Specific sublingual immunotherapy in children with perennial rhinitis: a systemic review and meta‐analysis

Abstract

Background Allergic rhinitis (AR) is a major public health problem and is increasing worldwide. AR affects children's learning efficiency, sleep quality, and other major aspects of life. Sublingual immunotherapy (SLIT) is effective and safe for children with seasonal AR, but for children with perennial allergic rhinitis (PAR) caused by house dust mites (HDM), its effectiveness and safety is less convincing. Methods Medical literature databases up to 2019 were searched for published and unpublished pieces of evidence. Studies were individually screened by 2 reviewers against the eligibility criteria. Primary outcomes were total nasal symptoms scores (TNSS) and total medication scores (TMS). The secondary outcomes were total ocular symptoms scores and adverse events (AEs). Random effect models and fixed‐effect models were used to calculate the standard mean difference (SMD) and risk ratio (RR), respectively. Results We identified 3772 abstracts, of which only 16 studies met our established criteria. SLIT significantly reduced TNSS (SMD –1.73; 95% CI, –2.62 to –0.84; p = 0.0001) and TMS (SMD –1.21; 95% CI, –1.75 to –0.67; p < 0.00001). Compared with children taking placebo, children taking SLIT were 1.08 (95% CI, 1 to 1.17; p = 0.05), 1.15 (95% CI, 0.87 to 1.51; p = 0.32), and 1.68 (95% CI, 0.68 to 4.11; p = 0.26) times more likely to develop mild, moderate, and severe AEs, respectively. Conclusion HDM SLIT can effectively alleviate TNSS and TMS in children with PAR, but care should be taken to avoid harm due to possible adverse drug reactions.

Nasal Nitric Oxide and Nasal Cytology as Predictive Markers of Short-Term Sublingual Allergen-Specific Immunotherapy Efficacy in Children with Allergic Rhinitis

“…Patient selection seems to be a cornerstone for both the effectiveness and efficiency of SLIT in the long term 2 . However, SLIT has a significantly low risk profile overall.…”

“…Respiratory allergies are triggered by allergens that are present in domestic environments (dust, mould) as well as in the external environment (pollen). In this context, specific sublingual immunotherapy (SLIT) provides new and important therapeutic perspectives and represents an approach that is currently available for redirecting the inappropriate immune response in atopic patients 1,2 . SLIT represents an invaluable improvement that can change the clinical history of different types of Immunoglobulin (Ig)E-mediated allergic diseases.…”

“…1 University of Catania, Catania, Italy 2 University of Pavia, Pavia, Italy SLIT is available as an aqueous solution or tablet. According to the directives of the European Medicines Agency (EMA), SLIT tablets for grass pollen and house dust mites (HDMs) have been approved 7 .…”

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

“…Since 2017, numerous SRMAs were identified for SLIT tablets (Table XI.D.6.a.‐1). Eight reported both aqueous and tablet SLIT, 2426,2438,2636,2637,2644,2661–2663 six presented aqueous and tablet SLIT separately, 2438,2550,2638,2639,2664,2665 and nine reported on tablet SLIT alone 1982,1986,1995,2532,2636,2640,2646,2651,2672 . All studies reported outcomes for HDM, grass pollen, and/or ragweed pollen.…”

“…Studies on SLIT efficacy in children were previously limited by the heterogeneity of trials and the considerable risk of bias 2633 . In addition to the ICAR‐Allergic Rhinitis 2018 evidence demonstrating moderate efficacy for symptom relief in pollen and HDM liquid SLIT 2634 and grass pollen tablet SLIT, 2635 there is additional evidence for a moderate reduction in symptoms and medication scores in pediatric perennial AR 2636,2637 . SLIT efficacy in children is judged to be grade A, with moderate impact.…”