Results from the 5-year SQ grass sublingual immunotherapy tablet asthma prevention (GAP) trial in children with grass pollen allergy

Valovirta, Erkka; Petersen, Thomas Houmann; Piotrowska, Teresa; Laursen, Mette K; Andersen, Jens S.; Sørensen, Helle F; Klink, Rabih; investigators, Gap

doi:10.1016/j.jaci.2017.06.014

Cited by 269 publications

(249 citation statements)

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“…Children and adolescents One low risk of bias pediatric study 110,111 Effective up to 2 y after cessation in adults. 108,109 One pediatric study was designed to look at prevention of asthma.…”

Section: Adultsmentioning

confidence: 99%

“…These studies demonstrate a sustained benefit for 3 years of SLIT-tablet grass pollen therapy for 2 years off therapy. 94,109,111,176 There are some data to suggest that HDM SLIT tablets give sustained benefit for at least 1 year after 1 year of therapy in 1 RCT 53 and also after 3 years of therapy in a SLIT drop RCT. 177 More data are required for HDM, and evidence is required on the optimal duration of therapy.…”

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

confidence: 99%

See 1 more Smart Citation

EAACI Guidelines on Allergen Immunotherapy: Allergic rhinoconjunctivitis

Roberts

Pfaar

Akdiş

et al. 2017

Allergy

561

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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Section: Adultsmentioning

confidence: 99%

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

561

705

View full text Add to dashboard Cite

show abstract

“…Both showed a significantly lower risk for developing asthma in the SCIT groups as compared to the controls, up to 7 years post‐AIT and 2 years post‐AIT . A large recently published low risk of bias RCT (Grazax Asthma Prevention Trial) explored the effect of a 3‐year course of SLIT tablets on the prevention of asthma in 812 children with AR and grass pollen allergy. This study failed to demonstrate the preventive effect of AIT on the development of asthma as defined by very strict a priori criteria including reversibility to beta‐2‐agonists (OR = 0.91; 95% CI [0.58 to 1.41]) 2 years post‐AIT.…”

Section: Ait For Prevention: Evidence and Clinical Recommendationsmentioning

confidence: 99%

EAACI guidelines on allergen immunotherapy: Prevention of allergy

Halken

Larenas‐Linnemann

Roberts

et al. 2017

Pediatric Allergy Immunology

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194

173

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Allergic diseases are common and frequently coexist. Allergen immunotherapy (AIT) is a disease-modifying treatment for IgE-mediated allergic disease with effects beyond cessation of AIT that may include important preventive effects. The European Academy of Allergy and Clinical Immunology (EAACI) has developed a clinical practice guideline to provide evidence-based recommendations for AIT for the prevention of (i) development of allergic comorbidities in those with established allergic diseases, (ii) development of first allergic condition, and (iii) allergic sensitization. This guideline has been developed using the Appraisal of Guidelines for Research & Evaluation (AGREE II) framework, which involved a multidisciplinary expert working group, a systematic review of the underpinning evidence, and external peer-review of draft recommendations. Our key recommendation is that a 3-year course of subcutaneous or sublingual AIT can be recommended for children and adolescents with moderate-to-severe allergic rhinitis (AR) triggered by grass/birch pollen allergy to prevent asthma for up to 2 years post-AIT in addition to its sustained effect on AR symptoms and medication. Some trial data even suggest a preventive effect on asthma symptoms and medication more than 2 years post-AIT. We need more evidence concerning AIT for prevention in individuals with AR triggered by house dust mites or other allergens and for the prevention of allergic sensitization, the first allergic disease, or for the prevention of allergic comorbidities in those with other allergic conditions. Evidence for the preventive potential of AIT as disease-modifying treatment exists but there is an urgent need for more high-quality clinical trials.

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“…Sublingual immunotherapy (SLIT) is certainly safe, and there is an increasing body of evidence that dust mite SLIT tablet may be clinically effective in adults with partially controlled allergic asthma 37. Grass SLIT tablet may also modify the natural history of airway symptoms in grass-allergic children38 …”

Section: Asthmamentioning

confidence: 99%