Allergen-specific immunotherapy for pediatric asthma and rhinoconjunctivitis: a systematic review

Abstract

Background and objective: Subcutaneous immunotherapy (SCIT) is approved in the United States for the treatment of pediatric asthma and rhinitis; sublingual immunotherapy (SLIT) does not have regulatory approval but is used in clinical practice. The objective of this study was to systematically review the evidence regarding the efficacy and safety of SCIT and SLIT for the treatment of pediatric asthma and allergic rhinoconjunctivitis.

Methods: Two independent reviewers selected articles for inclusion, extracted data, and graded the strength of evidence for each clinical outcome. All studies were randomized controlled trials of children with allergic asthma or rhinoconjunctivitis treated with SCIT or an aqueous formulation of SLIT. Data sources were Medline, Embase, LILACS, CENTRAL, and the Cochrane Central Register of Controlled Trials through May 2012.

Results: In 13 trials, 920 children received SCIT or usual care; in 18 studies, 1583 children received SLIT or usual care. Three studies compared SCIT with SLIT head-to-head in 135 children. The strength of evidence is moderate that SCIT improves asthma and rhinitis symptoms and low that SCIT improves conjunctivitis symptoms and asthma medication scores. Strength of evidence is high that SLIT improves asthma symptoms and moderate that SLIT improves rhinitis and conjunctivitis symptoms and decreases medication usage. The evidence is low to support SCIT over SLIT for improving asthma or rhinitis symptoms or medication usage. Local reactions were frequent with SCIT and SLIT. There was 1 report of anaphylaxis with SCIT.

Conclusions: Evidence supports the efficacy of both SCIT and SLIT for the treatment of asthma and rhinitis in children.

Keywords: allergen-specific immunotherapy; asthma; pediatric; rhinitis; rhinoconjunctivitis; subcutaneous immunotherapy; sublingual immunotherapy; systematic review.

FIGURE 1

Flow diagram of evidence search and selection. ^aThe total number of articles excluded may be exceeded by the number of reasons for exclusion, because articles were excluded by 2 reviewers at this level. ^bOther reasons: control group is healthy population, routes of administration not included (eg, oral, nasal, lymph node), abandoned interventions, outcomes not reported, no comparator group, continued medical education reports, editorials or reviews, studies about mechanism of action, other allergies (food, aspirin), study in animals or in vitro, or ≤6 patients per arm.