratory allergy demonstrated that 3 years of SCIT induces significant improvement in children with dust mite respiratory allergy, but a 5-year course added clinical improvement in rhinitis [142].…”

Section: Pediatric Populationsmentioning

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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Optimal duration of allergen immunotherapy in children with dust mite respiratory allergy

Abstract: Three years of SCIT induced significant improvement in children with dust mite respiratory allergy, but a 5-yr course added clinical improvement in rhinitis.

Cited by 25 publications

References 27 publications

House dust mite-specific immunotherapy with two licensed vaccines: Outcome under clinical routine conditions

House dust mite-specific immunotherapy with two licensed vaccines: Outcome under clinical routine conditions

EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

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

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