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The role of immunotherapy in pediatric allergic disease
1Huddinge University Hospital, Stockholm, Sweden.
Knowledge of the mechanisms of immunotherapy has increased substantially in recent years. The development of better extracts for both injection immunotherapy and local immunotherapy continues, and techniques for the production of recombinant allergens and peptides will be important for future vaccines. Immunotherapy with conventional commercially available extracts is best documented in childhood pollen allergy and is useful in children with severe hay fever symptoms or seasonal asthma. Immunotherapy for perennial allergy has so far been most beneficial in dust mite- and cat-allergic children with asthma. Dust mite therapy is most efficacious in children with isolated dust mite allergy. Appropriate environmental measures should, however, precede immunotherapy when possible. Recent data indicate that immunotherapy has no additional benefit in children with multiple allergies and asthma who receive optimal pharmacotherapy. It is therefore preferable that immunotherapy be combined with anti-inflammatory drug therapy in most children with asthma. For safety reasons, it is important that immunotherapy be administered by physicians well acquainted with standardized extracts in a clinic or hospital where treatment for systemic reactions is available. Long-term treatment for 3 to 5 years results in a more sustained effect than short-term therapy.
Knowledge of the mechanisms of immunotherapy has increased substantially in recent years. The development of better extracts for both injection immunotherapy and local immunotherapy continues, and techniques for the production of recombinant allergens and peptides will be important for future vaccines. Immunotherapy with conventional commercially available extracts is best documented in childhood pollen allergy and is useful in children with severe hay fever symptoms or seasonal asthma. Immunotherapy for perennial allergy has so far been most beneficial in dust mite- and cat-allergic children with asthma. Dust mite therapy is most efficacious in children with isolated dust mite allergy. Appropriate environmental measures should, however, precede immunotherapy when possible. Recent data indicate that immunotherapy has no additional benefit in children with multiple allergies and asthma who receive optimal pharmacotherapy. It is therefore preferable that immunotherapy be combined with anti-inflammatory drug therapy in most children with asthma. For safety reasons, it is important that immunotherapy be administered by physicians well acquainted with standardized extracts in a clinic or hospital where treatment for systemic reactions is available. Long-term treatment for 3 to 5 years results in a more sustained effect than short-term therapy.