When to initiate immunotherapy in children with allergic disease? Lessons from the paediatric studies

Immunotherapy is the only treatment that may alter the natural course of disease. From that perspective, treatment in children might be very valuable. An overview of the recent literature is discussed.

The recent literature shows a shift from injectable immunotherapy to noninjectable routes of administration. A systematic review focussing on all forms of immunotherapy in children indicates that there is a lack of high-quality studies to provide evidence for the use of subcutaneous immunotherapy; moreover, evidence for the use of sublingual immunotherapy is still a matter of debate in spite of previous positive meta-analyses. New forthcoming studies may be promising. The 10 years follow-up of the Preventive Allergy Treatment study further underwrites the preventive properties of immunotherapy.

Taking the potential preventive action of immunotherapy into account, there is a case to start treatment early in life. However, evidence of the efficacy should be provided by large randomized controlled trials. The lack of high-quality studies with subcutaneous immunotherapy in children requires new studies to fill the gap. The current variation in clinical trials hampers the formulation of clear-cut recommendations on how to perform sublingual immunotherapy (SLIT) in terms of doses, doses schemes, target populations, allergens and specific products from manufacturers.