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Age and indications to SLIT
L Terracciano1, E Calcinai, S Avitabile
1SS Asma e Malattie Polmonari, UO Pediatria, Presidio Ospedaliero Macedonio Melloni, Azienda Ospedaliera Fatebenefratelli ed Oftalmico, Milano.
Insights
Sublingual immunotherapy (SLIT) shows clinical efficacy in children with allergic asthma and rhinitis, potentially preventing new allergies and asthma. However, definitive recommendations are pending further evidence, with a suggested minimum age of 5 years.
Area of Science:
- Pediatric Allergy and Immunology
- Immunotherapy Research
- Clinical Evidence Synthesis
Background:
- Sublingual immunotherapy (SLIT) has been studied for two decades.
- Meta-analyses indicate SLIT's efficacy in pediatric allergic asthma and rhinitis.
- Current evidence limits strict treatment recommendations.
Purpose of the Study:
- To review the clinical efficacy and safety of SLIT in children.
- To evaluate SLIT's role in preventing new sensitizations and asthma.
- To assess the current evidence for SLIT in various allergic conditions.
Main Methods:
- Systematic review of meta-analyses and clinical studies on SLIT in children.
- Analysis of data regarding efficacy in allergic asthma, rhinitis, atopic dermatitis, and food allergies.
- Evaluation of safety data and age limitations for SLIT initiation.
Main Results:
- SLIT demonstrates clinical efficacy in children with allergic rhinitis and asthma.
- Evidence suggests SLIT can prevent new allergic sensitizations and the development of asthma.
- Studies on SLIT for asthma in children show discordant results, potentially due to symptom triggers.
- Emerging data on SLIT for atopic dermatitis, food, and latex allergies exist but require more research.
- SLIT is considered safe in children as young as 3 years, though 5 years is often cited as a minimum.
Conclusions:
- SLIT is effective for pediatric allergic rhinitis and asthma, with preventive benefits.
- Discordant results in asthma studies necessitate further investigation into allergic vs. non-allergic triggers.
- SLIT for atopic dermatitis, food, and latex allergies is still in the research phase.
- While safe from age 3, current evidence supports SLIT recommendations primarily for children aged 5 and above.
Abstract:
Clinical efficacy of sublingual immunotherapy (SLIT) has been investigated during the last 20 years and results of several meta-analyses are available, showing clinical efficacy of SLIT in children both in allergic asthma and in rhinitis, but strict recommendations are not possible under current evidence. Minimum age for starting SLIT is not clearly defined but several position paper and guidelines indicate a lower limit of 5 years of age. Guidelines on allergic rhinitis suggests SLIT in patients not well controlled with drugs or those who refuse to use drugs. Additional effects are prevention of new sensitizations (evidence IIa) and prevention of asthma in patients with allergic rhinitis (evidence I b). Studies on efficacy of SLIT in asthmatic children are discordant, but the different relevance of allergic and non allergic triggers of symptoms could explain the discordant results obtained in studies on SLIT and asthma, particularly when pooling short and long term studies. Data on efficacy and safety of SLIT are accruing for atopic dermatitis, food allergy and latex allergy, but at the current state of knowledge, SLIT remains an approach reserved to research, and no recommendations can be established. Some studies demonstrate that SLIT is safe in children below 5 years of age, with a lower limit of 3 years.
