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Preventive allergen immunotherapy with inhalant allergens in children
Varsha Dwivedi1, Sonja Kopanja1, Klara Schmidthaler1
1Division of Paediatric Pulmonology, Allergy and Endocrinology, Department of Paediatrics and Adolescent Medicine, Comprehensive Centre of Paediatrics, Medical University of Vienna, Vienna, Austria.
Insights
Preventive allergen immunotherapy (pAIT) in children shows promise for preventing allergic disease progression, particularly with pollen allergens. While safe, its effectiveness in preventing new sensitizations requires further research.
Area of Science:
- Pediatric Allergy and Immunology
- Immunotherapy Research
- Respiratory Allergic Diseases
Background:
- Preventive allergen immunotherapy (pAIT) is being investigated for its role in managing pediatric allergic conditions.
- Understanding pAIT's impact on new sensitizations, disease onset, and progression is crucial for early intervention strategies.
Purpose of the Study:
- To review the efficacy and safety of pAIT in children for preventing new sensitizations, allergic disease onset, and progression.
- To explore immunomodulatory effects associated with pAIT in pediatric populations.
Main Methods:
- A systematic review of clinical pAIT studies in children was conducted using three databases.
- Publications were analyzed based on prevention level (primary, secondary, tertiary), allergen type, administration route, dose, and duration.
Main Results:
- Primary pAIT is safe but lacks specific effects on new sensitizations. Secondary pAIT shows potential for inducing immune tolerance.
- Tertiary pAIT with pollen allergens effectively prevents allergic rhinitis/conjunctivitis progression to asthma; data for other allergens are inconclusive.
- Subcutaneous and sublingual routes appear similarly effective, though comparative pediatric studies are limited.
Conclusions:
- Limited but encouraging evidence suggests pAIT can prevent respiratory allergic diseases in children.
- Primary and secondary pAIT strategies hold potential and require further investigation through robust study designs.
Abstract:
The efficacy and safety of preventive allergen immunotherapy (pAIT) in children are currently under investigation. Here, we provide an overview of pAIT with respiratory allergens concerning the prevention of new sensitizations, allergic disease onset and progression as well as further immunomodulatory effects. Three databases were searched for clinical pAIT studies in children. Selected publications were reviewed for preventive outcomes according to prevention level (primary, secondary, and tertiary), allergen type, administration route, dose, and treatment duration. The primary prevention approach appears safe but showed no allergen-specific effect on new sensitizations. Secondary prevention seems feasible and may induce regulatory T cell-mediated immunotolerance. The number of studies at these prevention levels is limited. Tertiary prevention with grass and/or tree pollen-based pAIT has shown efficacy in preventing disease progression from allergic rhinitis/conjunctivitis to asthma. Data on tertiary pAIT with house dust mites and other allergen types are inconclusive. Subcutaneous and sublingual routes appear similarly effective, but head-to-head comparative paediatric studies are scarce. Additionally, there are fewer placebo-controlled studies. Nevertheless, immunomodulatory outcomes of pAIT are encouraging. Currently, limited but favourably suggestive evidence is available for preventing respiratory allergic diseases in children by pAIT. Primary and secondary prevention have potential and warrant further investigation through well-designed studies.
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